Culture and Cognitive Testing

Ardila, Alfredo

doi:10.1007/978-981-10-6887-4_7

Cited by 9 publications

(5 citation statements)

References 70 publications

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“…Thus, higher (i.e., less impaired) z-scores and cognitive domain-scores in Hispanic than Non-Hispanic patients with AD is not due to better performance in the Hispanic patients, but to worse performance in the Hispanic than the Non-Hispanic NC group despite equivalent age, education, and gender distribution. The difference in the control groups is consistent with previous findings of disadvantages on neuropsychological tests in non-cognitively impaired Hispanic older adults [21–23] and could be due to a number of factors including differences in the quality of the educational experience (e.g., [24]) or incomplete and inappropriate cultural and linguistic adaptation of the cognitive tests [25–27]. In addition, a higher prevalence of risk factors associated with cognitive impairment, such as high BMI and hypertension, in Hispanic than Non-Hispanic controls could contribute to the observed differences in cognitive performance [28–30].…”

Section: Discussionsupporting

confidence: 88%

Neuropsychological Deficit Profiles, Vascular Risk Factors, and Neuropathological Findings in Hispanic Older Adults with Autopsy-Confirmed Alzheimer’s Disease

Weissberger

Gollan

Bondi

et al. 2019

JAD

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This study aimed to determine if patterns of neuropsychological deficits, vascular risk factors, and neuropathology differ in Hispanic and Non-Hispanic patients with autopsy-confirmed Alzheimer’s disease (AD). Participants were enrolled in a longitudinal study at the Shiley-Marcos AD Research Center at the University of California, San Diego. Hispanic (n = 14) and Non-Hispanic (n = 20) patients with autopsy-confirmed AD who scored ≥95 on the Dementia Rating Scale (DRS) were included. Patient groups were matched on age, education, global mental status, and severity of functional decline; they were compared to Hispanic (n = 14) or Non-Hispanic (n = 20) cognitively-normal controls of similar age and education. Ethnicity (Hispanic, Non-Hispanic) by disease state (autopsy-confirmed AD or cognitively normal) comparisons were made for cognitive test performance and vascular risk factors. Patient groups were further compared on measures of AD (Braak stage, neuritic plaques, neurofibrillary tangles), vascular neuropathology, and performance across cognitive domains of memory, language, attention, executive functions, and visuospatial abilities after scores were z-transformed based on respective culturally-appropriate control groups. Patient groups had similar overall AD pathology burden, whereas Hispanics with AD had more small parenchymal arteriolar disease and amyloid angiopathy than Non-Hispanics with AD. Despite largely similar pathology, Hispanics with AD were less cognitively impaired (relative to respective NC groups) than Non-Hispanics with AD, and exhibited a different pattern of deficits across cognitive domains. Findings suggest that cognitive deficits that are usually prominent in AD may be less salient in Hispanic patients and this may adversely impact the ability to clinically detect the disease in mild to moderate stages.

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Section: Discussionsupporting

confidence: 88%

Neuropsychological Deficit Profiles, Vascular Risk Factors, and Neuropathological Findings in Hispanic Older Adults with Autopsy-Confirmed Alzheimer’s Disease

Weissberger

Gollan

Bondi

et al. 2019

JAD

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“…Patients’ educational level, presentation of symptoms, health professionals’ knowledge of patients’ culture, and health professionals’ attitudes toward ethnic minority patients were also substantially reported. Previous studies found that patients’ linguistic abilities and educational level could also affect their testing scores, their understanding, and their expression of symptoms 26,28 . This is also reflected in our data that revealed most dementia experts thought it was more challenging to diagnose MEGs, and only a few experts found their skills to be good in evaluating dementia in MEGs.…”

Section: Discussionsupporting

confidence: 77%

“…Moreover, despite the need for culturally and linguistically sensitive diagnostic tools, most countries used instruments with MEGs that were only validated in the Western population 11 . Cultural background and educational level could significantly influence cognitive testing scores; thus, using diagnostic tools only validated in ethnic majorities would lead to misinterpretation of results when applied to MEGs 26 . Considering that it is not practical to translate, culturally adapt, and validate every cognitive scale across all ethnic minority communities, a better alternative would be developing cognitive measures that are less influenced by cultural factors and language or implementing such tools that already exist 11,27 …”

Section: Discussionmentioning

confidence: 99%

Assessment of Dementia in Minority Ethnic Groups in Scotland

Tsai,

Ma,

Nielsen

et al. 2024

Alzheimer Disease &Amp; Associated Disorders

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Objective: Minority ethnic groups (MEGs) in Europe receive suboptimal dementia evaluation, yet related research in Scotland is lacking. This research examined the evaluation of dementia in MEGs in Scotland and compared it with previous research to highlight the changes in the clinical evaluation of dementia over the decade. Design and Setting: A self-administered survey was created online and emailed to 14 Heads of the boards under the Scottish National Health Service and dementia-associated settings and organizations. Results: Most surveyed centers (85.6%) received MEG referrals. Although 92.9% of the centers used professional translators when needed, 85.7% thought assessing dementia in MEGs was difficult, mostly due to the suitability of test instruments and rating scales and patients’ linguistic abilities. Very few found their skills to be good in evaluating MEGs. There was no mention of specialized dementia services for MEGs. Conclusions: The lack of culturally appropriate instruments and specialized dementia services reveals that the services are not ready to meet the demand for evaluating patients from diverse cultural and language backgrounds. Inadequate clinical evaluation may lead to misdiagnoses. Therefore, although significant work has been carried out in the past few years, improvements must be continued to enhance the current practices and apply suitable evaluation methods for MEGs.

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“…A strong rationale for developing a standardized, culturally informed clinical interview emerges when comparing the existing ESL neuropsychology literature to the most recent discussions of best practices in this area. In recent years, some researchers have advised that multiple demographic specifics about normative samples are necessary to select appropriate normative data for nonnative English-speaking patients (Ardila, 2018;Buré-Reyes et al, 2013;Fujii, 2017Fujii, , 2018. These may include country of data collection, study participants' country of origin, education level, age, and if applicable, level of assimilation to U.S. culture, often reflected by number of years living in the U.S.…”

Section: Lessons From Inconsistencies In the Literaturementioning

confidence: 99%

“…In the largest effort to rectify this problem, 2004 marked the publication of the first comprehensive normative dataset for 60 neuropsychological measures which included race (however only African American and White) as a stratification variable in addition to age and years of education (Gasquoine, 2009; Heaton et al, 2004). Although the Heaton norms may arguably represent a paradigm shift in the neurodiagnostic evaluation of African Americans, there remains a dearth of sound normative data for a number of other cultural and linguistic minorities (Ardila, 2018; Romero et al, 2009; Veliu & Leathem, 2017). Moreover, there persists a widely-held but false assumption that ethnic minority groups are more homogenous than they actually are (e.g., “Asians,” “Hispanics;” Buré-Reyes et al, 2013; Gasquoine, 1999; Rosselli & Ardila, 2003), which can lead well-intentioned clinicians to apply normative data erroneously.…”

Section: Historical Overviewmentioning

confidence: 99%

Integrating culturally informed qualitative data in neuropsychological evaluations of non-native English speakers.

Singh¹,

Hamilton²,

Soble³

2021

Professional Psychology: Research and Practice

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Objective: As the U.S. public challenges leaders to confront the racial injustices and ethnic disparities deeply rooted within American culture, neuropsychology as a field must engage in thoughtful selfreflection. Although progress has been made in reducing the impact of neuropsychology's White-and Euro-centric origins, vestiges of this bias remain, especially in evaluations of those who speak English as a second language (ESL). Of particular concern are the lack of a broad consensus for collecting datapoints relevant to ESL individuals through the use of existing acculturation measures, and insufficient acknowledgment that culture impacts performance on verbal and non-verbal measures. Method: This review provides: (a) a timely re-visit of the historical context of evaluating cultural and linguistic minorities, including a re-examination of the ethnocentric rationale underlying the origins of commonly used instruments; (b) a summary of potential confounds in evaluating non-native English speakers, many of which are not artifacts of language per se; and (c) a discussion about reaching a consensus for using acculturation measures to improve the quality of evaluations and future research. Results: Neuropsychological evaluations for non-native English speakers could be improved by developing an agreed-upon set of questions capturing the most pertinent acculturation information and using that information judiciously to inform test-related decision making. Conclusions: Accumulating more standardized data from acculturation measures can inform policy and best practices, improving the overall quality of neuropsychological evaluations. This review also underscores the need to take a critical eye to stimuli across instruments in order to reduce bias and promote cultural inclusivity. Public Significance StatementThere is currently no standardized way for conducting neuropsychological evaluations with non-native English speakers. Within a historical context, this paper discusses the importance of integrating qualitative information gained from acculturation measures, which can improve the quality of neuropsychological evaluations and clinical research with this population.

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Culture and Cognitive Testing

Cited by 9 publications

References 70 publications

Neuropsychological Deficit Profiles, Vascular Risk Factors, and Neuropathological Findings in Hispanic Older Adults with Autopsy-Confirmed Alzheimer’s Disease

Neuropsychological Deficit Profiles, Vascular Risk Factors, and Neuropathological Findings in Hispanic Older Adults with Autopsy-Confirmed Alzheimer’s Disease

Assessment of Dementia in Minority Ethnic Groups in Scotland

Integrating culturally informed qualitative data in neuropsychological evaluations of non-native English speakers.

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