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Rizkallah J, Staios M, Analytis P, Kosmidis MH, March E, Stolwyk RJ. Exploring How Sociocultural Factors Affect the Experience of Completing Neuropsychological Assessments Within Older Greek-Australians. Arch Clin Neuropsychol 2024; 39:65-77. [PMID: 37332261 PMCID: PMC10802220 DOI: 10.1093/arclin/acad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE The field of cultural neuropsychology has grown exponentially over the last three decades. With a limited culturally informed evidence base to guide neuropsychological practice, the acceptability of existing paradigms has been called into question when applied to culturally diverse and educationally disadvantaged groups. This qualitative study aimed to explore the experiences of Greek Australian older adults who underwent a cognitive assessment to better understand potential barriers and facilitators to engagement and to improve neuropsychological assessment outcomes. METHOD Semi-structured interviews were developed to explore cultural attitudes and contextual factors relating to neuropsychological assessment. Interviews were conducted by Greek-speaking neuropsychologists using a sample of 10 healthy elderly Greek Australians following the completion of a comprehensive neuropsychological assessment. Data were analyzed using a phenomenological design within a critical realist framework. RESULTS Analysis revealed the emergence of three broad themes: sociocultural factors, experiences within the broader medical system, and the assessment experience. Engagement with cognitive assessment was influenced by several factors, including rapport building, understanding of the assessment, and use of inappropriate tests. Furthermore, level and quality of education, sex differences, language barriers, acculturation, previous experiences of prejudice, anxiety, and a preference for Greek-speaking clinicians were additional factors reported to affect the client experience and validity of assessment outcomes. CONCLUSION Neuropsychological assessment is, in part, affected by culturally reinforced attitudes. Failing to adjust the relationship between the clinician and client, test environment, style of communication, and the use of culturally inappropriate tests is likely to affect the validity of assessment outcomes.
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Affiliation(s)
- Joyce Rizkallah
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
| | - Mathew Staios
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
| | - Penelope Analytis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evrim March
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
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Torkpoor R, Frolich K, Londos E, Nielsen TR. Diagnostic Accuracy of the Swedish Version of the Multicultural Cognitive Examination for Cognitive Assessment in Swedish Memory Clinics. J Alzheimers Dis 2024; 97:715-726. [PMID: 38143364 PMCID: PMC10836550 DOI: 10.3233/jad-230998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Cognitive assessment for foreign-born individuals is suboptimal. The Multicultural Cognitive Examination (MCE) was developed for use in culturally, linguistically and educationally diverse populations. The MCE includes the Rowland Universal Dementia Assessment Scale (RUDAS) and performs assessment of memory, verbal fluency, and visuospatial function. OBJECTIVE To compare the psychometric properties of the Swedish version of the Multicultural Cognitive Examination (MCE-S) with the Swedish versions of the RUDAS (RUDAS-S), the Mini-Mental State Examination (MMSE-SR), and the Clock Drawing Test (CDT), and to explore the ability of the MCE-S test to differentiate patients with and without dementia in a multicultural population. METHODS 117 outpatients at four memory clinics were tested using the MCE-S to complement the routine cognitive assessment. RESULTS Significant differences between patients with and without dementia were observed for all MCE-S components. There were significant differences between foreign-born and Swedish-born patients in the MMSE-SR, but not in the MCE-S or the RUDAS-S. The MCE-S, had good diagnostic performance for detecting dementia (AUC, 0.82), and was at least as good as the RUDAS-S alone (AUC, 0.79). The MCE-S also distinguished Alzheimer's disease (AD) from non-AD dementia. Contrary to expectations, the MCE-S was also at least as good as the MMSE-SR among the Swedish-born patients. CONCLUSIONS The MCE-S is adequate for detecting dementia in both foreign-born and Swedish-born populations. Based on the cultural diversity of general society, adapted cognitive tests that can be used for everyone are practical and beneficial for both patients and health-care professionals. Further studies are needed within primary care.
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Affiliation(s)
- Rozita Torkpoor
- Department of Clinical Sciences Malmö, Cognitive Disorder Research Unit, Lund University, Malmö, Sweden
- Memory Clinic, Skane University Hospital, Malmö, Sweden
| | - Kristin Frolich
- Department of Clinical Sciences Malmö, Cognitive Disorder Research Unit, Lund University, Malmö, Sweden
| | - Elisabet Londos
- Department of Clinical Sciences Malmö, Cognitive Disorder Research Unit, Lund University, Malmö, Sweden
- Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - T. Rune Nielsen
- Danish Dementia Research Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Tsai S, Ma S, Nielsen TR, Calia C. Assessment of Dementia in Minority Ethnic Groups in Scotland: Results of a Survey of Cognitive Specialists. Alzheimer Dis Assoc Disord 2024; 38:85-90. [PMID: 38315885 DOI: 10.1097/wad.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Minority ethnic groups (MEGs) in Europe receive suboptimal dementia evaluation, yet related research in Scotland is lacking. This research examined the evaluation of dementia in MEGs in Scotland and compared it with previous research to highlight the changes in the clinical evaluation of dementia over the decade. DESIGN AND SETTING A self-administered survey was created online and emailed to 14 Heads of the boards under the Scottish National Health Service and dementia-associated settings and organizations. RESULTS Most surveyed centers (85.6%) received MEG referrals. Although 92.9% of the centers used professional translators when needed, 85.7% thought assessing dementia in MEGs was difficult, mostly due to the suitability of test instruments and rating scales and patients' linguistic abilities. Very few found their skills to be good in evaluating MEGs. There was no mention of specialized dementia services for MEGs. CONCLUSIONS The lack of culturally appropriate instruments and specialized dementia services reveals that the services are not ready to meet the demand for evaluating patients from diverse cultural and language backgrounds. Inadequate clinical evaluation may lead to misdiagnoses. Therefore, although significant work has been carried out in the past few years, improvements must be continued to enhance the current practices and apply suitable evaluation methods for MEGs.
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Affiliation(s)
- Somying Tsai
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, Edinburgh, UK
| | - Shuning Ma
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, Edinburgh, UK
| | - Thomas Rune Nielsen
- Department of Psychology, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Clara Calia
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, Edinburgh, UK
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Nielsen TR, Staios M. Clinical Utility of WAIS-IV Matrix Reasoning Among Adult Low Educated Recent Immigrants; A Note of Caution. Arch Clin Neuropsychol 2023; 38:976-982. [PMID: 36702784 DOI: 10.1093/arclin/acad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/16/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To examine the clinical utility of Wechsler Adult Intelligence Scale-IV (WAIS-IV) Matrix Reasoning in limited educated recently arrived immigrants in Denmark. METHOD Participants were 64 limited educated (0-9 years' education) independently living adult immigrants primarily from Middle Eastern and Sub-Saharan African countries who completed WAIS-IV Matrix Reasoning as well as demographic, and medical questionnaires. RESULTS Thirty-eight participants (59%) scored more than two standard deviations below the Scandinavian mean (scaled score < 4). Performances were significantly associated with years of education but not with occupational status, years of residence in Denmark, or Danish language skills. The most common error types were repetition errors (15.84%) and incomplete correlate errors (10.47%), with a strong trend for a higher proportion of repetition errors in participants with <5 years of education. CONCLUSIONS The findings indicate that WAIS-IV Matrix Reasoning underestimates cognitive functioning in limited educated recently arrived immigrants, thus calling its clinical utility into question.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Mathew Staios
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
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Nielsen TR, Vinnner P. Cognitive assessment of literacy learning difficulties in adult non- or low-literate second language learners. Scand J Psychol 2023. [PMID: 36773002 DOI: 10.1111/sjop.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/19/2022] [Accepted: 01/21/2023] [Indexed: 02/12/2023]
Abstract
The population of non- or low-literate adult immigrants studying a new language is large and growing in many countries. The aim of this study was to develop and validate a new instrument for the assessment of cognitive impairment that may hinder literacy learning in adult non- or low-literate L2 learners, the Cognitive Assessment of Literacy Learning Difficulties (CALL), in a language center setting. This was a case-control study in which the CALL was validated in adult non- or low-literate students, or students who were not literate in the Latin alphabet, in nine Danish language centers. Educator classification of students with very slow progression in learning basic Danish literacy was used as a benchmark for literacy learning difficulties. Classification was further based on the number of lessons participants had required to pass tests during Danish language program levels. An acceptable discriminative validity (AUC 0.76; specificity 0.94, sensitivity 0.64) for literacy learning difficulties (n = 32) versus schooling and sex matched control participants (n = 28) was found. In comparison, years of formal schooling had an AUC of 0.58. Age had a small effect on the ability of the CALL to predict literacy learning difficulties (OR = 1.097, p = 0.013), whereas sex and years of schooling did not. CALL was found to be a valid instrument for identification of cognitive impairment that may hinder literacy learning in adult non- or low-literate L2 learners in a Danish language center setting.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pernille Vinnner
- Danish Agency for International Recruitment and Integration (SIRI), Ministry of Immigration and Integration, Copenhagen, Denmark
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Nyenhuis DL, Reckow J. Office- and Bedside-based Screening for Cognitive Impairment and the Dementias: Which Tools to Use, Interpreting the Results, and What Are the Next Steps? Clin Geriatr Med 2023; 39:15-25. [PMID: 36404027 DOI: 10.1016/j.cger.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Elderly patients and their families are concerned about the patients' cognitive abilities, and cognitive screening is an efficient diagnostic tool, as long as clinicians administer the screens in a standardized manner and interpret the screen results accurately. The following brief summary reviews commonly used screening instruments and provides information about how to interpret screening test results. It concludes by showing how cognitive screening fits into a four-step process (Education, Screening, Follow-up, and Referral) of how to respond to patients with cognitive concerns.
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Affiliation(s)
- David L Nyenhuis
- Neuropsychology Section, Hauenstein Neuroscience Center, Mercy Health of West Michigan, 220 Cherry Street SE, Grand Rapids, MI 49503, USA.
| | - Jaclyn Reckow
- Department of Psychology, LCC International University, Kretingos g. 36, Klaipeda, Lithuania
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Staios M, Kosmidis MH, Kokkinis N, Papadopoulos A, Nielsen TR, Kalinowski P, March E, Stolwyk RJ. The Greek Australian neuropsychological normative study: tests & norms for Greek Australians aged 70-85 years. AUSTRALIAN PSYCHOLOGIST 2023. [DOI: 10.1080/00050067.2022.2151337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Mathew Staios
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Mary H. Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Kokkinis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Papadopoulos
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - T. Rune Nielsen
- Department of Neurology, Danish Dementia Research Centre, Copenhagen, Denmark
| | - Pawel Kalinowski
- Melbourne Dementia Research Centre, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Evrim March
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Renerus J. Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
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Franzen S, van den Berg E, Bossenbroek W, Kranenburg J, Scheffers EA, van Hout M, van de Wiel L, Goudsmit M, van Bruchem-Visser RL, van Hemmen J, Jiskoot LC, Papma JM. Neuropsychological assessment in the multicultural memory clinic: Development and feasibility of the TULIPA battery. Clin Neuropsychol 2023; 37:60-80. [PMID: 35225154 DOI: 10.1080/13854046.2022.2043447] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neuropsychological assessment of culturally diverse populations is hindered by barriers in language, culture, education, and a lack of suitable tests. Furthermore, individuals from diverse backgrounds are often unfamiliar with being cognitively tested. The aim of this study was to develop a new neuropsychological test battery and study its feasibility in multicultural memory clinics. Composition of the TULIPA battery (Towards a Universal Language: Intervention and Psychodiagnostic Assessment) entailed a literature review and consultation with experts and individuals from diverse backgrounds. Feasibility was investigated by examining administration and completion rates and the frequency of factors complicating neuropsychological assessment in 345 patients from 37 countries visiting four multicultural memory clinics in the Netherlands. The test battery included existing tests such as the Cross-Cultural Dementia screening (CCD), Rowland Universal Dementia Assessment Scale (RUDAS), tests from the European Cross-Cultural Neuropsychological Test Battery, and newly developed tests. Completion rates for the test battery were generally high (82%-100%), except for CCD Dots subtest B (58%). Although tests of the "core" TULIPA battery were administered often (median: 6 of 7, IQR: 5-7), supplementary tests were administered less frequently (median: 1 of 9; IQR: 0-3). The number of administered tests correlated with disease severity (RUDAS, ρ=.33, adjusted p < .001), but not with other patient characteristics. Complicating factors were observed frequently, e.g. suboptimal effort (29%-50%), fatigue (29%), depression (37%-57%). The TULIPA test battery is a promising new battery to assess culturally diverse populations in a feasible way, provided that complicating factors are taken into account. Supplemental data for this article is available online at https://doi.org/10.1080/13854046.2022.2043447 .
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Affiliation(s)
- Sanne Franzen
- 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
| | - Willemijn Bossenbroek
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Medical Psychology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Judi Kranenburg
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Esther A Scheffers
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Moniek van Hout
- Department of Medical Psychology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Lotte van de Wiel
- Department of Medical Psychology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Miriam Goudsmit
- Department of Psychiatry and Medical Psychology, OLVG, Amsterdam, The Netherlands
| | | | - Judy van Hemmen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lize C Jiskoot
- 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
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Petri M, Messinis L, Patrikelis P, Nousia A, Nasios G. Illiteracy, Neuropsychological Assessment, and Cognitive Rehabilitation: A Narrative Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:477-484. [PMID: 37581821 DOI: 10.1007/978-3-031-31986-0_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECT Νeuropsychological assessment is particularly important for the accurate discrimination of cognitive abilities and weaknesses of patients in order to determine the appropriate therapeutic intervention. However, the reliability and validity of neuropsychological assessment appears to be influenced by a wide range of factors, including literacy and educational level. AIM This systematic review evaluates neuropsychological tests appropriate for the valid assessment of illiterate individuals and the effectiveness of cognitive rehabilitation programs for illiterate and/or low-educated individuals according to the results of English language studies that have been published in the PubMed/Medline electronic database until August 2022 (no initiation date). RESULTS 49 studies were included for neuropsychological assessment and 4 studies for cognitive rehabilitation. In terms of investigating the validity and reliability of neuropsychological tests for the assessment of healthy illiterate individuals, most studies concluded that for the majority of neuropsychological tests there is a significant difference in performance between healthy illiterate and literate individuals. However, there was consensus among studies that the performance of illiterate subjects was equivalent to the performance of literate subjects on tasks depicting colored and real objects. Regarding cognitive rehabilitation programs, all four studies concluded that they are effective in improving the cognitive functions of illiterate and/or low-literate patients with mild cognitive impairment and/or mild dementia. CONCLUSIONS For the assessment of illiterate individuals, it is imperative that neuropsychological tests with high ecological validity (i.e., tests related to activities of daily living) be administered so as not to underestimate their cognitive functioning. At the same time, cognitive enhancement/stimulation programs seem to be effective in this population group; however, this area needs further investigation.
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Affiliation(s)
- Maria Petri
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lambros Messinis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Panayiotis Patrikelis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Nousia
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Ramos-Henderson M, Calderón C, Domic-Siede M. Education bias in typical brief cognitive tests used for the detection of dementia in elderly population with low educational level: a critical review. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36519252 DOI: 10.1080/23279095.2022.2155521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Dementia is a significant decline in cognition that interfere with independent, daily functioning. Dementia is a syndrome caused by a myriad and include primary neurologic, neuropsychiatric, and medical conditions. It has been projected that the prevalence of dementia will triple in the elderly population by the year 2050. Despite the benefits of early diagnosis, there is an effective under-detection of around 62% of people with mild cognitive impairment (MCI) or dementia. One of the factors associated with this problem is that diagnostic techniques are affected by the educational level of those evaluated. This is an important aspect to consider in the use of brief cognitive tests for the detection of dementia. This review presents and critically analyzes the available evidence regarding the effect of educational level on the diagnostic utility of three of the most widely used tools in the clinical setting: the Mini-mental Test Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Addenbrooke's Cognitive Examination (ACE). Previous evidence shows that the tasks that require reading, writing, calculation, phonological fluency, and visuoconstruction are affected by educational level. These results lead to discourage the use of these tests in older people with less than 6 years of schooling. The development of brief cognitive tests appropriate for people with a low educational level is recommended. We posit that adequate cognitive tests should not consider tasks or items that resemble characteristics of academic contexts and should be more analogous to daily activities situations.
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Affiliation(s)
- Miguel Ramos-Henderson
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
- Centro de Investigación e Innovación en Gerontología Aplicada CIGAP, Facultad de Salud, Universidad Santo Tomás, Antofagasta, Chile
| | - Carlos Calderón
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
| | - Marcos Domic-Siede
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
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Staios M, Nielsen TR, Kosmidis MH, Papadopoulos A, Kokkinias A, Velakoulis D, Tsiaras Y, March E, Stolwyk RJ. Validity of Visuoconstructional Assessment Methods within Healthy Elderly Greek Australians: Quantitative and Error Analysis. Arch Clin Neuropsychol 2022; 38:598-607. [DOI: 10.1093/arclin/acac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 12/05/2022] Open
Abstract
Abstract
Aims
Visuospatial skills are frequently assessed with drawing tests. Research has suggested that the use of drawing tasks in low educated groups may lack the ability to discriminate healthy individuals from clinical populations. The aims of this study were to investigate the validity of visuoconstructional tests in a sample of older Greek Australian immigrants and compare their performances to a matched sample of patients with Alzheimer’s disease (ad).
Method
We assessed visuoconstructional performances in a sample of 90 healthy older Greek Australians, with a primary school level of education, and compared performances to a demographically matched sample of 20 Greek Australians with a diagnosis of ad on four visuoconstructional drawing tests: Greek cross, four-pointed star, intersecting pentagons, and the Necker Cube.
Results
While healthy participants tended to outperform the ad group on most copy tasks, high fail rates within the healthy sample were observed for the intersecting pentagons and Necker cube (78% and 73% fail rates, respectively) when using established clinical cut-off scores. High rates of curved angle, omission, distorted relation between elements, spatial disorganization and three-dimensional design errors were found across the four-pointed star, intersecting pentagons, and the Necker cube in both healthy participants and those with ad. Exploratory receiver operating characteristic curve analysis revealed that, with perhaps the exception of the Greek cross, meaningful sensitivity and specificity could not be reached for the four-pointed star, intersecting pentagons, and Necker cube.
Conclusion
Cognitively healthy immigrants with low education appear to be at a disadvantage when completing visuoconstructional drawing tests, as their performance may be misinterpreted as indicating cognitive impairment. Future research is needed to identify alternative approaches to assess visuoconstructional ability in culturally and linguistically diverse older cohorts with limited education.
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Affiliation(s)
- Mathew Staios
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
| | - T Rune Nielsen
- Danish Dementia Research Centre, Neuroscience Centre, Copenhagen University Hospital Department of Neurology, , Rigshospitalet, Copenhagen, Denmark
| | - Mary H Kosmidis
- School of Psychology, Aristotle University of Thessaloniki Lab of Cognitive Neuroscience, , Thessaloniki, Greece
| | - Alexandra Papadopoulos
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
| | - Arthur Kokkinias
- The Royal Melbourne Hospital, Inner West Area Mental Health Service , Parkville, Australia
| | - Dennis Velakoulis
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health Department of Psychiatry, , Melbourne, Australia
- The Royal Melbourne Hospital Neuropsychiatry, , Melbourne, Australia
| | - Yiannis Tsiaras
- School of Psychology, Aristotle University of Thessaloniki Lab of Cognitive Neuroscience, , Thessaloniki, Greece
| | - Evrim March
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre , Melbourne, Australia
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Abstract
OBJECTIVE Dementia among migrants is an emerging phenomenon worldwide and the development of neuropsychological tests sensitive to cultural differences is increasingly regarded as a priority. The Clock Drawing Test (CDT) is one of the most used screening tools for the detection of cognitive decline. Nevertheless, there is still a debate about its adoption as a cross-cultural assessment. METHODS To identify cultural variables influencing performance at CDT, we performed a systematic review of literature on three databases of all studies considering the role of at least one of the following: (1) language; (2) education; (3) literacy; (4) acculturation; and (5) ethnicity. RESULTS We extrapolated 160 analyses from 105 studies. Overall, an influence of cultural determinants on performance at CDT was found in 127 analyses (79.4%). Regarding specific cultural factors, 22 analyses investigated the effect of ethnicity on CDT scores, reporting conflicting results. Only two scoring systems turned out to be sufficiently accurate in a multicultural population. Language influenced performance in only 1 out of 8 analyses. A higher level of education positively influenced test performance in 118 out of 154 analyses (76.6%), and a better quality of education in 1 analysis out of 2. A negative influence of illiteracy on CDT performance emerged in 9 out of 10 analyses. Acculturation affected performances at CDT in 1 out of 2 studies. CONCLUSIONS Based on the present findings, caution is needed when using CDT in a multicultural context, even if it requires limited linguistic competence.
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Abstract
OBJECTIVES We investigated the utility of traditional neuropsychological tests in older uneducated/illiterate individuals without dementia to determine the possibility that they are likely not appropriate for this group. METHODS We assessed the neuropsychological performance of 1122 older adults [≥65 years old; mean age: 74.03 (SD = 5.46); mean education: 4.76 (SD = 2.5) years; women: n = 714], in the context of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population-based study conducted in Greece. RESULTS We based our analyses on three groups: high-functioning/cognitively healthy (i.e., without dementia) uneducated/illiterate individuals (n = 80), high-functioning/cognitively healthy educated/literate individuals (n = 932), and low-functioning/cognitively impaired educated/literate individuals (presumably with dementia; n = 110). We used binary regression analyses with Bonferroni correction to investigate whether test performance differentiated uneducated/illiterate from educated/literate individuals. Models were adjusted for age and sex; raw test scores were the predictor variables. The uneducated/illiterate cohort was at a disadvantage relative to the healthy educated/literate group on all variables but verbal memory recognition and consolidation, congruent motor responses, and phonological fluency clustering (p > .002). Moreover, only word list learning immediate and delayed free recall and delayed cued recall differentiated the high-functioning/cognitively healthy uneducated/illiterate from the low-functioning/cognitively impaired educated/literate group, favoring the former (p's < .002). CONCLUSIONS Our findings suggest that only particular verbal memory test variables are fair in determining whether older uneducated/illiterate individuals have functional/cognitive impairment suggestive of a neurodegenerative process. On all other neuropsychological variables, this cohort was at a disadvantage. Therefore, we highlight the need for identifying appropriate methods of assessment for older uneducated/illiterate individuals.
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Torkpoor R, Frolich K, Nielsen RT, Londos E. Diagnostic Accuracy of the Swedish Version of the Rowland Universal Dementia Assessment Scale (RUDAS-S) for Multicultural Cognitive Screening in Swedish Memory Clinics. J Alzheimers Dis 2022; 89:865-876. [PMID: 35964182 PMCID: PMC9535584 DOI: 10.3233/jad-220233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: The number of people with a migration background and dementia is increasing in Europe. All patients with suspected dementia have the right to an appropriate cognitive assessment and correct diagnosis for optimal treatment and support. Rowland Universal Dementia Assessment Scale (RUDAS) cognitive screening instrument is less affected by language, culture, and educational background, and adapted for use in multicultural populations. Objective: To compare the diagnostic accuracy of RUDAS-S to the Swedish version of Mini-Mental State Examination (MMSE-SR) for detecting dementia in a multicultural group of outpatients in Swedish memory clinics. Methods: We tested 123 outpatients (36 nonnative Swedish), in 4 memory clinics in Southern Sweden with RUDAS-S to supplement the usual cognitive assessment. Results: RUDAS-S had moderate to good diagnostic performance for detecting dementia in a multicultural population in Sweden, with an area under the receiver operating characteristic curve (AUC) of 0.81. At a cutoff score <25 its sensitivity was 0.92, specificity 0.60, and accuracy 76%. The AUC for the MMSE-SR was 0.79. At a cutoff score <23 its sensitivity was 0.65, specificity 0.81, and accuracy 73%. Conclusion: RUDAS-S is at least as accurate as MMSE-SR for detecting dementia in memory clinics in Sweden and can be used for all patients undergoing a cognitive assessment, irrespective of their cultural, language, and educational background. However, there is a need for other cross-cultural cognitive tests to complement RUDAS-S to extend cognitive examination.
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Affiliation(s)
- Rozita Torkpoor
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.,Memory Clinic, Skane University Hospital, Malmö, Sweden
| | - Kristin Frolich
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Rune T Nielsen
- Danish Dementia Research Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.,Memory Clinic, Skane University Hospital, Malmö, Sweden
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Esteves CDS, Oliveira CRD, Lima MP, Gonzatti V, Irigary TQ. Teste do Desenho do Relógio: Dados Normativos Para Idosos. PSICO-USF 2022. [DOI: 10.1590/1413-82712027270306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Resumo Trata-se de um estudo quantitativo, retrospectivo, correlacional e de corte transversal, com objetivo de fornecer dados normativos do TDR para idosos, levando em consideração diferentes faixas etárias e níveis de escolaridade. Duzentos e trinta e cinco foram entrevistados individualmente, distribuídos em cinco grupos etários e quatro níveis de escolaridade. Os instrumentos foram Ficha de Dados Sociodemográficos, Miniexame do Estado Mental (MEEM), Escala de Depressão Geriátrica, versão reduzida (GDS-15), Tarefa de Fluência Verbal Semântica (TFVS) e o TDR. Utilizou-se estatísticas descritivas, correlação de Pearson e análise univariada (one-way ANOVA) com post hoc Scheffe. Os escores do TDR apresentaram associações significativas com os anos de idade, anos de escolaridade, MEEM, TFVS e GDS-15. Houve diferença de desempenho no TDR ao considerarem os grupos por idade. O estudo fornece valores normativos para o TDR em uma amostra de idosos do sul do Brasil que foram influenciados pela idade, escolaridade, sintomatologia depressiva e fluência verbal.
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Crombie M, Dutt A, Dey P, Nandi R, Evans J. Examination of the validity of the 'Papadum test': an alternative to the clock drawing test for people with low levels of education. Clin Neuropsychol 2022:1-18. [PMID: 35317719 DOI: 10.1080/13854046.2022.2047789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives: The clock drawing test (CDT) is a widely used cognitive screening test. However, CDT performance is affected by education. This study examined an alternative, the Papadum test, designed for people with low levels of education/literacy. The association between education and test performance, correlation between CDT and Papadum test, and diagnostic accuracy of both CDT and Papadum tests were examined. Method: 89 healthy literate adults and 59 literate adults (all Bengali speaking) with a diagnosis of mild-moderate dementia from hospitals in Kolkata, India undertook the CDT and the Papadum test. Results: Education had a significant association with the CDT but not with the Papadum test. Across the whole sample there was a significant correlation between CDT and Papadum, but not within separate groups of healthy controls and patients. Diagnostic accuracy for the Papadum test was similar to that for CDT. Conclusions: Results highlight the strong influence that education has on CDT performance indicating that it is not suitable for those with low levels of literacy. The Papadum test could provide a viable alternative as a screening tool to the CDT for use with people who are illiterate or have low levels of education. Further validation studies are required.
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Affiliation(s)
- Mairi Crombie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Aparna Dutt
- Neuropsychology and Clinical Psychology Unit, Duttanager Mental Health Centre, Kolkata, West Bengal, India
| | - Priyanka Dey
- Neuropsychology and Clinical Psychology Unit, Duttanager Mental Health Centre, Kolkata, West Bengal, India
| | - Ranita Nandi
- Neuropsychology and Clinical Psychology Unit, Duttanager Mental Health Centre, Kolkata, West Bengal, India
| | - Jonathan Evans
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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17
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Nielsen TR. Cognitive Assessment in Culturally, Linguistically, and Educationally Diverse Older Populations in Europe. Am J Alzheimers Dis Other Demen 2022; 37:15333175221117006. [PMID: 36325840 PMCID: PMC10581111 DOI: 10.1177/15333175221117006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Due to increasing cultural, linguistic, and educational diversity in older populations across Europe, accurate assessment of cognitive functioning in people from diverse backgrounds becomes increasingly important. This paper aims to provide a state-of-the-art review of cognitive assessment in culturally, linguistically, and educationally diverse older populations in Europe, focusing on challenges and recent advances in cross-cultural assessment. Significant work has been carried out on the identification of challenges in cognitive assessment in culturally, linguistically, and educationally diverse older populations and on development and validation of cross-cultural cognitive tests. Most research has addressed the influences of language barriers, education and literacy, and culture and acculturation and in particular, the European Cross-Cultural Neuropsychological Test Battery (CNTB) and the Rowland Universal Dementia Assessment Scale (RUDAS) are well-validated across European countries. However, cross-cultural cognitive assessment is largely still a developing field in Europe, and there is a continuing need for developments within the field.
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Affiliation(s)
- T. Rune Nielsen
- Danish Dementia Research Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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18
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Gove D, Nielsen TR, Smits C, Plejert C, Rauf MA, Parveen S, Jaakson S, Golan‐Shemesh D, Lahav D, Kaur R, Herz MK, Monsees J, Thyrian JR, Georges J. The challenges of achieving timely diagnosis and culturally appropriate care of people with dementia from minority ethnic groups in Europe. Int J Geriatr Psychiatry 2021; 36:1823-1828. [PMID: 34378237 PMCID: PMC9291493 DOI: 10.1002/gps.5614] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In a just society, everyone should have equal access to healthcare in terms of prevention, assessment, diagnosis, treatment and care. Europe is a multicultural society made up of people who identify with a wide range of ethnic groups. Many older people from minority ethnic groups also have a direct migration background. Several studies have shown that there is a lack of equity in relation to dementia diagnoses and care because equal opportunities do not necessarily translate into equal outcomes. An expert ethics working group led by Alzheimer Europe has produced an extensive report on this issue, a policy brief and a guide for health and social care workers. In this brief summary, the authors/members of the expert working group present some of the key challenges and recommendations for healthcare clinicians striving to provide timely diagnosis and good quality care and treatment to people with dementia from all ethnic groups.
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Affiliation(s)
| | - Thomas Rune Nielsen
- Department of NeurologyDanish Dementia Research CentreCopenhagen University HospitalKobenhavnDenmark
| | - Carolien Smits
- Pharos Dutch Centre of Expertise on Health DisparitiesUtrechtthe Netherlands
| | - Charlotta Plejert
- Department of Biomedical and Clinical SciencesDivision of Sensory Organs and CommunicationLinköping UniversityLinköpingSweden
| | | | - Sahdia Parveen
- Centre for Applied Dementia StudiesUniversity of BradfordBradfordUK
| | - Siiri Jaakson
- Multicultural Memory Centre ‐ the Finnish Society for Memory WorkVantaaFinland
| | | | - Debi Lahav
- Emda Alzheimer's AssociationKefar SabaIsrael
| | | | | | - Jessica Monsees
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)GreifswaldGermany
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)GreifswaldGermany
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Franzen S. Cross-cultural neuropsychological assessment in Europe: Position statement of the European Consortium on Cross-Cultural Neuropsychology (ECCroN). Clin Neuropsychol 2021; 36:546-557. [PMID: 34612169 DOI: 10.1080/13854046.2021.1981456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Over the past decades European societies have become increasingly diverse. This diversity in culture, education, and language significantly impacts neuropsychological assessment. Although several initiatives are under way to overcome these barriers - e.g. newly developed and validated test batteries - there is a need for more collaboration in the development and implementation of neuropsychological tests, such as in the domains of social cognition and language. To address these gaps in cross-cultural neuropsychological assessment in Europe, the European Consortium on Cross-Cultural Neuropsychology (ECCroN) was established in 2019. ECCroN recommends taking a broad range of variables into account, such as linguistic factors, literacy, education, migration history, acculturation and other cultural factors. We advocate against race-based norms as a solution to the challenging interpretation of group differences on neuropsychological tests, and instead support the development, validation, and standardization of more widely applicable/cross-culturally applicable tests that take into account interindividual variability. Last, ECCroN advocates for an improvement in the clinical training of neuropsychologists in culturally sensitive neuropsychological assessment, and the development and implementation of guidelines for interpreter-mediated neuropsychological assessment in diverse populations in Europe. ECCroN may impact research and clinical practice by contributing to existing theoretical frameworks and by improving the assessment of diverse individuals across Europe through collaborations on test development, collection of normative data, cross-cultural clinical training, and interpreter-mediated assessment.
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Affiliation(s)
- Sanne Franzen
- Department of Neurology, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
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20
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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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21
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Custodio N, Montesinos R, Diaz MM, Herrera-Perez E, Chavez K, Alva-Diaz C, Reynoso-Guzman W, Pintado-Caipa M, Cuenca J, Gamboa C, Lanata S. Performance of the Rowland Universal Dementia Assessment Scale for the Detection of Mild Cognitive Impairment and Dementia in a Diverse Cohort of Illiterate Persons From Rural Communities in Peru. Front Neurol 2021; 12:629325. [PMID: 34305773 PMCID: PMC8292605 DOI: 10.3389/fneur.2021.629325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 06/14/2021] [Indexed: 12/05/2022] Open
Abstract
Background: The accurate diagnosis of neurocognitive disorders in illiterate Peruvian populations is challenging, largely owing to scarcity of brief cognitive screening tools (BCST) validated in these diverse populations. The Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) is a BCST that relies minimally on educational attainment and has shown good diagnostic accuracy in an urban illiterate population in Peru, yet its psychometric properties in illiterate populations in rural settings of the country have not been previously investigated. Objectives: To establish the diagnostic accuracy of the RUDAS-PE compared to expert clinical diagnosis using the Clinical Dementia Rating (CDR) Scale in healthy and cognitively impaired illiterate persons living in two culturally and geographically distinct rural communities of Peru. Methods: A cross-sectional, population-based study of residents ≥ 50 years of age living in the Peruvian rural communities of Santa Clotilde and Chuquibambilla. A total of 129 subjects (76 from Santa Clotilde and 53 from Chuquibambilla) were included in this study. Gold standard diagnostic neurocognitive evaluation was based on expert neurological history and examination and administration of the CDR. Receiver operating characteristics, areas under the curve (AUC), and logistic regression analyses were conducted to determine the performance of RUDAS-PE compared to expert gold standard diagnosis. Results: Compared to gold standard diagnosis, the RUDAS-PE was better at correctly discriminating between MCI and dementia than discriminating between MCI and controls in both sites (97.0% vs. 76.2% correct classification in Chuquibambilla; 90.0% vs. 64.7% in Santa Clotilde). In Chuquibambilla, the area under the curve (AUC) of the RUDAS to discriminate between dementia and MCI was 99.4% (optimal cutoff at <18), whereas between MCI and controls it was 82.8% (optimal cutoff at <22). In Santa Clotilde, the area under the curve (AUC) of the RUDAS to discriminate between dementia and MCI was 99.1% (optimal cutoff at <17), whereas between MCI and controls it was 75.5% (optimal cutoff at <21). Conclusions: The RUDAS-PE has acceptable psychometric properties and performed well in its ability to discriminate MCI and dementia in two cohorts of illiterate older adults from two distinct rural Peruvian communities.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Unidad de epidemiología, ITS y VIH, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Peru
| | - Kristhy Chavez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Carlos Alva-Diaz
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
| | - Willyams Reynoso-Guzman
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Atlantic Fellow, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - José Cuenca
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Serggio Lanata
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
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Ortega LV, Aprahamian I, Martinelli JE, Cecchini MA, Cação JDC, Yassuda MS. Diagnostic Accuracy of Usual Cognitive Screening Tests Versus Appropriate Tests for Lower Education to Identify Alzheimer Disease. J Geriatr Psychiatry Neurol 2021; 34:222-231. [PMID: 32969281 DOI: 10.1177/0891988720958542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The accuracy of commonly used screening tests for Alzheimer's disease (AD) has not been directly compared to those that could be more appropriate for lower schooling. OBJECTIVE To compare the diagnostic accuracy of usual screening tests for AD with instruments that might be more appropriate for lower schooling among older adults with low or no literacy. METHODS The study included a clinical sample of 117 elderly outpatients from a Geriatric Clinic classified as literate controls (n = 39), illiterate controls (n = 30), literate AD (n = 30) and illiterate AD (n = 18). The tests were compared as follows: Black and White versus Colored Figure Memory Test; Clock Drawing Test versus Clock Reading Test; Verbal Fluency (VF) animal versus grocery category; CERAD Constructional Praxis versus Stick Design Test. RESULTS The means of literate and illiterate controls did not differ in the Black and White Figure Memory Test (immediate recall), Colored Figure Memory Test (delayed recall), Clock Reading Test and VF animals and grocery categories. The means of the clinical groups (controls versus AD), in the 2 schooling levels, differed significantly in most of the tests, except for the CERAD Constructive Praxis and the Stick Design Test. Diagnostic accuracy was not significantly different between the compared tests. CONCLUSION Commonly used screening tests for AD were as accurate as those expected to overcome the education bias in a sample of older adults with lower or no education.
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Affiliation(s)
- Luciane Viola Ortega
- 67791Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Ivan Aprahamian
- Division of Geriatrics, Department of Internal Medicine, 146840Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - José Eduardo Martinelli
- Division of Geriatrics, Department of Internal Medicine, 146840Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Mário Amore Cecchini
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Mônica Sanches Yassuda
- 67791Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil.,School of Arts, Sciences and Humanities, 28133University of São Paulo (USP), São Paulo, Brazil
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Al-Jawahiri F, Nielsen TR. Effects of Acculturation on the Cross-Cultural Neuropsychological Test Battery (CNTB) in a Culturally and Linguistically Diverse Population in Denmark. Arch Clin Neuropsychol 2021; 36:381-393. [PMID: 31942602 DOI: 10.1093/arclin/acz083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/01/2019] [Accepted: 12/12/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Assessment of individuals from diverse ethnic backgrounds is a major challenge in current clinical neuropsychology as most neuropsychological tests are biased by linguistic, educational, and cultural differences. The aim of this study was to examine the effects of acculturation on the newly developed European Cross-Cultural Neuropsychological Test Battery. METHOD The study was a cross-sectional study carried out in Copenhagen, Denmark. Neuropsychological test performances of a Danish sample were compared to a culturally and linguistically diverse sample, and the effects of a number of acculturation variables were assessed using group comparisons, correlation analyses, and regression analyses. RESULTS A total of 152 participants were included in the study: 26 were native-born monolingual Danes and 126 had culturally and linguistically diverse backgrounds: 66 were immigrants from Turkey, 41 from Poland, and 19 from former Yugoslavia. In direct comparison, the only significant difference between the Danish and culturally and linguistically diverse samples was found on Animal Fluency. However, within the culturally and linguistically diverse sample, higher and lower acculturated groups significantly differed on several measures. The main associations between neuropsychological test performance and acculturation variables were found on measures loading on processing speed and executive function. CONCLUSIONS Overall, only limited effects of acculturation were found on the European Cross-Cultural Neuropsychological Test Battery. However, administering cross-cultural measures in the preferred language may not be sufficient to resolve challenges in cross-cultural assessment of processing speed and executive function as concept of speed and speeded performance is highly culture dependent.
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Affiliation(s)
| | - T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
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24
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Nielsen TR. Effects of Illiteracy on the European Cross-Cultural Neuropsychological Test Battery (CNTB). Arch Clin Neuropsychol 2020; 34:713-720. [PMID: 30272111 DOI: 10.1093/arclin/acy076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/16/2018] [Accepted: 08/30/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Test performances of illiterate and literate immigrants were compared to investigate the effects of illiteracy on the European Cross-cultural Neuropsychological Test Battery (CNTB), and associations between test performance and participant characteristics were examined. METHOD Participants were 20 illiterate and 21 literate middle-aged and older Turkish immigrants (50-85 years) matched by age and gender that completed the CNTB as well as a number of demographic and medical questionnaires. RESULTS No significant group differences or correlations between education, acculturation or health characteristics and test performances were found on 10 of 16 measures. Illiteracy status and participant characteristics affected measures of mental processing speed, executive function, and visuoconstruction. CONCLUSIONS The preliminary findings suggest that several of the measures in the CNTB may be valid for assessment of cognitive functioning in people who are illiterate when applied using available normative data. However, these findings need to be replicated in larger samples.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
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25
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A Systematic Review of Neuropsychological Tests for the Assessment of Dementia in Non-Western, Low-Educated or Illiterate Populations. J Int Neuropsychol Soc 2020; 26:331-351. [PMID: 31511111 DOI: 10.1017/s1355617719000894] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neuropsychological tests are important instruments to determine a cognitive profile, giving insight into the etiology of dementia; however, these tests cannot readily be used in culturally diverse, low-educated populations, due to their dependence upon (Western) culture, education, and literacy. In this review we aim to give an overview of studies investigating domain-specific cognitive tests used to assess dementia in non-Western, low-educated populations. The second aim was to examine the quality of these studies and of the adaptations for culturally, linguistically, and educationally diverse populations. METHOD A systematic review was performed using six databases, without restrictions on the year or language of publication. RESULTS Forty-four studies were included, stemming mainly from Brazil, Hong Kong, Korea, and considering Hispanics/Latinos residing in the USA. Most studies focused on Alzheimer's disease (n = 17) or unspecified dementia (n = 16). Memory (n = 18) was studied most often, using 14 different tests. The traditional Western tests in the domains of attention (n = 8) and construction (n = 15), were unsuitable for low-educated patients. There was little variety in instruments measuring executive functioning (two tests, n = 13), and language (n = 12, of which 10 were naming tests). Many studies did not report a thorough adaptation procedure (n = 39) or blinding procedures (n = 29). CONCLUSIONS Various formats of memory tests seem suitable for low-educated, non-Western populations. Promising tasks in other cognitive domains are the Stick Design Test, Five Digit Test, and verbal fluency test. Further research is needed regarding cross-cultural instruments measuring executive functioning and language in low-educated people.
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Standardising Dementia Diagnosis Across Linguistic and Educational Diversity: Study Design of the Indian Council of Medical Research-Neurocognitive Tool Box (ICMR-NCTB). J Int Neuropsychol Soc 2020; 26:172-186. [PMID: 31826780 DOI: 10.1017/s1355617719001127] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES While the burden of dementia is increasing in low- and middle-income countries, there is a low rate of diagnosis and paucity of research in these regions. A major challenge to study dementia is the limited availability of standardised diagnostic tools for use in populations with linguistic and educational diversity. The objectives of the study were to develop a standardised and comprehensive neurocognitive test battery to diagnose dementia and mild cognitive impairment (MCI) due to varied etiologies, across different languages and educational levels in India, to facilitate research efforts in diverse settings. METHODS A multidisciplinary expert group formed by Indian Council of Medical Research (ICMR) collaborated towards adapting and validating a neurocognitive test battery, that is, the ICMR Neurocognitive Tool Box (ICMR-NCTB) in five Indian languages (Hindi, Bengali, Telugu, Kannada, and Malayalam), for illiterates and literates, to standardise diagnosis of dementia and MCI in India. RESULTS Following a review of existing international and national efforts at standardising dementia diagnosis, the ICMR-NCTB was developed and adapted to the Indian setting of sociolinguistic diversity. The battery consisted of tests of cognition, behaviour, and functional activities. A uniform protocol for diagnosis of normal cognition, MCI, and dementia due to neurodegenerative diseases and stroke was followed in six centres. A systematic plan for validating the ICMR-NCTB and establishing cut-off values in a diverse multicentric cohort was developed. CONCLUSIONS A key outcome was the development of a comprehensive diagnostic tool for diagnosis of dementia and MCI due to varied etiologies, in the diverse socio-demographic setting of India.
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Tan YW, Burgess GH, Green RJ. The effects of acculturation on neuropsychological test performance: A systematic literature review. Clin Neuropsychol 2020; 35:541-571. [DOI: 10.1080/13854046.2020.1714740] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Yi Wen Tan
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Gerald H. Burgess
- Salomons Institute for Applied Psychology Canterbury, Christ Church University, Canterbury, United Kingdom
| | - Robin J. Green
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
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Franzen S, van den Berg E, Kalkisim Y, van de Wiel L, Harkes M, van Bruchem-Visser RL, de Jong FJ, Jiskoot LC, Papma JM. Assessment of Visual Association Memory in Low-Educated, Non-Western Immigrants with the Modified Visual Association Test. Dement Geriatr Cogn Disord 2019; 47:345-354. [PMID: 31319408 PMCID: PMC6878732 DOI: 10.1159/000501151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neuropsychological tests are influenced by culture, language, level of education, and literacy, but there are few cognitive tests of which the applicability in ethnic minority populations has been studied. OBJECTIVES The aim of this study was to assess the reliability and validity of the Visual Association Test (VAT), a test of visual association memory, in a non-Western, low-educated memory clinic population. Additionally, a modified version of the VAT using colored photographs instead of line drawings was studied (mVAT). METHOD Both the original VAT and the mVAT were administered to non-Western immigrants (n = 73) from 2 multicultural memory clinics in Rotterdam, The Netherlands, and a control sample of non-demented Turkish elderly (n = 14) with low education levels (32 and 29% illiterate, respectively). RESULTS Both the VAT and the mVAT were able to discriminate persons with and without dementia (area under the curve: VAT, 0.77-0.88; mVAT, 0.85-0.95). The mVAT had more homogeneous item difficulty levels than the VAT. Administration of parallel versions of the VAT and the mVAT within the same person revealed higher scores on the mVAT (Z = -3.35, p = 0.001). CONCLUSIONS The mVAT is a reliable and valid measure of memory in non-Western immigrants. Clinicians and researchers should be aware that the memory performance of immigrants may be systematically underestimated when using tests with black-and-white line drawings, such as the original VAT.
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Affiliation(s)
- Sanne Franzen
- 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
| | - Yuled Kalkisim
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Department of Medical Psychology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Lotte van de Wiel
- Department of Medical Psychology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Marleen Harkes
- Department of Geriatric Medicine, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Frank Jan de Jong
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lize C. Jiskoot
- 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
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Dominguez JC, Phung TKT, de Guzman MFP, Fowler KC, Reandelar M, Natividad B, Waldemar G, Nielsen TR, Pamintuan Aquial MR, Holandez RL, Ligsay AD. Determining Filipino Normative Data for a Battery of Neuropsychological Tests: The Filipino Norming Project (FNP). Dement Geriatr Cogn Dis Extra 2019; 9:260-270. [PMID: 31572422 PMCID: PMC6751438 DOI: 10.1159/000500519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 01/12/2023] Open
Abstract
Background Filipino normative data for neuropsychological tests are lacking. Objectives This study aimed to determine the Filipino normative data for the Filipino Norming Project (FNP) Neuropsychological Battery, combining the Alzheimer's Disease Assessment Scale – Cognitive (ADAS-Cog) and the Neuropsychological Test Battery from the Uniform Dataset of Alzheimer's Disease Center (UDS-ADC). Methods We recruited participants 60 years and older with normal cognition (MMSE score of 25 and above and did not fulfill criteria for dementia according to DSM-IV criteria). Psychologists administered the tests to the study participants. We conducted multivariate analyses to study the effect of age, gender, and education on test performance. Results A total of 191 participants underwent the FNP Neuropsychological Test Battery. The mean age was 68.8 years (SD 5.4). The majority were female (84.1%). The mean score of ADAS-Cog was 9.98 (SD 4.74). The effect of education was prominent throughout the cognitive domains tested while the effect of age was limited to a few cognitive domains. The mean ADAS-Cog scores were 11.80 ± 4.40 for primary education, 9.93 ± 5.08 for secondary, and 8.15 ± 3.95 for tertiary. On average, women scored 2.75 points lower than men and performed better on the verbal components. Men performed better on the constructional praxis component. The same effect of education and gender was observed for the UDS-ADC. Conclusion For the first time, normative data are available for the ADAS-Cog and UDS-ADC for a Filipino older population. This study stresses the importance of establishing population-specific normative data, taking into account the specific sociocultural and linguistic context of that population.
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Affiliation(s)
| | - Thien Kieu Thi Phung
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Krizelle Cleo Fowler
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Macario Reandelar
- Research and Biotechnology Division, St. Luke's Medical Center, Quezon City, Philippines
| | - Boots Natividad
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Gunhild Waldemar
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Rune Nielsen
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Statucka M, Cohn M. Origins Matter: Culture Impacts Cognitive Testing in Parkinson's Disease. Front Hum Neurosci 2019; 13:269. [PMID: 31440150 PMCID: PMC6694800 DOI: 10.3389/fnhum.2019.00269] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022] Open
Abstract
Cognitive decline is common in Parkinson’s disease (PD), and precise cognitive assessment is important for diagnosis, prognosis, and treatment. To date, there are no studies in PD investigating cultural bias on neuropsychological tests. Clinical practice in multicultural societies such as, Toronto Canada where nearly half of the population is comprised of first generation immigrants, presents important challenges as most neuropsychological tools were developed in Anglosphere cultures (e.g., USA, UK) and normed in more homogeneous groups. We examine total scores and rates of deficits on tests of visuoperceptual/visuospatial, attention, memory, and executive functions in Canadians with PD born in Anglosphere countries (n = 248) vs. in Canadians with PD born in other regions (International group; n = 167). The International group shows lower scores and greater rates of deficits on all visuoperceptual and some executive function tasks, but not on attention or memory measures. These biases are not explained by demographic and clinical variables as groups were comparable. Age at immigration, years in Canada, and English proficiency also do not account for the observed biases. In contrast, group differences are strongly mediated by the Historical Index of Human Development of the participants’ country of birth, which reflects economic, health, and educational potential of a country at the time of birth. In sum, our findings demonstrate lasting biases on neuropsychological tests despite significant exposure to, and participation in, Canadian culture. These biases are most striking on visuoperceptual measures and non-verbal executive tasks which many clinicians still considered to be “culture-fair” despite the growing evidence from the field of cross-cultural neuropsychology to the contrary. Our findings also illustrate that socio-development context captures important aspects of culture that relate to cognition, and have important implications for clinical practice.
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Affiliation(s)
- Marta Statucka
- Krembil Brain Institute, Toronto Western Hospital UHN, Toronto, ON, Canada
| | - Melanie Cohn
- Krembil Brain Institute, Toronto Western Hospital UHN, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
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Nielsen TR, Antelius E, Waldemar G. Cognitive Advantages in Adult Turkish Bilingual Immigrants - a Question of the Chicken or the Egg. J Cross Cult Gerontol 2019; 34:115-129. [PMID: 31119462 DOI: 10.1007/s10823-019-09375-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A number of studies suggest both cognitive disadvantages and advantages of bilingualism. In the current study, it is attempted to provide an account of the cognitive advantages associated with bilingualism in a Turkish immigrant population in Denmark.The total sample consisted of 71 middle-aged and older adults born and raised in Turkey who had migrated to Denmark in their teenage years or later. All participants were assessed with a neuropsychological test battery and degree of Turkish-Danish bilingualism was estimated via rater assessment according to a three-point scale. Associations between bilingualism and cognitive function were established for five cognitive domains: executive function, memory, language, visuospatial function and speed. Analysis of covariance was used to estimate the independent association between bilingualism and cognitive function for each cognitive domain. Covariates included education, gender, ethnicity, and proportion of life lived in Denmark. In unadjusted analyses, greater degree of bilingualism was associated with better executive functioning (p < .001), visuospatial functioning (p = .002) and speed (p < .001). However, in analyses adjusted for covariates only executive functioning (p = .01) and task switching ability (p = .01) remained significant, while a trend for better memory function was found in those with a high degree of bilingualism (p = .07).The current study indicates that bilingual Turkish immigrants have better executive functioning and episodic memory compared to Turkish immigrant monolinguals. Whether this is due to the effects of bilingualism or reflects inherent cognitive abilities in those able to acquire bilingualism in later life remains to be resolved.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Center, Department of Neurology, Neuroscience Center, University of Copenhagen, Rigshospitalet, section 6922, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark.
| | - Eleonor Antelius
- Center for Dementia Research, Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Gunhild Waldemar
- Danish Dementia Research Center, Department of Neurology, Neuroscience Center, University of Copenhagen, Rigshospitalet, section 6922, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
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Nielsen TR, Segers K, Vanderaspoilden V, Beinhoff U, Minthon L, Pissiota A, Bekkhus-Wetterberg P, Bjørkløf GH, Tsolaki M, Gkioka M, Waldemar G. Validation of a European Cross-Cultural Neuropsychological Test Battery (CNTB) for evaluation of dementia. Int J Geriatr Psychiatry 2019; 34:144-152. [PMID: 30246268 DOI: 10.1002/gps.5002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 09/08/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aims of this study were to establish the diagnostic accuracy of the European Cross-Cultural Neuropsychological Test Battery (CNTB) for dementia in different ethnic populations in Western Europe, to examine its ability to differentiate cognitive impairment profiles for dementia subtypes, and to assess the impact of demographic variables on diagnostic properties. METHODS The study was a Western European cross-sectional multi-center study. A total of 66 patients with dementia and 118 cognitively intact participants were included across six memory clinics; 93 had ethnic minority background and 91 had ethnic majority background. Tests in the CNTB cover global cognitive function, memory, language, executive functions, and visuospatial functions. RESULTS Significant differences with moderate to large effect sizes were present between patients with dementia and control participants on all CNTB measures. Area under the curves (AUC) ranged from .62 to .99 with a mean AUC across all measures of .83. Comparison of ethnic minority and majority groups generally revealed higher sensitivity in the minority group but no significant difference in the mean AUC's across all measures (.84 vs78, P = .42). Comparison of impairment profiles for patients with Alzheimer's disease (AD) and non-AD dementia revealed that AD patients were significantly more impaired on the memory domain, whereas patients with non-AD dementia were more impaired on the executive functions domain. CONCLUSIONS The CNTB was found to have promising cross-cultural diagnostic properties for evaluation of dementia in the targeted minority and majority populations and could represent a valid cross-cultural alternative to other well-established neuropsychological test batteries when assessing patients from these populations.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Segers
- Department of Neurology, Brugmann University Hospital, Brussels, Belgium
| | | | - Ulrike Beinhoff
- Ambulantes Gesundheitszentrum der Charité GmbH, Berlin, Germany
| | - Lennart Minthon
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Anna Pissiota
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Peter Bekkhus-Wetterberg
- Memory Clinic, Oslo University Hospital Ullevål and Norwegian Center for Minority Health Research, Oslo University Hospital, Oslo, Norway
| | | | - Magda Tsolaki
- 1st Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mara Gkioka
- 1st Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gunhild Waldemar
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
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Nielsen TR, Segers K, Vanderaspoilden V, Bekkhus-Wetterberg P, Minthon L, Pissiota A, Bjørkløf GH, Beinhoff U, Tsolaki M, Gkioka M, Waldemar G. Performance of middle-aged and elderly European minority and majority populations on a Cross-Cultural Neuropsychological Test Battery (CNTB). Clin Neuropsychol 2018; 32:1411-1430. [DOI: 10.1080/13854046.2018.1430256] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T. Rune Nielsen
- Danish Dementia Research Center, Department of Neurology, The Neuroscience Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Kurt Segers
- Department of Neurology, Brugmann University Hospital, Brussels, Belgium
| | | | - Peter Bekkhus-Wetterberg
- Memory Clinic, Oslo University Hospital Ullevål, Oslo, Norway
- Norwegian Center for Minority Health Research, Oslo University Hospital, Oslo, Norway
| | - Lennart Minthon
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Anna Pissiota
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ulrike Beinhoff
- Ambulantes Gesundheitszentrum der Charité GmbH, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Magda Tsolaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mara Gkioka
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gunhild Waldemar
- Danish Dementia Research Center, Department of Neurology, The Neuroscience Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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McIntosh CJ, James AIW. The jungle book of neuropsychology: Disentangling the influence of feral childhood from adult brain injury in order to provide effective rehabilitation. Neuropsychol Rehabil 2017; 28:293-308. [DOI: 10.1080/09602011.2017.1408472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
| | - A. I. W. James
- NHS Leeds Community Neurological Rehabilitation Team, Leeds, UK
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Dementia prevalence, care arrangement, and access to care in Lebanon: A pilot study. Alzheimers Dement 2017; 13:1317-1326. [PMID: 28579315 DOI: 10.1016/j.jalz.2017.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 04/07/2017] [Accepted: 04/22/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In North Africa and the Middle East, studies about dementia prevalence are scarce. A pilot study was conducted in Lebanon to assess dementia prevalence, using the Arabic-validated 10/66 Dementia Research Group (DRG) diagnostic assessment for case ascertainment. The study also examined care arrangement and access to care. METHODS A random sample of 502 persons older than 65 years and their informant were recruited from Beirut and Mount Lebanon governorates through multistage cluster sampling. RESULTS The crude and age-standardized dementia prevalences were 7.4% and 9.0%, respectively. People with dementia were mainly cared for by relatives at home. Access to formal care was very limited. DISCUSSION Dementia prevalence in Lebanon ranks high within the global range of estimates. These first evidence-based data about disease burden and barriers to care serve to raise awareness and call for social and health care reform to tackle the dementia epidemic in Lebanon and in North Africa and the Middle East.
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Julayanont P, Ruthirago D. The illiterate brain and the neuropsychological assessment: From the past knowledge to the future new instruments. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 25:174-187. [PMID: 27841690 DOI: 10.1080/23279095.2016.1250211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The lifetime learning of illiterate and low-educated individuals shapes their cognitive skills, which are challenging to grade by the current available neuropsychological tools. Eight hundred million of the global population are illiterate. It is very challenging to interpret the cognitive performance of this population by the available formal neuropsychological tests, mainly developed for higher educated people. From extensive literature investigation, we reviewed the cognitive process and performance of illiterate and low-educated population on various cognitive domains including language, executive function, memory, visual-related function, and motor skills. We also suggested the concept in the development of the appropriate tools for the cognitive assessment among this population. Finally, we provide the available cognitive screening tools validated in the illiterate and low-educated subjects within the last three decades.
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Affiliation(s)
- Parunyou Julayanont
- a Department of Neurology , Texas Tech University Health Sciences Center , Lubbock , Texas , USA
| | - Doungporn Ruthirago
- a Department of Neurology , Texas Tech University Health Sciences Center , Lubbock , Texas , USA
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Chaaya M, Phung TKT, El Asmar K, Atweh S, Ghusn H, Khoury RM, Prince M, Nielsen TR, Waldemar G. Validation of the Arabic Rowland Universal Dementia Assessment Scale (A-RUDAS) in elderly with mild and moderate dementia. Aging Ment Health 2016; 20:880-7. [PMID: 25984584 DOI: 10.1080/13607863.2015.1043620] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Validated screening tests for dementia in Arabic are lacking. Given the low levels of education among elderly in the Middle East and North Africa region, the commonly used screening instrument, the Mini Mental State Examination, is not best suited. Alternatively, the Rowland Universal Dementia Assessment Scale (RUDAS) was especially designed to minimize the effects of cultural learning and education. The aim of this study was to validate the RUDAS in the Arabic language (A-RUDAS), evaluate its ability to screen for mild and moderate dementia, and assess the effect of education, sex, age, depression, and recruitment site on its performance. METHODS A-RUDAS was administered to 232 elderly aged ≥65 years recruited from the communities, community-based primary care clinics, and hospital-based specialist clinics. Of these, 136 had normal cognition, and 96 had dementia. Clinicians diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria. Interviewers, blind to the cognitive status of participants, administered A-RUDAS. The psychometric properties of A-RUDAS were examined for three cutoffs. RESULTS At the cutoff of ≤22, A-RUDAS exhibited good sensitivity (83%) and specificity (85%) with an area under the receiver operating characteristic curve of 83.95%. Adjusting for age, sex, education, depression, and recruitment site, A-RUDAS score demonstrated a high level of accuracy in screening for mild and moderate dementia against DSM-IV diagnosis. CONCLUSION The A-RUDAS is proposed for dementia screening in clinical practice and in research in Arabic-speaking populations with an optimal cutoff of ≤22.
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Affiliation(s)
- M Chaaya
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - T K T Phung
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
| | - K El Asmar
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - S Atweh
- c Department of Neurology , American University of Beirut Medical Center , Beirut , Lebanon
| | - H Ghusn
- d Department of Geriatrics , American University of Beirut Medical Center , Beirut , Lebanon
| | - R M Khoury
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - M Prince
- e Department of Health Service and Population Research , Institute of Psychiatry , King's College London , London , UK
| | - T R Nielsen
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
| | - G Waldemar
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
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Nielsen TR, Waldemar G. Effects of literacy on semantic verbal fluency in an immigrant population. AGING NEUROPSYCHOLOGY AND COGNITION 2016; 23:578-90. [DOI: 10.1080/13825585.2015.1132668] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- T. Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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