Group differences in normal neuropsychological test performance for older non-Hispanic White and Black/African American adults.

Abstract

Objective: Although researchers have documented the influence of cultural factors on neuropsychological test performance, few studies have examined the distribution of test scores among neurologically healthy older adults from different ethnic groups. The objective of this study was to determine whether there are group differences in neuropsychological test score distributions with ethnicity-specific norms for non-Hispanic White and Black/African American older adults. Method: Participants from the National Alzheimer's Coordinating Center were selected if they were not diagnosed with dementia within 5 years (M age ϭ 75.26, SD age ϭ 6.98; M education ϭ 15.70, SD education ϭ 2.91). Groups were formed based on self-identified ethnicity of White (n ϭ 5,311) or Black/African American (n ϭ 1,098). All participants completed neuropsychological testing, including the Mini Mental State Exam, Logical Memory Immediate and Delayed, Digit Span Forward and Backward, Trail Making Test A & B, Animal Naming, Vegetable Naming, Digit Symbol, and Boston Naming Test. Results: Based on combined ethnicity norms, the scores of Black participants were overrepresented in the below-average and low-average clinical ranges, and the scores of White participants were overrepresented in the high-average and superior clinical ranges for all 11 neuropsychological measures. When group specific norms were used, the unbalanced pattern of score categorization was no longer present for any of the neuropsychological measures. Conclusions: These findings emphasize the importance of developing and using ethnically and culturally appropriate neuropsychological test norms as well as the risk of interpreting some Black individual's scores as below average when they likely are not.

Regression-Based Normative Data for Independent and Cognitively Active Spanish Older Adults: Digit Span, Letters and Numbers, Trail Making Test and Symbol Digit Modalities Test

“…Another potential limitation of the present study is that, due to the composition of the sample, these normative data will be useful only for people between 55 and 87 years old and with 3 to 22 years of education. Additionally, taking into account the well-documented effects of culture on the discrepancy in performance in the different cognitive domains [ 109 , 110 ], another limitation of these normative data is that they are only applicable to the Spanish population. Their use with other Spanish-speaking populations, with different cultural backgrounds, is limited.…”

Longitudinal change in hippocampal and dorsal anterior insulae functional connectivity in subjective cognitive decline

“…Third, but not least, our dataset consists of largely African American participants. It is well-established that cognitively unimpaired African American adults tend to score lower on neuropsychological tests than cognitively unimpaired white adults [ 35 , 36 ]. When there are no culturally appropriate norms available there is a risk of interpreting their scores as below average while they likely are not, which we aimed to prevent here.…”

Psychometric Equivalence of Standard and Prorated Boston Naming Test Scores

“…The test has long been scrutinized for apparent performance discrepancies across non-White individuals, with particular emphasis on African American populations. These differences remain after controlling for education, occupation, literacy, and medical history (Werry et al, 2019). These differences are also apparent among both older and younger African Americans (Na & King, 2019), which suggests a need for closer analysis of racial norms, item-level functioning, and administration of the BNT.…”

“…The Boston Naming Test (BNT; Kaplan et al, 1983) remains one of the most commonly used confrontation naming measures by clinical neuropsychologists (Rabin et al, 2016). However, questions persist concerning the test's cultural fit and norms, particularly in reference to ethnicity (Harry & Crowe, 2014;Horwitz & McCaffey, 2010;Werry et al, 2019). The test has long been scrutinized for apparent performance discrepancies across non-White individuals, with particular emphasis on African American populations.…”

“…This is significant, as the norms provided with the test are limited regarding ethnicity and geographic location. Use of such normative data may not be appropriate for non-White groups, and may result in misdiagnosis of dementia or mild cognitive impairment in older adults (Werry et al, 2019). In addition, some studies have indicated that while establishing age, education, and gender norms among African American populations can help reduce misdiagnosis (Manly et al, 1998;Werry et al, 2019), it may remain insufficient because educational and cultural experiences can vary greatly within groups.…”