Abstract
BackgroundA lack of culturally appropriate tests hampers accurate assessment of cognition in remote Australian Aboriginal communities. In Arnhem Land, this study employed a community consultation process to evaluate commonly used Western tests of executive function, memory, attention, and visuospatial function.MethodsAn initial consultation process and a follow-up pilot study resulted in the rejection of some common tests, the development of new tests, and culturally adapted versions of others. In the subsequent 30-person main trial, adult Aboriginal volunteers were examined on nine tests, plus the Kimberly Indigenous Cognitive Assessment screen, and a brief literacy test.ResultsExecutive function, memory, and attention tests were found to group separately after an exploratory principal components analysis. Correlations between new tests and similar Kimberly screen items were not significant, but ceiling effects may be relevant. Six of 13 test scores were found to correlate with the literacy measure.ConclusionsA selection of cognitive tests were identified that Aboriginal people found culturally acceptable and engaging. In particular, Self-Ordered Pointing, Trail-Making, a verbal-switching task, and a new test “Which car?” show promise for further development. This work may contribute to the need for culturally appropriate cognitive testing in Aboriginal communities.
Highlights
A lack of culturally appropriate tests hampers accurate assessment of cognition in remote Australian Aboriginal communities
We examined the extent to which the scores from each test correlated with scores from the Kimberly Indigenous Cognitive Assessment (KICA) that related to the same function
KICA-General scores were excluded from all analyses as only one person made one error, a considerable ceiling effect
Summary
A lack of culturally appropriate tests hampers accurate assessment of cognition in remote Australian Aboriginal communities. Effective assessment should integrate information from a range of sources including informant-reports and contextual information [1] This is especially the case when working with Aboriginal populations [2, 3]. In remote parts of Northern Australia, Aboriginal people may be disproportionally exposed to factors impacting brain function, such as traumatic brain injuries, substance abuse, and gestational complications [4]. Compounding these challenges is the difficulty of diagnosing impairment in these populations due to a lack of suitable tools [5]; a situation requiring attention
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