Challenges and opportunities for harmonization of cross-cultural neuropsychological data.

Abstract

Objective: In this position article, we highlight the importance of considering cultural and linguistic variables that influence neuropsychological test performance and the possible moderating impact on our understanding of brain/behavior relationships. Increasingly, neuropsychologists are realizing that cultural and language differences between countries, regions, and ethnic groups influence neuropsychological outcomes, as test scores may not have the same interpretative meaning across cultures. Furthermore, attempts to apply the same norms across diverse populations without accounting for culture and language variations will result in detrimental ethical dilemmas, such as misdiagnosis of clinical conditions and inaccurate interpretations of research outcomes. Given the lack of normative data for ethnically and linguistically diverse communities, it is often challenging to merge data across diverse populations to investigate research questions of global significance. Methodological Considerations: We highlight some of the inherent challenges, limitations, and opportunities for efforts to harmonize cross-cultural neuropsychological data. We also explore some of the cultural factors that should be considered when attempting to harmonize cross-cultural neuropsychological data, sources of variance that should be accounted for in data analyses, and the need to identify evaluative criteria for interpreting data outcomes of cross-cultural harmonization approaches. Conclusion: In the future, it will be important to further solidify principles for aggregating data across diverse cultural and linguistic cohorts, validate whether assumptions are being satisfied regarding the relationship between neuropsychological measures and the brain and/or behavior of individuals from diverse cultural and linguistic backgrounds, as well as methods for evaluating relative successful validation for data harmonization efforts.

Is the Montreal cognitive assessment culturally valid in a diverse geriatric primary care setting? Lessons from the Bronx

“…In our Bronx sample, a “normal” MoCA score was just above 50% of the total score, indicating that there may be irrelevant or redundant items on this screener, consistent with prior findings that some MoCA items (i.e., cube drawing) are frequently missed in these populations 9 . Cultural and language factors also contribute to approach and completion of cognitive tests, and even when culturally appropriate normative data are used, tests may be measuring different constructs in these different cultural/linguistic groups 31,32 . Thus, clinicians working in culturally/ethnically diverse communities, such as the Bronx, should be cautious when administering and interpreting the MoCA.…”

“…9 Cultural and language factors also contribute to approach and completion of cognitive tests, and even when culturally appropriate normative data are used, tests may be measuring different constructs in these different cultural/linguistic groups. 31,32 Thus, clinicians working in culturally/ethnically diverse communities, such as the Bronx, should be cautious when administering and interpreting the MoCA.…”

Harmonization of neuropsychological and other clinical endpoints: Pitfalls and possibilities.

“…• Merkley et al (2023) provide a thorough discussion of the importance of big data analytic approaches and their relevance to the harmonization of cross-cultural neuropsychological This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

“…Merkley et al (2023) provide a thorough discussion of the importance of big data analytic approaches and their relevance to the harmonization of cross-cultural neuropsychological data. In this article, the authors further highlight the importance of considering cultural and linguistic factors that influence performance on neuropsychological tests.…”

A Systematic Review and Meta-Analysis of the Brief Cognitive Assessment for Multiple Sclerosis (BICAMS) International Validations

“…There is increasing recognition that the stimuli should not disadvantage any particular cultures [ 3 ]. Harmonisation of data across different national and ethnic communities needs careful consideration of cultural and linguistic variables [ 4 ]. The increasingly diverse populations within individual countries require health services to be agile and inclusive [ 5 ].…”