Cultural Adaptation of the Remote Version of Global Examination Mental State (tele-GEMS) for the Iranian population

Abstract Background: Cognitive impairment represents a significant public health challenge worldwide. Its burden is increasing mainly due to population aging, which is linked to an increased incidence of traumatic conditions and neurological disorders. In Iran, additional barriers such as limited access to specialized clinics, geographical dispersion, and resource constraints further emphasize the need for remote assessment solutions that can reach underserved populations. At the same time, existing cognitive screening tools such as the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Telephone Interview for Cognitive Status–modified (TICS-M), although widely used, present limitations in the Iranian context. Their dependence on literacy and culturally relevant information increases cultural bias and decreases accuracy in those with low educational attainment. Objectives: This study aimed to translate, culturally adapt, and pilot-test the Persian version of tele-GEMS, and to evaluate the influence of demographic variables and cognitive reserve on test performance. Methods: The adaptation of tele-GEMS included several stages: forward translation into Persian by a bilingual expert, back-translation into English, expert committee review to ensure semantic, conceptual, and cultural equivalence, and pilot testing with Persian-speaking adults to refine clarity and cultural appropriateness. After finalization, the Persian tele-GEMS and the short Cognitive Reserve Index questionnaire (s-CRIq) were administered to 78 healthy Persian-speaking adults (aged 22–86 years) recruited through convenience sampling between December 2024 and June 2025. Participants had no major neurological or psychiatric conditions. Data were analyzed using descriptive statistics, correlations, and regression models to assess feasibility, demographic influences, and associations with cognitive reserve. Results: The Persian tele-GEMS was characterised as practicable and efficient, with an average administration time of around ten minutes. The average tele-GEMS score was 89.79 (SD:10.24; Median =93.75 ; Range = 63.58–100). Statistical analysis found that Age had a detrimental impact on performance, but Education and Cognitive Reserve predicted favourable scores. Sex had no major impact, either directly or as a moderator. Regression analysis showed Age as the most powerful predictor, with Cognitive Reserve approaching significance in the multivariate model. Conclusion: The Persian tele-GEMS represents a culturally adapted, multidomain, telephone-based cognitive screening tool for the Iranian population. It suggests a practical and accessible method for detection of cognitive decline in the early phase, particularly valuable in telehealth and resource-limited settings. Further research is required to validate its diagnostic accuracy in clinical populations and to explore its sensitivity to change over time. Keywords: cognitive screening, tele-neuropsychology, cognitive reserve, telehealth, Iranian population