Exploring the reliability and acceptability of cognitive tests for Indigenous Australians: a pilot study

Kylie M. Dingwall,Jennifer F. Delima,Annette R. McCarthy,Stephen C. Bowden,Allison O. Gray

doi:10.1186/s40359-017-0195-y

Abstract

BackgroundReliable cognitive assessment for Indigenous Australians is difficult given that mainstream tests typically rely on Western concepts, content and values. A test’s psychometric properties should therefore be assessed prior to use in other cultures. The aim of this pilot study was to examine the reliability and acceptability of four cognitive tests for Australian Aboriginal people.MethodsParticipants were 40 male and 44 female (N = 84) Aboriginal patients from Alice Springs Hospital. Four tests were assessed for reliability and acceptability – Rowland Universal Dementia Assessment Screen (RUDAS) (n = 19), PEBL Corsi Blocks (Corsi) (n = 19), Story Memory Recall Test (SMRT) (n = 17) and a CogState battery (n = 18). Participants performed one to three of the tests with repeated assessment to determine test-retest reliability. Qualitative interviews were conducted and analysed based on an adapted phenomenological approach to explore test acceptability. An Indigenous Reference Group gave advice and guidance.ResultsIntra-class correlations (ICC) for test retest reliability ranged from r = 0.58 (CogState One Back accuracy) to 0.86 (RUDAS). Themes emerged relating to general impressions, impacts on understanding and performance, appropriateness, task preferences and suggested improvements.ConclusionsRUDAS, CogState Identification task, and SMRT showed the highest reliabilities. Overall the tests were viewed as a positive challenge and an opportunity to learn about the brain despite provoking some anxiety in the patients. Caveats for test acceptability included issues related to language, impacts of convalescence and cultural relevance.

Highlights

Reliable cognitive assessment for Indigenous Australians is difficult given that mainstream tests typically rely on Western concepts, content and values
Cognitive dysfunction may be prevalent among some Indigenous Australians due to the high rates of substance abuse, domestic violence, chronic illness, psychological stress or trauma, and malnutrition reported in this group [1]
Impairments in cognition including psychomotor, memory, attention, learning and executive functions have been reported for Indigenous Australians with chronic substance misuse [2, 3]

Summary

Introduction

Reliable cognitive assessment for Indigenous Australians is difficult given that mainstream tests typically rely on Western concepts, content and values. A test’s psychometric properties should be assessed prior to use in other cultures. The aim of this pilot study was to examine the reliability and acceptability of four cognitive tests for Australian Aboriginal people. Cognitive assessment enables the measurement of changes in brain function. In conditions such as WKS, repeated cognitive assessments may be required to monitor response to treatment and results can inform. It is important to examine these psychometric properties when using cognitive tests to monitor change to ensure clinical decisions or research conclusions are based on reliable data

Methods

Results

Conclusion