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Franzen S, Papma JM, van den Berg E, Nielsen TR. Cross-cultural neuropsychological assessment in the European Union: a Delphi expert study. Arch Clin Neuropsychol 2021; 36:815-830. [PMID: 33043958 PMCID: PMC8292927 DOI: 10.1093/arclin/acaa083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/06/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The increasing ethnic diversity in the European Union (EU) calls for adaptations to neuropsychological assessment practices. The aims of this study were to examine the current state of cross-cultural neuropsychological assessment in EU-15 countries and to provide recommendations for researchers and policy makers. METHOD Twelve experts from nine EU-15 countries participated in a Delphi consensus study involving two sequential rounds of web-based questionnaires and an in-person consensus meeting. The experts individually rated Delphi topics on the basis of importance (scale 1-10). The degree of consensus was determined by assessing first and third quartiles (Q1 and Q3) and medians. RESULTS Consensus outcomes showed the following priorities: (a) the development of tests (median importance rating 10, Q1-Q3: 9-10), (b) the collection of normative data (median importance rating 9, Q1-Q3: 8-10), and (c) more training, awareness, and knowledge regarding cross-cultural assessment among neuropsychologists in the EU (median importance rating 9, Q1-Q3: 8-10). Whereas memory tests were often available, tests measuring social cognition (median 9, Q1-Q3: 8-10) and language (median 9, Q1-Q3: 7-10) are particularly lacking. Recommendations were made regarding essential skills and knowledge necessary for cross-cultural neuropsychological assessment. CONCLUSIONS This study in a small group of experts suggests that the development and availability of cross-cultural tests and normative data should be prioritized, as well as the development and implementation of training initiatives. Furthermore, EU guidelines could be established for working with interpreters during neuropsychological assessment. Before implementing these recommendations, follow-up studies are recommended that include more minority neuropsychologists and community stakeholders.
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Affiliation(s)
- Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M Papma
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
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Claassen D, Ascoli M, Berhe T, Priebe S. Research on mental disorders and their care in immigrant populations: a review of publications from Germany, Italy and the UK. Eur Psychiatry 2020; 20:540-9. [PMID: 15963698 DOI: 10.1016/j.eurpsy.2005.02.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 02/15/2005] [Indexed: 11/28/2022] Open
Abstract
AbstractObjectiveThe review aims to identify the extent and nature of research on mental disorders and their care in immigrant populations in three major European countries with high levels of immigration, i.e. Germany, Italy, United Kingdom (UK).MethodsPeer-reviewed publications on the subject from the three countries between 1996 and 2004 were analyzed. The research questions addressed, the methods used, and the results obtained were assessed.ResultsThirteen papers reporting empirical studies were found from Germany, four from Italy and 95 from the UK. Studies addressed a range of research questions and most frequently assessed rates of service utilization in different immigrant groups. The most consistent finding is a higher rate of hospital admissions for Afro-Caribbean patients in the UK. Many studies had serious methodological shortcomings with low sample sizes and unspecified inclusion criteria.DiscussionDespite large scale immigration in each of the three studied countries, the numbers of relevant research publications vary greatly with a relatively high level of empirical research in the UK. Possible reasons for this are a generally stronger culture of mental health service research and a higher number of researchers who are themselves from immigrant backgrounds in the UK.ConclusionOverall the evidence base to guide the development of mental health services for immigrant populations appears limited. Future research requires appropriate funding, should be of sufficient methodological quality and may benefit from collaboration across Europe.
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Affiliation(s)
- Dirk Claassen
- Unit for Social and Community Psychiatry, Queen Mary (University of London), Newham Centre for Mental Health, Glen Road, Plaistow, London E13 8SP, UK.
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Waheed W, Mirza N, Waheed MW, Blakemore A, Kenning C, Masood Y, Matthews F, Bower P. Recruitment and methodological issues in conducting dementia research in British ethnic minorities: A qualitative systematic review. Int J Methods Psychiatr Res 2020; 29:e1806. [PMID: 31808215 PMCID: PMC7051842 DOI: 10.1002/mpr.1806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/11/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Identifying existing recruitment and methodological issues within dementia research conducted in UK studies that included ethnic minorities. METHODS We searched for and included any publication detailing dementia research in the UK that included any ethnic minority. The search results and all titles and abstracts were screened according to the inclusion criteria followed by screening of the full texts. We extracted data regarding the recruitment and methodological issues faced by the researchers. This data was combined and listed, and related issues were grouped into overarching themes and subthemes. RESULTS Of 52 publications suitable for analysis, 33 provided data collated into six themes: attitudes and beliefs about dementia in ethnic minority communities, recruitment process, data collection issues, practical issues, researcher characteristics, and lack of published research and normative data. These themes allowed us to identify three areas responsible for addressing these recruitment and methodological issues: community and patient education, health services, and researchers' training. CONCLUSIONS This is the first review identifying recruitment and methodological issues within UK dementia research that included ethnic minorities. We now have a compilation of reported existing issues and a framework of areas responsible for addressing them and devising solutions.
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Affiliation(s)
- Waquas Waheed
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Nadine Mirza
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Amy Blakemore
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Cassandra Kenning
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Yumna Masood
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Fiona Matthews
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
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Patnode CD, Perdue LA, Rossom RC, Rushkin MC, Redmond N, Thomas RG, Lin JS. Screening for Cognitive Impairment in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 323:764-785. [PMID: 32096857 DOI: 10.1001/jama.2019.22258] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Early identification of cognitive impairment may improve patient and caregiver health outcomes. OBJECTIVE To systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (≥65 years) to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials through January 2019, with literature surveillance through November 22, 2019. STUDY SELECTION Fair- to good-quality English-language studies of cognitive impairment screening instruments, and pharmacologic and nonpharmacologic treatments aimed at persons with mild cognitive impairment (MCI), mild to moderate dementia, or their caregivers. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction; random-effects meta-analyses and qualitative synthesis. MAIN OUTCOMES AND MEASURES Sensitivity, specificity; patient, caregiver, and clinician decision-making; patient function, quality of life, and neuropsychiatric symptoms; caregiver burden and well-being. RESULTS The review included 287 studies with more than 280 000 older adults. One randomized clinical trial (RCT) (n = 4005) examined the direct effect of screening for cognitive impairment on patient outcomes, including potential harms, finding no significant differences in health-related quality of life at 12 months (effect size, 0.009 [95% CI, -0.063 to 0.080]). Fifty-nine studies (n = 38 531) addressed the accuracy of 49 screening instruments to detect cognitive impairment. The Mini-Mental State Examination was the most-studied instrument, with a pooled sensitivity of 0.89 (95% CI, 0.85 to 0.92) and specificity of 0.89 (95% CI, 0.85 to 0.93) to detect dementia using a cutoff of 23 or less or 24 or less (15 studies, n = 12 796). Two hundred twenty-four RCTs and 3 observational studies including more than 240 000 patients or caregivers addressed the treatment of MCI or mild to moderate dementia. None of the treatment trials were linked with a screening program; in all cases, participants were persons with known cognitive impairment. Medications approved to treat Alzheimer disease (donepezil, galantamine, rivastigmine, and memantine) improved scores on the ADAS-Cog 11 by 1 to 2.5 points over 3 months to 3 years. Psychoeducation interventions for caregivers resulted in a small benefit for caregiver burden (standardized mean difference, -0.24 [95% CI, -0.36 to -0.13) over 3 to 12 months. Intervention benefits were small and of uncertain clinical importance. CONCLUSIONS AND RELEVANCE Screening instruments can adequately detect cognitive impairment. There is no empirical evidence, however, that screening for cognitive impairment improves patient or caregiver outcomes or causes harm. It remains unclear whether interventions for patients or caregivers provide clinically important benefits for older adults with earlier detected cognitive impairment or their caregivers.
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Affiliation(s)
- Carrie D Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | | - Megan C Rushkin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Rachel G Thomas
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Tuerk R, Sauer J. Dementia in a Black and minority ethnic population: characteristics of presentation to an inner London memory service. BJPsych Bull 2015; 39:162-6. [PMID: 26755947 PMCID: PMC4706140 DOI: 10.1192/pb.bp.114.047753] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method To examine data on referrals to an inner-city London memory service to explore any differences in referral rates, cognitive assessments and stages of dementia at presentation between ethnic groups. Results African-Caribbean patients were well represented in the memory service. They were diagnosed with dementia on average 4.5 years younger than their White British counterparts and were more likely to be diagnosed with a vascular or mixed type dementia. However, scores on initial cognitive testing were significantly lower in the African-Caribbean group, possibly representing more advanced disease at presentation. Clinical implications Initiatives to access Black and minority ethnic populations earlier in the course of their illness should be considered. Professionals need to consider the potential for cultural bias in memory testing and diagnosing dementia in these populations, and the importance of cultural competency in assessments.
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Affiliation(s)
- Rosalyn Tuerk
- South London and Maudsley NHS Foundation Trust, London UK
| | - Justin Sauer
- South London and Maudsley NHS Foundation Trust, London UK; Institute of Psychiatry, King's College London
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Plejert C, Antelius E, Yazdanpanah M, Nielsen TR. ‘There’s a letter called ef’ on Challenges and Repair in Interpreter-Mediated Tests of Cognitive Functioning in Dementia Evaluations: A Case Study. J Cross Cult Gerontol 2015; 30:163-87. [DOI: 10.1007/s10823-015-9262-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ohsugi H, Murata S, Kubo A, Hachiya M, Hirao A, Fujiwara K, Kamijou K. Verification of the Correlation between Cognitive Function and Lower Limb Muscle Strength for the Community-dwelling Elderly. J Phys Ther Sci 2014; 26:1861-3. [PMID: 25540482 PMCID: PMC4273042 DOI: 10.1589/jpts.26.1861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/29/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to evaluate the lower limb muscle strength of the
community-dwelling elderly, with or without cognitive decline, using isometric knee
extension strength (IKES) and the 30-second chair stand test (CS-30). [Subjects] A total
of 306 community-dwelling elderly participated in this study. Assessment items were the
CS-30, IKES, Mini-Mental State Examination (MMSE), and Trail-Making Test Part A (TMT-A).
[Methods] Participants were divided into three groups according to their MMSE score:
cognitive impairment (MMSE ≤ 24), cognitive decline (MMSE 25 to 27), and normal (MMSE ≥
28). We compared IKES and CS-30 among the three groups. [Results] IKES was not
significantly different among the three groups. However, the CS-30 was significantly
different among the three groups. Upon further analysis the CS-30 score of each group,
when adjusted for age and TMT-A, did not indicate a significant difference. [Conclusion]
These results suggest that the lower limb muscle strength of the elderly does not differ
with cognitive decline. Moreover, we suggest that when using the CS-30 score as an
indicator of lower limb muscle strength attentional function should be taken into
account.
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Affiliation(s)
- Hironori Ohsugi
- Faculty of Health Science, Kyoto Tachibana University, Japan
| | - Shin Murata
- Faculty of Health Science, Kyoto Tachibana University, Japan
| | - Atsuko Kubo
- Department of Rehabilitation Sciences, Nishikyusyu University, Japan
| | - Mizuki Hachiya
- Department of Rehabilitation Sciences, Nishikyusyu University, Japan
| | - Aya Hirao
- Department of Rehabilitation Sciences, Nishikyusyu University, Japan
| | - Kazuhiko Fujiwara
- Department of Rehabilitation Sciences, Nishikyusyu University, Japan
| | - Kenji Kamijou
- Department of Rehabilitation Sciences, Nishikyusyu University, Japan
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Adelman S, Blanchard M, Rait G, Leavey G, Livingston G. Prevalence of dementia in African-Caribbean compared with UK-born White older people: two-stage cross-sectional study. Br J Psychiatry 2011; 199:119-25. [PMID: 21653946 DOI: 10.1192/bjp.bp.110.086405] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Preliminary studies in the UK, all using screening instruments of unknown cultural validity, indicate that there may be an increased prevalence of dementia in African-Caribbean people, possibly related to vascular risk factors and potentially amenable to preventative measures. AIMS To determine the prevalence of dementia in older people of African-Caribbean country of birth compared with their White UK-born counterparts. METHOD A total of 218 people of African-Caribbean country of birth and 218 White UK-born people aged ≥60 years were recruited from five general practices in North London. Those who screened positive for cognitive impairment using a culturally valid instrument were offered a standardised diagnostic interview. Two independent assessors diagnosed dementia according to standard operationalised criteria. RESULTS African-Caribbean participants were 2 years younger, and those with dementia nearly 8 years younger than their White counterparts. The prevalence of dementia was significantly higher in the African-Caribbean (9.6%) than the White group (6.9%) after adjustment for the confounders age and socioeconomic status (odds ratio (OR) = 3.1, 95%CI 1.3-7.3, P = 0.012). CONCLUSIONS There is an increased prevalence of dementia in older people of African-Caribbean country of birth in the UK and at younger ages than in the indigenous White population. These findings have implications for service provision and preventive interventions. Further research is needed to explore the role of vascular risk factors and social adversity in the excess of dementia in this population.
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Affiliation(s)
- Simon Adelman
- Department of Mental Health Sciences, UCL, 67-73 Riding House Street, 2nd Floor, Charles Bell House, London W1W 7EJ, UK.
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Conroy RM, Golden J, Jeffares I, O'Neill D, McGee H. Boredom-proneness, loneliness, social engagement and depression and their association with cognitive function in older people: A population study. PSYCHOL HEALTH MED 2010; 15:463-73. [DOI: 10.1080/13548506.2010.487103] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
SummaryThis review examines the demographic changes, the epidemiology of mental disorders and suicides, the potential risk and protective factors, access to secondary care old age psychiatry services (OAPSs) and the policy context pertaining to older people from ethnic minority groups in the United Kingdom. The number of older people from ethnic minority groups is increasing. The prevalence of mental disorders in older people from ethnic minority groups is either similar to or higher than that in the indigenous population. Therefore, the number of older people from ethnic minority groups with psychiatric morbidity is also increasing. Ethnic minority older people also have inequity of access to secondary care OAPSs. There is an urgent need to develop and implement practical strategies to improve access by older people from ethnic minority groups to OAPSs.
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Forbat L. Concepts and understandings of dementia by 'gatekeepers' and minority ethnic 'service users'. J Health Psychol 2009; 8:645-55. [PMID: 19177723 DOI: 10.1177/13591053030085013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this article I outline research which seeks to explore the intersections of dementia, ethnicity and family care. My focus is how research that aims to focus on dementia care and ethnicity illuminates the experiences of members of minoritized ethnic groups in accessing statutory services. I reflect on how the intersections of racialized identities and western medical terminology make researching and providing services across racialized boundaries and health/illness a complex procedure. This commentary has direct implications for the care of people with dementia, their family members and for service development within health and social care fields.
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Affiliation(s)
- Liz Forbat
- School of Health and Social Welfare, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK.
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Shah A. Demographic Changes among Ethnic Minority Elders in England and Wales: Implications for Development and Delivery of Old Age Psychiatry Services. INTERNATIONAL JOURNAL OF MIGRATION HEALTH AND SOCIAL CARE 2007. [DOI: 10.1108/17479894200700010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shah A, Dalvi M, Thompson T. Behavioural and psychological signs and symptoms of dementia across cultures: current status and the future. Int J Geriatr Psychiatry 2005; 20:1187-95. [PMID: 16315147 DOI: 10.1002/gps.1417] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Behavioural and psychological symptoms of dementia (BPSD) have been poorly studied in developing countries, in ethnic minority groups in a given country and in cross-national studies. METHODS The literature on BPSD from developing countries, ethnic minority groups in a given country and cross-national studies was examined. RESULTS There is emerging literature on BPSD from the settings was studied. These studies provide useful preliminary data on the prevalence and correlates of BPSD. Moreover, the data illustrate possible cross-cultural differences in BPSD and their correlates. A number of instruments measuring either individual BPSD within a BPSD domain, measuring features of a BPSD domain or features of a range of BPSD domains have been developed in languages other than English for use in developing countries and ethnic minority groups in a given country. CONCLUSIONS There is a need for methodologically similar and uniform studies of BPSD across countries and ethnic groups in a given country using appropriately validated instruments. It is suggested that a consensus should be reached by researchers on the best instrument(s) to be developed in languages other than English for use in these settings and, in turn, these instruments should be developed using appropriate methodology. This could allow identification of the genetic and environmental aetiology of BPSD and the influence of gene-environment interaction.
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Affiliation(s)
- Ajit Shah
- Psychiatry of Old Age, West London Mental Health NHS Trust, London, UK.
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Byrd DA, Sanchez D, Manly JJ. Neuropsychological test performance among Caribbean-born and U.S.-born African American elderly: the role of age, education and reading level. J Clin Exp Neuropsychol 2005; 27:1056-69. [PMID: 16207624 DOI: 10.1080/13803390490919353] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Within-group variation is an important yet under-studied component of cross-cultural neuropsychology. The current study explored this potential source of variation in a neurologically healthy African American elderly sample by comparing the neuropsychological test performance of nondemented groups of Caribbean-born and U.S.-born African American elders who live in New York City. Caribbean-born elders resided in the U.S. for a mean of 41.5 years (SD=17.0). Results indicate that in general, Caribbean-born elders in this cohort did not demonstrate a unique cognitive testing profile from U.S.-born African American elders. However, the Caribbean-born group demonstrated a higher quality of education than their U.S.-born counterparts. The influence of demographic factors (i.e., age and education) on neuropsychological test performance was markedly attenuated in Caribbean-born elders though reading level was the strongest predictor of test performance for all elders, regardless of birthplace.
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Affiliation(s)
- Desiree A Byrd
- G. H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Stewart R, Johnson J, Richards M, Brayne C, Mann A. The distribution of Mini-Mental State Examination scores in an older UK African-Caribbean population compared to MRC CFA study norms. Int J Geriatr Psychiatry 2002; 17:745-51. [PMID: 12211125 DOI: 10.1002/gps.698] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE to describe normative data for the Mini-Mental State Examination (MMSE) in a UK African-Caribbean population and compare these with norms for white UK-born elders. DESIGN a comparison of MMSE data from two cross-sectional surveys. METHOD the MMSE had been administered to a community UK African-Caribbean population and scores were compared to norms from the Medical Research Council Cognitive Function and Ageing Study (CFAS). MMSE data were analysed for 248 African-Caribbean participants aged 55-75 and 5379 CFAS participants aged 65-74, without visual or auditory problems. Distributions of scores were tabulated and error rates for individual items compared. RESULTS Median MMSE scores were 25 (interquartile range 22-27) for the whole African-Caribbean sample, 24 (22-27) for those aged 65-75 in the African-Caribbean sample, and 27 (25-29) for CFAS. Differences in error rates were specific to particular items: naming the season, serial seven subtraction, phrase repetition, three-stage command, and copying intersecting pentagons. These differences persisted when both samples were restricted to those with statutory duration of education, who were literate and who had worked in non-manual occupations. Normative data are displayed for MMSE scores in both groups. CONCLUSION different distributions of MMSE scores between UK African-Caribbean and Caucasian groups can be principally explained by cultural bias in certain items. If the MMSE is to be administered to older African-Caribbean people, specific normative data should be referred to or else a culturally modified version of the instrument should be used.
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Affiliation(s)
- Robert Stewart
- Section of Epidemiology, Institute of Psychiatry, London, UK.
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Stewart R, Asonganyi B, Sherwood R. Plasma homocysteine and cognitive impairment in an older British African-Caribbean population. J Am Geriatr Soc 2002; 50:1227-32. [PMID: 12133017 DOI: 10.1046/j.1532-5415.2002.50309.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate the association between homocysteine concentrations and cognitive impairment in an older African-Caribbean population. To investigate other measures of risk for vascular disease and nutritional status as potential confounding factors. DESIGN A secondary analysis from a cross-sectional community study. SETTING The sample was drawn from registration lists for seven primary care services in south London, United Kingdom. PARTICIPANTS Two hundred forty-eight individuals aged 55 to 75 who were born in a Caribbean nation and for whom homocysteine concentrations had been ascertained. MEASUREMENTS Plasma homocysteine and serum folate were assayed from frozen samples. Cognitive impairment as a composite measure was derived from 11 psychometric tests. Other measures of risk for vascular disease were considered as potential confounding factors: diagnosed hypertension/diabetes mellitus; physical exercise; and concentrations of cholesterol, triglycerides, and fibrinogen. RESULTS Cognitive impairment was classified in 68 (27%) participants. Raised homocysteine (highest quartile: >13.85 micromol/L) was significantly associated with cognitive impairment (odds ratio (OR)=2.50, 95% confidence interval (CI)=1.33-4.69). This association persisted after adjustment for age, occupation, other measures of vascular risk, folate, body mass index, and waist:hip ratio (OR=3.00, 95% CI=1.35-6.69). As with other risk factors for vascular disease in this sample, the association was significant only in those with less education (P-value for interaction=.049). CONCLUSION Raised homocysteine was associated with cognitive impairment in this sample, but this was modified by previous educational attainment. This association was independent of other measures of vascular risk and was not explained by folate concentrations.
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Affiliation(s)
- Robert Stewart
- Section of Epidemiology, Institute of Psychiatry, London, United Kingdom.
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Reeves S, Stewart R, Howard R. Service contact and psychopathology in very-late-onset schizophrenia-like psychosis: the effects of gender and ethnicity. Int J Geriatr Psychiatry 2002; 17:473-9. [PMID: 11994937 DOI: 10.1002/gps.614] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Epidemiological data on very-late-onset (>60 years) schizophrenia-like psychosis (SLP) are scarce. There are only two published follow-up studies. OBJECTIVE To examine the associations of gender and ethnicity with health service contact and psychopathology in SLP. METHOD We identified all new referrals of SLP to the Maudsley hospital between 1995-2000. Demographic details and information on the course of the illness were obtained from case notes. Those patients who agreed to take part were seen at home and assessed with respect to psychopathology and neurological side effects. RESULTS The median duration of illness at the time of assessment was 3 years (range 1-6 years). Male patients were more likely to be admitted to hospital compulsorily and to be lost to follow-up than female patients. Caribbean-born patients were more likely to refuse to take part than British-born patients. Of the 26 (48%) patients who were interviewed, 38% were experiencing paranoid symptoms, 94% of patients receiving medication were in regular contact with a community psychiatric nurse (CPN). Treatment response was dose related and was not increased by the use of a depot. CONCLUSION The effects of gender and ethnicity on outcome need to be further investigated through larger studies. High loss to follow-up amongst male patients may be indicative of a poor prognosis. Regular contact with a CPN may be more important than the use of a depot in maintaining treatment response.
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Affiliation(s)
- S Reeves
- Section of Old Age Psychiatry, Institute of Psychiatry, London, UK.
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Stewart R, Richards M. Surveying older people from minority ethnic groups: an evaluation of a primary care sampling method for UK African-Caribbean elders. Int J Methods Psychiatr Res 2002; 11:178-83. [PMID: 12459821 PMCID: PMC6878490 DOI: 10.1002/mpr.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
There are substantial logistical difficulties in conducting community surveys of minority ethnic group populations. Primary care lists have been identified as an important potential resource but the representativeness of samples derived through this method has received little evaluation. In a community survey of psychiatric morbidity, African-Caribbean people aged 55-75 were identified by practice staff from registration lists for seven primary care teams in south London. The sensitivity of the process was evaluated by contacting a random sample of people whose ethnicity was not known. Participants aged 65-75 (n = 174) were also compared to a similarly aged group sampled through household enumeration (n = 34) with respect to demographic factors, risk factors for vascular disease, depression and cognitive function. For those with correct addresses, the identified group was estimated to include 72% of the potentially eligible population. Only 8% of contacted people were found not to be eligible in terms of ethnicity. Compared to the household enumeration sample, the primary care sample had marginally higher socio-economic status but was similar with respect to all other measured characteristics. Primary care list sampling with staff-assigned ethnicity therefore appeared highly specific, reasonably sensitive, and did not seem to introduce substantial bias for this population.
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Affiliation(s)
- Robert Stewart
- Section of Epidemiology, Institute of Psychiatry, London, UK.
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Stewart R, Richards M, Brayne C, Mann A. Cognitive function in UK community-dwelling African Caribbean elders: normative data for a test battery. Int J Geriatr Psychiatry 2001; 16:518-27. [PMID: 11376469 DOI: 10.1002/gps.384] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many 'first generation' African Caribbean residents in the UK have now reached ages where risk of cognitive impairment and dementia starts to increase. In addition, conditions which may impair cognitive function, such as hypertension, diabetes and stroke, have high prevalence rates in African Caribbean populations. However, there is a lack of normative data for cognitive tests in this ethnic group. Cognitive assessment was carried out in a south London community population of 285 African Caribbean participants aged 55-75 years. Tests were drawn principally from the consortium to establish a registry for Alzheimer's disease (CERAD) battery (Boston Naming Test, verbal fluency, word list recall, and Trailmaking Tests A and B) and also included orientation items from the Mini-Mental State Examination (MMSE) and the Clock Drawing Test. Independent effects of age, sex, education and occupation were identified on scores for most but not all cognitive tests. Compared with normative data for African American populations, lower scores on verbal fluency and the Boston Naming Test were observed but scores on memory tests were comparable. Normative data for the tests are presented, stratified by level of education.
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Affiliation(s)
- R Stewart
- Clinical Research Fellow, Section of Old Age Psychiatry, Institute of Psychiatry, London, UK.
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