Assessment of Visual Association Memory in Low-Educated, Non-Western Immigrants with the Modified Visual Association Test

Abstract

<b><i>Background:</i></b> Neuropsychological tests are influenced by culture, language, level of education, and literacy, but there are few cognitive tests of which the applicability in ethnic minority populations has been studied. <b><i>Objectives:</i></b> The aim of this study was to assess the reliability and validity of the Visual Association Test (VAT), a test of visual association memory, in a non-Western, low-educated memory clinic population. Additionally, a modified version of the VAT using colored photographs instead of line drawings was studied (mVAT). <b><i>Method:</i></b> Both the original VAT and the mVAT were administered to non-Western immigrants (<i>n</i> = 73) from 2 multicultural memory clinics in Rotterdam, The Netherlands, and a control sample of non-demented Turkish elderly (<i>n</i> = 14) with low education levels (32 and 29% illiterate, respectively). <b><i>Results:</i></b> Both the VAT and the mVAT were able to discriminate persons with and without dementia (area under the curve: VAT, 0.77–0.88; mVAT, 0.85–0.95). The mVAT had more homogeneous item difficulty levels than the VAT. Administration of parallel versions of the VAT and the mVAT within the same person revealed higher scores on the mVAT (<i>Z</i> = –3.35, <i>p</i> = 0.001). <b><i>Conclusions:</i></b> The mVAT is a reliable and valid measure of memory in non-Western immigrants. Clinicians and researchers should be aware that the memory performance of immigrants may be systematically underestimated when using tests with black-and-white line drawings, such as the original VAT.

Cross-cultural neuropsychological assessment in Europe: Position statement of the European Consortium on Cross-Cultural Neuropsychology (ECCroN)

“…Several of such widely-applicable instruments have already been developed over the years across Europe, such as the aforementioned European Cross-Cultural Neuropsychological Test Battery (CNTB, Nielsen et al, 2018), the Multicultural Cognitive Examination (MCE, Nielsen et al, 2019), the Cross-Cultural Dementia Screening (CCD, Goudsmit et al, 2017), the computerized EMBRACED battery (Ibanez-Casas et al, in press), the computerized Battery for Neuropsychological Evaluation of Children (BENCI, Fasfous et al, 2015), an innovative verbal fluency-switching task (TFA-93, Narme et al, 2019) and a number of culturally -or regionally -appropriate picture-based memory tests, such as the Recall of Pictures Test (RPT, Nielsen et al, 2012), modified Visual Association Test (mVAT, Franzen et al, 2019), TMA-93 (Maillet et al, 2017), and TNI-93 (Maillet et al, 2016). A normative data and validation study was carried out for European majority groups, Pakistani/Indian, Polish, Turkish, and to a lesser extent Moroccan and Former yugoslavian participants for CNTB (using multilingual research assistants or trained interpreters); for the CCD, the normative data and validation study was conducted among native Dutch, Moroccan-Arabic, Moroccan-Amazigh (Berber), Turkish, Surinamese-Creole, and Surinamese-Hindustani participants (assessed by bilingual, bicultural neuropsychologists); a general multicultural immigrant population as well as native French individuals were studied for the normative data and validity studies of the .…”

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

“…2000a ; Rait et al. 2000b ) were used in the UK; the modified Visual Association Test ( Franzen et al., 2019 ), a literacy screener (unpublished), and the Stick Design Test ( Baiyewu et al., 2005 ) in the Netherlands; the computerized EMBRACED battery (unpublished) in Spain; the Cross-Linguistic Naming Test ( Ardila, 2007b ), the WHO/UCLA adaptation of the Rey Auditory Verbal Learning Test ( Maj et al., 1993 ), and the Multicultural Cognitive Examination ( Nielsen et al., 2019a ) in Denmark; and the TNI-93 ( Maillet et al., 2016 ), TMA-93 ( Maillet et al., 2017 ), TFA-93 ( Narme et al., 2019 ), and Montreal Cognitive Assessment ( Nasreddine et al., 2005 ) in France.…”

“…The development of new neuropsychological tests is therefore warranted. To suit a diverse patient population, the international literature recommends designing tests without black-and-white line drawings ( Franzen et al. 2019 ; Reis, Faisca, Ingvar, & Petersson, 2006 ; Reis, Petersson, Castro-Caldas, & Ingvar, 2001 ), culture-specific stimuli ( Ardila, 2005 , 2007a , 2007b ), or test elements that require skills learned in school ( Nielsen & Jørgensen, 2013 ).…”

Caregiver Burden in a Culturally Diverse Memory Clinic Population: The Caregiver Strain Index-Expanded

“…All patients were referred to the memory clinic for cognitive evaluation and underwent a comprehensive clinical evaluation, after which they were discussed in a multidisciplinary meeting (see [15]). Patients were diagnosed according to established research criteria for dementia subtypes [16][17][18] or the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders for primary psychiatric disorders [19].…”

“…All patients in the multicultural memory clinic underwent a neuropsychological assessment, which consisted predominantly of cognitive and behavioral measures that have been validated in culturally diverse populations in the Netherlands, such as the Cross-Cultural Dementia screening (CCD [26]), modified Visual Association Test (mVAT [15]), and Rowland Universal Dementia Assessment Scale (RUDAS [27]). The CCD covers the domains of memory (Objects tests A and B), mental speed (Dots test A and Sun-Moon test A), and executive functioning (Dots test B and Sun-Moon test B).…”