Do neuropsychological test norms from African Americans in the United States generalize to a Zambian population?

Abstract

Healthy Zambian adults (N = 324) were evaluated to determine to what degree a Western neuropsychological (NP) test battery, with African American norms adjusted for age, gender, and education could be used in healthy Zambians, including 157 (48.46%) men and 167 (51.54%) women with an average age of 38.48 (SD = 12.80) years and an average education level of 11.02 (SD = 2.58) years. The NP battery included tests of attention/working memory, executive function, verbal fluency, processing speed, verbal and visual episodic memory, and fine motor skills. The Zambian Achievement Test (ZAT) and the U.S. Wide Range Achievement Test-4 (WRAT-4) reading subtest also were administered to assess literacy and quality of education. Similar to findings in Western countries, the Zambian results show substantial age and education effects on most tests and smaller, less consistent effects of gender. Beyond the basic demographic effects, urban/rural background had small effects on some cognitive variables, and the ZAT (but not WRAT-4) reading level was a robust predictor of performance on many NP tests, even when other background characteristics were controlled. Women in the United States tend to outperform men on tests of processing speed and episodic memory, Zambian women showed modest but statistically significant disadvantages versus their male counterparts. The results show that tests developed in the United States may be used in Zambia, but development and use of local cultural norms remains very important and is a must. New demographically corrected norms were developed for the cohort that was examined.

HIV- and AIDS-associated neurocognitive functioning in Zambia – a perspective based on differences between the genders

“…However, the effects of “normal” age, education, and sex on the NC test performances were controlled for by using demographically corrected standard scores ( T -scores) generated with a previously collected 324 HIV− normative sample. 21 …”

“…Age range – All the participants were required to be between 20 and 65 years of age (to conform to the age range of the HIV− controls who participated in the Zambian NC norming study). 21 …”

“…The norming process was similar to that used for the US normative data. 21 , 23 The raw scores were corrected for the effects of age, education, sex, and urban/rural background by first converting them to normally distributed scaled scores with a mean of 10 and SD of 3; the scaled scores were then converted to demographically corrected T -scores with a mean of 50 and SD of 10. Detailed procedures and results of the norming study have been reported elsewhere.…”

The Chinese Australian Neuropsychological Normative Study sample performance on Western and Chinese norms: Caveats for cross‐cultural neuropsychology

“…An important contribution of the rapidly growing field of cross cultural neuropsychology is determining the appropriateness of the use of western tests and norms across diverse cultural groups. While much of the work to date has been conducted on large ethnic minorities (e.g., Hispanic and African Americans), mainly in the United States (Andreotti & Hawkins, ; Flores et al, ; Manly et al, ; Manly, Byrd, Touradji, & Stern, ; Ostrosky‐Solís, López‐Arango, & Ardila, ; Pontón, Gonzalez, Hernandez, Herrera, & Higareda, ; Rosselli & Ardila, ), broader efforts have been undertaken internationally, including determining the validity of the use of American minority norms outside of the United States (e.g., Hestad et al, ), the development of norms across different countries that use the same language (e.g., Guardia‐Olmos, Pero‐Cebollero, Rivera, & Arango‐Lasprilla, ) and the development of norms for smaller ethnic minorities outside of the United States (e.g., Nielsen et al, ).…”

Neuropsychological Assessment: Past and Future

“…A recent review by Fasfous, Al-Joudi, Puente, and Perez-Garcia (2017) identified that, (Fasfous et al, 2017). Other efforts to develop normative standards outside of American and European cultures suggest comparability of the construct measured when normative standardizations and underlying issues of cultural validity are appropriately addressed (e.g., Zambia, Hestad et al, 2016, Kabula et al, 2017China, Gupta et al, 2014, Heaton et al, 2008, Shi et al, 2015Brazil, de Almeida, et al, 2013;India, Ghate et al, 2015, Kamat et al, 2012, Malda, van de Vijver, Srinivasan, Transler, & Sukumar, 2010Czech Republic, Bezdicek et al, 2012South Africa, Nell, 1999;Nell, Myers, Colvin, & Rees, 1994;Cameroon, Ruffieux, et al, 2010;South Korea, Ko, Rosen, Simpson, & Brown, 2014), although there are some exceptions (e.g., lexical fluency and block design in Cameroon, Ruffieux, et al, 2010).…”