Diagnostic mistakes of culturally diverse individuals when using North American neuropsychological tests

Abstract

Although the role of culture has increasingly gained acceptance in clinical neuropsychology, relatively minimal research exists regarding the actual impact on clinical activities. In this study, we assess how using North American neuropsychological tests affects diagnostic accuracy in cognitive disorders of culturally diverse individuals. To address this question, participants from Colombia, Morocco, and Spain were administered five commonly used neuropsychological tests and the test results were used to determine whether they would be classified as having the DSM-5 diagnostic criteria for Mild Cognitive and Major Cognitive Disorder. Results reveal that diagnostic error occurred up to 20% of the time, and that the frequency of misdiagnosis differed by nationality. These results provide evidence that using tests from one culture to assess individuals from other cultures produces significant false positives. Findings are discussed in terms of the foundations of neuropsychological assessment and its relationship to cultural variables.

A Systematic Review of Neuropsychological Tests for the Assessment of Dementia in Non-Western, Low-Educated or Illiterate Populations

“…Only a third of the studies made use of both imaging and neuropsychological assessment to determine the reference standard. This can be problematic considering that misdiagnoses are likely to be more prevalent in a population in which barriers to dementia diagnostics in terms of culture, language, and education are present (Daugherty, Puente, Fasfous, Hidalgo-Ruzzante, & Perez-Garcia, 2017;Espino & Lewis, 1998;. Another remarkable finding in this review was that only a handful of studies applied a rigorous adaptation procedure in which the instrument was translated, back translated, reviewed by an expert committee, and pilot-tested.…”

The Development of the Dementia Screening Battery-100: Instrument Presentation, Reliability, and Construct Validity

“…In the Western world, illiteracy is not generally a problem among the elderly [63]. However, in non-Western and low-to-middle-income countries such as Tunisia, illiteracy continues to be characteristic of elderly people especially women [26].…”

Country and Sex Differences in Decision Making Under Uncertainty and Risk

“…For instance, IGT performance declined after the uncertainty blocks for strongly right-handed Indian females (Singh, 2016), presence of female-dominant sample in the United States was linked with poor deck choice (deck B) in the uncertainty phase of the IGT (Okdie et al, 2016), and stress-induced IGT deficit was high in German males whereas the non-stressed males continued to show maleadvantage in the task (Starcke et al, 2017). Even though the IGT is a non-linguistic measure of neuropsychological assessment, authors have cautioned that country and cultural differences should be considered in task interpretation (Fasfous et al, 2013;Daugherty et al, 2017). These observations, combined with reports of sociocultural factors potentially influencing the IGT (Ekhtiari et al, 2009;Bakos et al, 2010), or cultural variation in the IGT as a part of neuropsychological assessment (Fasfous et al, 2013;Daugherty et al, 2017), prompted us to analyze potential country and sex interactions in two distinct phases of IGT decision making (i.e., uncertainty and risk phases).…”

“…Even though the IGT is a non-linguistic measure of neuropsychological assessment, authors have cautioned that country and cultural differences should be considered in task interpretation (Fasfous et al, 2013;Daugherty et al, 2017). These observations, combined with reports of sociocultural factors potentially influencing the IGT (Ekhtiari et al, 2009;Bakos et al, 2010), or cultural variation in the IGT as a part of neuropsychological assessment (Fasfous et al, 2013;Daugherty et al, 2017), prompted us to analyze potential country and sex interactions in two distinct phases of IGT decision making (i.e., uncertainty and risk phases).…”