REVIEW AND ANALYSIS OF CROSS-CULTURAL NORMATIVE DATA FOR THE REPEATABLE BATTERY FOR THE ASSESSMENT OF NEUROPSYCHOLOGICAL STATUS (RBANS): IMPLICATIONS FOR MULTI-NATIONAL MCI CLINICAL TRIALS

Abstract

The National Institute on Aging (NIA) and Alzheimer's Association Workgroup criteria for the diagnosis of mild cognitive impairment (MCI) includes “objective evidence of impairment in one or more cognitive domains, typically memory” that is “worse than that expected for age and education” (Albert et al. 2011), but no specific test has been identified. For multi-national clinical trials that use memory tests as a screening method for MCI, this diagnostic criterion relies on normative data, the availability of which varies depending on language and country. The purpose of this research is to review and analyze published normative RBANS data globally to determine the extent to which norms across cultures are similar to US based norms and to discuss associated implications of the use of the RBANS for clinical trials in MCI. A PubMed search using search terms including “RBANS”, “normative data”, “cross-cultural”, and specific language terms (e.g., Spanish, Chinese, etc.) was conducted, including a review of publication reference sections to identify potentially relevant datasets. RBANS normative data for healthy elderly and MCI have been published in several countries, including several US English samples and samples from Spain, Singapore, Australia, Greece, Armenia, Hungary, and France. Sample sizes across studies ranged from small (e.g., 28) to large (e.g., 718) and reporting of demographic and clinical features varied, limiting direct comparisons across studies. Studies provided differing level of details regarding RBANS translations and despite available translations, normative data in MCI or AD do not appear to have been published for several countries. Descriptive and graphical analyses were compiled across samples, comparing raw and Index scores according to demographic variables (i.e., age, education), highlighting key similarities and differences across countries and languages. The diagnosis of MCI requires cognitive (typically memory) test performance worse than expected for age and education, but no gold standard cognitive test has emerged for application in multi-national clinical trials. Implications of the strengths and limitations of the existing RBANS research will be discussed, including the need for research on educational influences on cognitive tests cross-culturally and consistent data reporting conventions to facilitate direct comparisons across countries.