Objective The Cultural Neuropsychology Program (CNP) is the sole bilingual clinical training program specifically focused on culturally and linguistically competent neuropsychological services to the Latino/a population in the UCLA Health System. Following the Socially Responsible Neuropsychology Model (SRN; Suarez et al., 2016), trainees learn the best practices in providing equitable clinical care to all patients irrespective of their background. The current paper discusses various trainees’ professional development in the process of becoming culturally and linguistically competent clinical neuropsychologists. Method The use of case studies illustrates the competency paradigm shift trainees encounter when systematically integrating the SRN model with their clinical training. Three components of the model are emphasized: (1) integration of Etic and Emic approaches during the clinical intake, (2) merging psychometric properties with qualitative processes to compensate for the cultural-linguistic limitations of mainstream gold-standard neuropsychological tools, and (3) becoming an advocate through this social justice framework. Outcomes All trainees were previously exposed to the foundational - and typically required - knowledge-based competency model of understanding and appreciating cultural-individual differences and diversity in neuropsychology. Attaining cultural and linguistic competency through the SRN model, however, requires a salient paradigm shift in all skill-based competencies that trainees may not have been prepared for through their previous education. Discussion By presenting trainees’ perspectives regarding their professional development, the importance of the explicit and systematic integration of fundamental brain-behavior relationships with the SRN model early in graduate training is highlighted. In so doing, this approach can ultimately augment the number of culturally- and linguistically-competent neuropsychologists needed to reduce health disparities. References Suárez, P., Casas, R., Lechuga, D., Cagigas, X. Socially Responsible Neuropsychology in Action: Another Opportunity for California to Lead the Way. Feature in The California Psychologist. Fall of 2016.
Objective Early identification of cognitive symptoms pathognomonic of Alzheimer’s disease (AD) in highly educated bilingual adults remains challenging. We present a clinical case illustrating the application of an SRN model in a 70-year-old highly educated, balanced bilingual Latina eventually diagnosed with moderate-severe stages of AD following an event of severe confusion and disorientation. Method An SRN model was applied to promote equitable care through evidence-based consideration of cognitive aging-reserve and its putative manifestation in neurodegenerative disorders. The patient underwent a neuropsychological assessment and structural/functional neuroimaging. Her educational background, linguistic proficiencies, acculturation level, social/behavioral comportment, and limitations in available neuropsychological tools/norms were integrated to reflect the complexity in conducting a reliable bilingual assessment and formulating differential diagnoses. Results The SRN model guided clinical decision-making to determine the appropriate target language for bilingual assessment, and to identify reliable normative anchors of impairment relative to premorbid estimates, resulting in incorporation of validated Spanish measures/norms. Neuroimaging revealed bilateral parietal-temporal hypometabolism, which was generally consistent with neuropsychological findings, and the patient was diagnosed with major neurocognitive disorder due to AD. Conclusions Given the advanced nature of this patient’s cognitive decline by the time of assessment, it was hypothesized that the combination of bilingualism and high education further masked the precipitous decline atypically observed in AD individuals with high cognitive reserve. Cognitive reserve theories, nonetheless, continue to be anchored strictly within a monocultural-monolingual framework. This complex case, therefore, highlights the urgent need to incorporate bilingualism in current models of cognitive reserve to boost sensitivity in detecting early expression of bilingual AD.
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