CROSSCULTURAL NEUROPSYCHOLOGICAL ASSESSMENT OF DEMENTIA: DIRECTIONS FOR TEST DEVELOPMENT

Abstract

Neuropsychological assessment plays an important role in the diagnostic work-up for dementia. Increasing evidence suggests that Western neuropsychological measures are inappropriate for culturally and linguistically diverse populations, due to multiple obstacles: language barriers, cultural differences such as inexperience with timed tests, insufficient normative data and the use of culture-specific stimuli. Considering the rising numbers of non-Western elderly immigrants with dementia in the Netherlands, there is an urgent need for appropriate cross-cultural neuropsychological measures. The aim of the current study was to assess which test characteristics were suitable for a population of non-Western immigrants. 49 Moroccan, Turkish and Cape Verdean patients with diverse cognitive complaints visited the multicultural memory clinic of the Alzheimer Center Rotterdam, The Netherlands. 35% of the patients were illiterate; 71% did not complete primary education. An adapted test protocol including the Cross Cultural Dementia screening test (CCD‡) was used, as well as Dutch neuropsychological tests that are considered cross-culturally applicable. A medical interpreter translated the test instructions. Nearly all patients could complete the recognition memory task of the CCD, a test that is not timed and contains culture-sensitive photographs. 24% of patients were unable to finish the CCD's timed task involving dot counting (similar to TMT A); 60% of all patients were unable to complete the combined counting/switching task. Most of the other cognitive tests required too many scholastic skills and abstract reasoning (e.g. figure copy, digit span, BADS key search test) and were therefore not even attempted with many patients. Qualitative analysis of the results revealed difficulties in recognizing line drawings (e.g. visual-associative memory), drawing linear designs and processing depth cues. Similarly, tests relying heavily on verbal responses and vocabulary (such as naming tasks, verbal memory, orientation questions) often were not administered. In the memory clinic, neuropsychological assessments requiring basic scholastic skills, involving line drawings and relying heavily on language/vocabulary are unfit for use in linguistically and culturally diverse populations. Adapting stimuli to include life-like material (e.g. photographs) might be promising. Our future research will focus on the development of cross-cultural tests measuring all cognitive domains. ‡ Goudsmit et al. 2016 J Clin Exp Neuropsychol.