A scoping review of neuropsychological assessment for Asian Indians in the United States - research and clinical recommendations

Objective: There is an increasing focus on understanding health disparities among various cultural groups in the United States. The need for heterogeneity in norms and test stimuli across ethnically diverse individuals are being increasingly recognized. However, to date it remains unknown whether and to what extent differences in cognitive norms and tests exist in Asian Indians, a fast-growing population in the U.S. It is essential to understand these differences to improve diagnostic accuracy and provide timely and appropriate clinical care. Method: In this study, we conducted a scoping review of available cognitive tests that were normed, developed, or adapted for Asian Indians living in the U.S. Results: The results suggested a paucity of norms and tests specifically examining cognition in this community. Conclusions: Based on the findings, we provide suggestions for research directions focusing on the development of culturally sensitive neuropsychological tools, normative data representative of this demographic, and interventions addressing healthcare access barriers. Overall, this review provides readers with relevant clinical information to immediately enhance patient care as well as provide actionable items in research to improve the future utility of neuropsychology for Asian Indians in the United States.

B - 35 An Application of the ECLECTIC Framework to Neuropsychological Evaluation of a Korean-Speaking Older Adult with End-Stage Renal Disease (ESRD): a Case Study

OBJECTIVE

The ECLECTIC framework (Fujii, 2018) provides a comprehensive and systematic approach to addressing ethnic diversity in neuropsychological assessment, moving beyond a focus only on test and normative group. It presents a unique opportunity to gain cultural insight, establish rapport and trust, integrate contextual factors, and tailor recommendations. We present a case that illustrates the application of this framework to the neuropsychological evaluation of a first-generation Korean American, bilingual man in his mid-60s.

METHODS

The patient emigrated to the United States from South Korea in his 30s. He was referred for neuropsychological evaluation for cognitive problems after ESRD diagnosis. Consistent with ECLECTIC framework, hypothesis-testing and qualitative analysis were conducted to create cultural and linguistic equivalence. Informant reports were collected and incorporated. Linguistic competency was established, and a Korean interpreter was used. The flexible battery included Korean- and English-translated measures.

RESULTS

Cognitive performance was normed against peer groups with similar demographics (age, gender, academic level), and interpreted within cultural contextual factors (education quality, highest occupation, immigration context, linguistic competence, informant report). Results indicated significant memory impairment with relatively preserved language and visuospatial skills. He endorsed severe depression.

CONCLUSIONS

Recognizing the impact of cultural biases on the assessment of Korean-speaking individuals with medical comorbidities, we found the ECLECTIC framework to be a valuable tool in supporting careful consideration of cultural and contextual factors in the absence of a cultural broker or Korean-speaking neuropsychologist. Overall, the ECLECTIC model offers an example for clinicians and trainees to employ a culturally responsive framework for ethnically diverse patients.

B - 36 Indian Educational System and Neuropsychological Evaluation among Indian Americans: a Review with Clinical and Cultural Considerations

OBJECTIVE

India's educational system is highly complex and intricate. Individuals who emigrate to the United States from India, commonly referred to as Indian Americans, demonstrate a wide range of educational backgrounds. Nonetheless, little is known about the impact of their education on cognition. This study sought to investigate the association between education and cognition among Indian Americans who moved to the United States subsequent to obtaining minimum high school education in India.

METHOD

A literature review was undertaken to determine the extent and the nature of the relationship between education and cognitive performance in Indian Americans.

RESULTS

No studies were identified that systematically examined the links between educational attainment and cognitive performance among Indian Americans. Previous research conducted in India found that higher educational attainment was associated with better cognitive performance in the domains of attention, memory, language, and executive functioning. However, other studies report gender and regional differences as variables influencing association between education and cognitive performance.

CONCLUSION

The study provides clinicians with a deeper understanding of the nuanced and multifaceted nature of educational experiences among Indian Americans. Variability in education stemming from a multitude of factors including language of instruction in the school vs. language/s spoken at home, school's funding, location of the school, school curriculum (public vs. private schools), and societal attitudes towards gender and literacy can impact cognitive performance. These aspects need to be clearly parsed out for accurate selection of the test battery and interpretation of the test performance.