A Systematic Review of Neuropsychological Tests for the Assessment of Dementia in Non-Western, Low-Educated or Illiterate Populations

Abstract

Objective:Neuropsychological tests are important instruments to determine a cognitive profile, giving insight into the etiology of dementia; however, these tests cannot readily be used in culturally diverse, low-educated populations, due to their dependence upon (Western) culture, education, and literacy. In this review we aim to give an overview of studies investigating domain-specific cognitive tests used to assess dementia in non-Western, low-educated populations. The second aim was to examine the quality of these studies and of the adaptations for culturally, linguistically, and educationally diverse populations.Method:A systematic review was performed using six databases, without restrictions on the year or language of publication.Results:Forty-four studies were included, stemming mainly from Brazil, Hong Kong, Korea, and considering Hispanics/Latinos residing in the USA. Most studies focused on Alzheimer’s disease (n = 17) or unspecified dementia (n = 16). Memory (n = 18) was studied most often, using 14 different tests. The traditional Western tests in the domains of attention (n = 8) and construction (n = 15), were unsuitable for low-educated patients. There was little variety in instruments measuring executive functioning (two tests, n = 13), and language (n = 12, of which 10 were naming tests). Many studies did not report a thorough adaptation procedure (n = 39) or blinding procedures (n = 29).Conclusions:Various formats of memory tests seem suitable for low-educated, non-Western populations. Promising tasks in other cognitive domains are the Stick Design Test, Five Digit Test, and verbal fluency test. Further research is needed regarding cross-cultural instruments measuring executive functioning and language in low-educated people.

The Magnitude and Effect of Work-Life Imbalance on Cognition and Affective Range among the Non-Western Population: A Study from Muscat.

“…Previous studies have suggested high concordance between conventional neuropsychology batteries and indices of memory, absent-mindedness, or slips of action as tapped into by the Cognitive Failure Questionnaire 60 . But there is a dissenting view in the ndings of this study 61 . Socio-Cultural patterns might contribute to the noted discrepancy in endorsing self-reported cognitive di culties 62 .…”

Test-retest reliability and minimal detectable change of the Contextual Memory Test in older adults with and without mild cognitive impairment

“…Most memory and meta-memory tests do not directly assess memory/meta-memory performance related to daily contexts [7][8][9][10][11][12][13]. The CMT is specifically designed for evaluating awareness, self-perception and evaluation, self-efficacy, recall and strategy-use involving common daily contexts and therefore can be a potentially useful screening tool for identifying individuals that may have memory or meta-memory impairment in daily contexts and an assessment tool for evaluating memory and meta-memory changes involving daily tasks after treatments [16][17][18].…”

“…Although these measurements provide information about memory function, they do not address implications of memory deficits on daily life. Furthermore, most memory assessments examined memory capacity using names, digits and texts (e.g., word-pairs) that do not involve activities of daily living [9]. As a result, outcomes of these measurements may not necessarily reflect actual performance in daily life.…”

Cross-cultural neuropsychological assessment in the European Union: a Delphi expert study

“…In sum, language, (quality of) education, literacy, and culture substantially influence neuropsychological assessment. Thorough adaptations or newly developed neuropsychological tests are needed, but such tests are often lacking ( Franzen et al., 2020 ). Although neuropsychologists in several of the countries of origin of minority ethnic patients are working on the validation of cognitive tests, these initiatives mostly seem to focus on tests originally designed for (educated) populations in North America and Europe, such as the trail making test ( Oumellal, El Alaoui Faris, & Benabdeljlil, 2018 ) or the Montreal Cognitive Assessment ( Azdad, Benabdeljlil, Al Zemmouri, & El Alaoui Faris, 2019 ) in Morocco, and tests from the BİLNOT battery in Turkey ( Karakaş, Erdoğan Bakar, & Doğutepe Dinçer, 2013 ).…”