Cultural modification of neuropsychiatric assessment: complexities to consider

Abstract

Summary Cognitive screening tests are culture bound and have been shown to perform differently depending on the culture, even with adequate translation. Khan et al examine in detail ways in which the Montreal Cognitive Assessment (MoCA) has been modified for different languages and cultures and produce a systematic guide for future modifications. However, questions arise regarding the availability of the MoCA. Other important issues in the transcultural use and modification of neuropsychiatric tests include providing a culturally safe context for testing, understanding the cultural context in which screening takes place and assessing other neuropsychiatric conditions, which may manifest differently in different cultural contexts and which affect cognition.

An Insight into developmental changes in reasoning skills among Indian Preschoolers: A cross-sectional study using a story-based approach

“…All the developmental changes in reasoning obtained in this study could be attributed to the biological maturational change of the brain and reconfiguration of frontoparietal networks (Andrews, 2020) and facilitated by the everyday interactional context (Niklas et al, 2018;Säre, Luik, & Tulviste, 2016b), working memory (Andrews, 2020), language (Richland & Burchinal, 2013) and theory of mind development (Taggart et al, 2005;Whittaker & McMullen, 2014). Consistent with existing literature gender wise differences were not found in all the reasoning tasks (Ardila et al, 2011).…”

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A new tool for assessing the cultural adaptation of cognitive tests: demonstrating the utility of the Manchester Translation Evaluation Checklist (MTEC) through the Mini-Mental State Examination Urdu

“…There is an increased international demand for quick and accurate cognitive tests to facilitate the neuropsychiatric assessment process as instances of cognitive decline grow. 1 Mild cognitive impairment (MCI) is present in 42% of the global population over 60 years of age 2 and there are approximately 55 million people living with dementia globally, expected to rise to 139 million by 2050. 3 The majority of cases are seen in low-and middle-income countries (LMICs), with dementia in these regions accounting for two-thirds of total global cases.…”

“…16 However, the majority of cognitive tests available at present are designed for English speakers in the context of Western cultures such as those in Europe and North America. 1,17,18 They were standardised on male, White out-patients, not accounting for the populations of non-Western countries, including LMICs. 17,18 Owing to the content of cognitive tests, both language and culture affects an individual's perception of test questions and responses to them.…”

“…[26][27][28] Furthermore, translation does not account for cross-cultural influence on the ability to answer questions beyond fluency in a target language. 1,27,28 This is commonly seen in cognitive tests as they utilise questions requiring familiarity with the Western alphabet, names, idioms or history to assess cognitive domains such as language and memory. 21,27,28 This cultural bias in test questions compromises the reliability of these cognitive tests: 29,30 the same person may produce different scores owing to misunderstandings propagated by mismatched language and culture.…”