Challenges for neuropsychology in the global context

Abstract

Globally, the demand for culturally appropriate and equitable neuropsychological services is greater than ever before. However, providing culturally competent neuropsychological services is challenging. This chapter provides an understanding of the complex set of interlinked and interdependent challenges that contributes to inequalities in neuropsychological assessment. These challenges are relevant to the ethnic minorities, international migrants, and indigenous groups in countries with well-established neuropsychological services, and also to the national majority and minority groups in countries where neuropsychology is less established. Inequalities in access to neuropsychological services are the first challenge. Second, several socio-cultural and contextual factors relating to clinicians and patients may bias assessment outcomes. Finally, the large majority of neuropsychological tests and norms lack clinical utility for culturally, linguistically, and educationally diverse populations. The available indigenous and locally developed tools have not yet filled the gap. Deviation from standard administration procedures in cross-cultural situations further poses a threat to valid assessment. Failure to address these challenges increases the risk of under- and over-diagnosis, undertreatment and misdiagnosis of cognitive impairment in patients from diverse populations.