African American acculturation and neuropsychological test performance following traumatic brain injury

Abstract

The present study examined the influence of African American acculturation on the performance of neuropsychological tests following traumatic brain injury (TBI). Seventy one participants already enrolled in a larger-scale study assessing the impact of TBI (i.e., the South Eastern Michigan Traumatic Brain Injury Model Systems project) completed a self-report measure of African American acculturation (African American Acculturation Scale-Short Form; Landrine & Klonoff, 1995) in addition to a standardized battery of neuropsychological tests. Hierarchical regression analyses were conducted to evaluate the relationship between level of acculturation and test performance after controlling for injury-related (initial Glasgow Coma Scale score, time since injury) and demographic variables (age, sex, years of education, and socioeconomic status). Lower levels of acculturation were associated with significantly poorer performances on the Galveston Orientation & Amnesia Test, MAE Tokens test, WAIS-R Block Design, Rey Auditory Verbal Learning Test, and Symbol Digit Modalities Test. Decreased levels of acculturation were also significantly related to lower scores on a composite indicator of overall neuropsychological test performance. In addition, the examiner's ethnicity (Black or White) was related with scores on a few of the tests (i.e., Block Design, Trail Making Test), but was not significantly associated with the overall neuropsychological test performance. Overall, these findings suggest that differences in cultural experience may be an important factor in the neuropsychological assessment of African Americans following TBI, and provide additional support for the hypothesis that cultural factors may partially account for the differences among ethnic/cultural groups on neuropsychological tests.

Neuropsychological impairment in racial/ethnic minorities with HIV infection and low literacy levels: Effects of education and reading level in participant characterization

“…For example, applying norms developed for African Americans reduced the percentage of impairment in HIV1 African American men from 71% to 44%, which was closer to the 38% impairment rate of the study's non-Hispanic White males (Miller et al, 1997). Whether the best approach is to use racial0ethnic group norms that adjust for education, to use reading-grade-level based norms, to account for acculturation (Ardilia et al, 1989;Helms, 1997;Manly et al, 1998aManly et al, , 2002Kennepohl et al, 2004), some combination of these factors, or even some additional variable is uncertain. However, a recent study found that among elder African Americans, educational quality (as measured by reading level) was a more influential predictor of neuropsychological performance than acculturation (Manly et al, 2004).…”

Traumatic Brain Injury and Executive Functioning in an Incarcerated Sample

“…Some research has suggested that gender also has an impact (Jorm, Anstey, Christensen, & Rodgers, 2004), though other studies have found no difference (Gilmore, Royer, & Gruhn, 1983). Level of acculturation in an African American sample was found to affect scores on the written version (Kennepohl, Shore, & Nabors, 2004). Others have reportedly found an ethnicity effect on SDMT scores, although their results should be interpreted with caution as their sample contained a small portion of non-white participants (Uchiyama et al, 1994 years.…”

Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)

“…Third, racial and cultural biases need to be considered in evaluating the results of neuropsychological testing. While there are only a few studies that have examined racial differences in neuropsychological testing in the context of TBI (Kennepohl, Shore, Nabors, & Hanks, 2004), such biases have been broadly documented when testing different racial or ethnic groups (Baird, Ford, & Podell, 2007;Pedraza & Mungas, 2008;Wilkie et al, 2003). Fourth, ligation status of the patient needs to be considered, as it can often distort the clinical presentation, particularly in mild TBI (Larrabee, 1997(Larrabee, , 2000.…”