The Impact of Education and Acculturation on Nonverbal Neuropsychological Test Performance Among Latino/a Patients with Epilepsy

Abstract

The present study examined the relationship between various sociocultural factors (e.g., acculturation, education), neurological variables (e.g., epilepsy duration and seizure frequency) and nonverbal neuropsychological (NP) test performance in a sample of 305 Latino/a and Non-Latino/a White adults with and without epilepsy. All participants completed nonverbal NP measures of visuospatial skills, memory, executive functioning, and psychomotor speed. An acculturation scale was administered to Spanish-speaking epilepsy patients and controls. Education was strongly correlated with performance on all but one of the nonverbal measures across the entire sample. Among Spanish-speaking Latino/a patients with epilepsy, level of acculturation to U.S. culture was associated with a measure of behavioral inflexibility (p < .05) and with a composite measure of nonverbal NP test performance (p < .05). Finally, the results of hierarchical regression models showed that sociocultural factors accounted for a greater proportion of variance in nonverbal NP test performance than did neurological factors. These results provide further evidence that sociocultural factors are strong predictors of NP test performance in clinical populations, even on nonverbal tests. Assessment of acculturation may be as critical as assessment of disease factors in interpreting cognitive performance in Latino/a individuals.

The Multidimensional Influence of Acculturation on Digit Symbol-Coding and Wisconsin Card Sorting Test in Hispanics

“…This finding is supported unambiguously by Coffey and colleagues' research, which demonstrated that more highly acculturated individuals, as measured by a language-based acculturation measure, exhibited better performance on the WCST total trials and non-perseverative errors relative to a those less acculturated (Coffey et al, 2005). Beyond this circumscribed finding, linguistic cultural factors have also been found to have a significant effect on an array of both verbal and nonverbal cognitive functions (Arentoft et al, 2012;Arnold et al, 1994;Artiola i Fortuny et al, 1998;Coffey et al, 2005;Jeste et al, 2005;Luria, 1976;Saez et al, 2014;Vygotsky, 1962). The strong relevance of language can be seen even on tests that do not require a verbal response if one considers the receptive language skills needed to understand the task instructions or the use of internal language processing during task performance.…”

“…Years of residence in the US and years of education outside of the US were not related to any of the cognitive measures. In other studies, significant relationships have been found between acculturation and its proxies with performance on a ACCULTURATION, DSC AND WCST IN HISPANICS 9 number of verbal and nonverbal tasks, including DSC and WCST indices (e.g., Arnold & Orozco, 1989;Boone et al, 2007;Razani et al, 2007;Saez et al, 2014). Only 2 of the 8 acculturation studies conducted with Hispanics evaluated proxy variables (Artiola i Fortuny et al, 1998;Boone et al, 2007), thereby limiting comparisons in this respect.…”

“…In a mixed neurological population of English-speaking Latinos, acculturation predicted performance on naming, fluency, and digit span, but not on any set-shifting, problem-solving, visuospatial, or memory test (Boone et al, 2007). In Spanish speakers with epilepsy, acculturation was consistently associated with nonverbal neuropsychological functioning (Saez et al, 2014). In more homogeneous samples of healthy Mexicans, acculturation was related to performance on some nonverbal measures (e.g., category test, Wisconsin Card Sorting Test (WCST)) but not others (e.g., Trail Making Test), and on some verbal measures (e.g., verbal fluency and list learning), but not others (e.g., story learning, digit span) (Arnold et al, 1994;Artiola i Fortuny et al, 1998;Coffey et al, 2005).…”

“…Acculturation, the degree to which an individual shares the language, customs, values, traditions, and social practices of his/her own ethnic community relative to those of the dominant culture, is important in evaluating test performance of individuals from pluralistic societies such as the US (Landrine & Klonoff, 1995). Although the research in this area is relatively limited, studies to date have shown that acculturation is strongly related to test performance, that is, the less acculturated the individual, the more poorly they perform on neuropsychological measures (Arnold & Orozco, 1989;Boone et al, 2007;Byrd, Sanchez, & Manly, 2005;Manly, Miller, et al, 1998;Razani, Burciaga, Madore, & Wong, 2007;Razani et al, 2006;Saez et al, 2014). Further, acculturation has been shown to explain a significant amount of test score variance, often above and beyond demographic factors.…”

“…(The term "nonverbal neuropsychological test" is operationally defined here as a measure that does not require expressive language). For example, some studies have found a significant relationship between acculturation and executive tasks, such as planning, reasoning, problem-solving, and set-shifting (Arnold et al, 1994;Coffey et al, 2005;Manly, Miller, et al, 1998;Razani et al, 2007;Saez et al, 2014;Touradji, Manly, Jacobs, & Stern, 2001), whereas other studies have found no relationship with these same executive functions (Arentoft et al, 2012;Boone et al, 2007;Kennepohl et al, 2004;Razani et al, 2006). Within the language domain, acculturation has been found to affect naming, repetition, fluency, and receptive and expressive vocabulary (Arnold & Orozco, 1989;Artiola i Fortuny et al, 1998;Manly, Jacobs, et al, 1998;Manly, Miller, et al, 1998) in some studies; however, other studies have found acculturation to be unrelated to some of the same measures (Boone et al, 2007;Kennepohl et al, 2004;Manly, Miller, et al, 1998;Touradji et al, 2001).…”