Differential Item Functioning Research Articles

Psychometric evaluation of the extended inclusion of nature in self scale in Chinese adults through the Rasch analysis

Abstract How humans connect with nature impacts the well‐being of both people and ecosystems. Being disconnected from nature can lead to attitudes and behaviours that ultimately damage our physical and mental health and cause irreparable harm to the planet. To measure the human‐nature connection, measurements with good psychometric properties are warranted. By synthesizing the existing instruments, we suggested the distinctive advantages of the Extended Inclusion of Nature in Self scale (EINS), such as using multiple graphical spatial metaphors. Based on the back‐translation method, we translated the EINS into a Chinese version (EINS‐C). Then, using the Rasch model and the classical test theory, we elaborately examined the psychometric properties of the scale with a sample of 786 Chinese adults. Exploratory factor analysis, principal components analysis of Rasch residuals, and confirmative factor analysis together provided robust evidence for the one‐factor structure of the EINS‐C. Category probability curves showed the satisfying functioning of the rating scale. The scale further exhibited high criterion validity, convergent validity, internal consistency and test–retest reliability. The Rasch model fit statistics were also substantial for items. Each item presented a moderate difficulty, suggesting high discrimination power for levels of self‐nature connection. Scores on the scale could be meaningfully compared across genders, as no substantial differential item functioning was found. The EINS‐C consequently demonstrated generally robust psychometric properties, which could be applied to the Chinese‐speaking community, approximately 16 per cent of the world's population. This high‐quality and convenient tool for evaluating and monitoring the relationship between humans and nature lays a foundation for and might facilitate conservation‐related research and policy formulation. Read the free Plain Language Summary for this article on the Journal blog.

Using Exact Tests from Algebraic Statistics in Sparse Multi-Way Analyses: An Application to Analyzing Differential Item Functioning

Asymptotic goodness-of-fit methods in contingency table analysis can struggle with sparse data, especially in multi-way tables where it can be infeasible to meet sample size requirements for a robust application of distributional assumptions. However, algebraic statistics provides exact alternatives to these classical asymptotic methods that remain viable even with sparse data. We apply these methods to a context in psychometrics and education research that leads naturally to multi-way contingency tables: the analysis of differential item functioning (DIF). We explain concretely how to apply the exact methods of algebraic statistics to DIF analysis using the R package algstat, and we compare their performance to that of classical asymptotic methods.

Development and validation of the 5-Dimension Comprehensive Assessment Scale (5DCAS) for assessing physical function and health in axial spondyloarthritis.

To describe the development and validation of a novel patient reported scale, which is a comprehensive assessment of the physical function and health specific for patients with axial spondyloarthritis (axSpA). This is a multiphase, mixed methods study. Based on opinion collection and discussions of multidisciplinary consensus meetings and patients, an initial item pool covering all of the ranges of functioning was generated. The item optimization, model fit, response category functioning, differential item functioning, reliability, structure validity, and unidimensionality were tested by confirmatory factor analysis and Rasch measurement theory framework. After the consensus meeting and the two rounds of surveys in patients with axSpA, the initial pool of 135 items was reduced to 25 items formed in five dimensions, which exhibited preferable item reliability, item fit, and person fit to the Rasch model. The Five-Dimensional Comprehensive Assessment Scale (5DCAS) had the best reliability and validity (Kaiser-Meyer-Olkin was 0.919, and the standardized Cronbach's α coefficient was 0.932). The final version of 5DCAS had good unidimensionality, and the Person Separation Index ranged from 0.77 to 0.85. 5DCAS significantly correlated with ASAS-HI, SF-36, BASFI, and disease activity with p values of < 0.001. 5DCAS is a novel patient-reported outcome specific to axSpA, and it forms five dimensions providing a linear sum score of 25 items. 5DCAS comprehensively and significantly represents the physical function and health status of patients with axSpA, although its performance needs further validation in future clinical practices. Key Points • The primary goal in the management of axial spondyloarthritis is to maximize health-related quality of life. Except for the current instruments of ASAS-HI, BASFI, or SF-36, the heterogeneous clinical symptoms and rapid updated treat-to-target concept require a new instrument which can comprehensive and significant evaluate the changes of physical function and health-related quality of life due to disease. • 5DCAS is a novel patient-reported outcome specific to axSpA, and it forms five dimensions providing a linear sum score of 25 items, which contained aspect of pain involvement, spine mobility, global body performance and activity, social participation and environment, and mental health. All of the items were set to a 4-point semantic rating scale measuring severity, frequency, or interference from score 0 to 3. Total 5DCAS score ranges from 0 to 75; higher scores represented greater symptom burden and worse physical function. • 5DCAS is a comprehensive, multidisciplinary, and convenient disease outcome measurement specific for axSpA. It provides a new evaluation instrument in clinical trial and treat-to-target clinical remission for patients and physicians, and also provides a sensitive and accurate assessment standard for optimized health benefits.

Bias and Linking Error in Fixed Item Parameter Calibration

The two-parameter logistic (2PL) item response theory (IRT) model is frequently applied to analyze group differences for multivariate binary random variables. The item parameters in the 2PL model are frequently fixed when estimating the mean and the standard deviation for a group of interest. This method is also called fixed item parameter calibration (FIPC). In this article, the bias and the linking error of the FIPC approach are analytically derived in the presence of random uniform differential item functioning (DIF). The adequacy of the analytical findings was validated in a simulation study. It turned out that the extent of the bias and the variance in distribution parameters increases with increasing variance of random DIF effects.

Effect of Differential Item Functioning on Computer Adaptive Testing Under Different Conditions.

This study provides an overview of the effect of differential item functioning (DIF) on measurement precision, test information function (TIF), and test effectiveness in computer adaptive tests (CATs). Simulated data for the study was produced and analyzed with the Rstudio. During the data generation process, item pool size, DIF type, DIF percentage, item selection method for CAT, and the test termination rules were considered changed conditions. Sample size and ability parameter distribution, Item Response Theory (IRT) model, DIF size, ability estimation method, test starting rule, and item usage frequency method regarding CAT conditions were considered fixed conditions. To examine the effect of DIF, measurement precision, TIF and test effectiveness were calculated. Results show DIF has negative effects on measurement precision, TIF, and test effectiveness. In particular, statistically significant effects of the percentage DIF items and DIF type are observed on measurement precision.

Differential item functioning in the autism behavior checklist in children with autism spectrum disorder based on a machine learning approach.

Our study utilized the Rasch analysis to examine the psychometric properties of the Autism Behavior Checklist (ABC) in children with autism spectrum disorder (ASD). A total of 3,319 children (44.77 ± 23.52 months) were included. The Rasch model (RM) was utilized to test the reliability and validity of the ABC. The GPCMlasso model was used to test the differential item functioning (DIF). The response pattern of this sample showed acceptable fitness to the RM. The analysis supported the unidimensionality assumption of the ABC. Disordered category functions and DIF were found in all items in the ABC. The participants responded to the ABC items differently depending not only on autistic traits but also on age groups, gender, and symptom classifications. The Rasch analysis produces reliable evidence to support that the ABC can precisely depict clinical ASD symptoms. Differences in population characteristics may cause unnecessary assessment bias and lead to overestimated or underestimated symptom severity. Hence, special consideration for population characteristics is needed in making an ASD diagnosis.

The Effectiveness of Mantel Haenszel Log Odds Ratio Method in Detecting Differential Item Functioning Across Different Sample Sizes and Test Lengths Using Real Data Analysis

Objectives: This study aims to determine the effectiveness of the Mantel Haenszel Log Odds Ratio method in detecting Differential Item Functioning (DIF) across gender, while considering variations in sample size and test length. Utilizing real data, the study draws from a sample of tenth-grade students in Jordan who participated in the 2018 PISA International Mathematics Test. Methods: The study employs the experimental methodology, utilizing three levels of sample size and test length: (342, 200, and 100) and (30, 20, and 10), respectively. Nine iterations of the DDFS program were conducted to collect the results, representing nine scenarios resulting from the intersection of sample size and test length levels. Results: The study indicates that variations in sample size and test length significantly affect the Mantel-Hanzel (MH) method. Specifically, it observes an improvement in the MH method’s ability to detect DIF items with larger sample sizes, while maintaining a consistent test length. Conversely, the method’s efficacy declines with longer test lengths, despite maintaining a fixed sample size at a specific level. Conclusion: The study recommends using a large sample size and a short test length for effective detection of DIF items using the MH method.

Rasch Analysis of the Chinese Version of the Nociception Coma Scale-Revised in Patients with Prolonged Disorders of Consciousness.

The aim of this study was to analyze the Chinese version of the Nociception Coma Scale-Revised in patients with prolonged disorders of consciousness within the framework of Rasch modeling, including investigating the invariance of total scores across different etiologies of disorders of consciousness. Prospective psychometric study. Patients with prolonged disorders of consciousness from the Rehabilitation and Neurology units in hospital. None. The Nociception Coma Scale-Revised was undertaken by trained raters and the Coma Recovery Scale-Revised was used to assess patients' consciousness. The psychometric properties within the Rasch model including item-person targeting, reliability and separation, item fit, unidimensionality, and differential item functioning were assessed. 84 patients with prolonged disorders of consciousness (mean age 53 years; mean injury 5 months; 42 with Minimally Conscious State and 42 with Unresponsive Wakefulness Syndrome) of 252 observations were enrolled in the study. Through the procedure of repeated assessment and differential item function, a lower item bias Rasch set was purified. The Rasch model assumptions were examined and met, with item reliability and validity meeting the recommended threshold. The Chinese version of the Nociception Coma Scale-Revised demonstrated unidimensionality, good reliability and separation, and good item fit, but dissatisfied person fit and item-person targeting. The verbal subscale showed a notable discrepancy between person responses and the difficulty of the items, suggesting limited clinical significance.

Investigating differential item functioning among borderline personality disorder diagnostic criteria and internalizing/externalizing domains based on sexual orientation.

Borderline personality disorder (BPD) is more frequently diagnosed among sexual minority (SM) populations. SM populations also report higher levels of internalizing and externalizing psychopathology, two core domains of clinical problems that are highly comorbid with BPD. Contextual factors (e.g., group-specific norms) might affect endorsement of BPD items for reasons other than an underlying liability to experience BPD or internalizing and externalizing psychopathology. Therefore, BPD items may be "easier" to endorse (i.e., be associated with lower indicator thresholds) for SM populations relative to non-SM populations. We tested this hypothesis in a large, nationally representative sample of the U.S. population (N = 35,723, SM n = 1,150) using an item response theory approach. Several BPD indicators demonstrated differential item functioning of indicator thresholds, though these results varied based on impairment and sex. Endorsement of impulsive sex and chronic suicidality were consistently associated with lower indicator thresholds among SM groups; lower BPD, internalizing and externalizing factor levels were necessary for item endorsement for SM individuals. Chronic suicidality and impulsivity criteria may conflate BPD-related variance with SM-specific factors, such as potentially nonpathological SM group norms and minority stress processes. Implications for equitable diagnosis and future research on the BPD syndrome in SM populations are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessing the Psychometric Properties of Quality Experience in Undergraduate Research Using Item Response Theory

Undergraduate research, recognized as one of the High-Impact Practices (HIPs), has demonstrated a positive association with diverse student learning outcomes. Understanding the pivotal quality factors essential for its efficacy is important for enhancing student success. This study evaluates the psychometric properties of survey items employed to gauge the quality of undergraduate research, including alignment with Kuh and O’Donnell’s (2013) eight HIP characteristics, alongside assessments of reliability, validity, and generalizability across demographic groups. The study assesses the validity and reliability of these measures at both the scale and item levels using data from the National Survey of Student Engagement’s (NSSE) HIP Quality Topical Module. The methodological approaches employed include Exploratory Factor Analysis, Parallel Analysis, Item Response Theory, and Differential Item Functioning (DIF). Our findings uncover a misalignment between NSSE’s HIP Quality module items and HIP characteristics, leading to the identification of seven subscales instead of eight. Nevertheless, four subscales—Reflective and Integrative Learning, Real-World Applications, Interactions with Others, and High-Performance Expectations—emerge as valid indicators of undergraduate research experiences. While specific items yield valuable insights at the item level, refinement is recommended for others. Despite the identification of two items exhibiting DIF, their negligible effect sizes suggest that major revisions are unwarranted solely on DIF grounds. This study offers recommendations for item refinement, including the incorporation of new items, wording updates, and tailored utilization of assessment tools within educational institutions. These recommendations are intended to empower educators and researchers to effectively capture the quality dimensions of students’ undergraduate research experiences, thereby fostering their academic success.

Screening for depression in patients with epilepsy: same questions but different meaning to different patients.

Patient-reported outcome measures (PROMs) such as the Neurological Disorders Depression Inventory in Epilepsy (NDDI-E), a 6-item epilepsy-specific PROM, is used to screen for major depressive disorder symptoms for patients with epilepsy (PWE). The validity and interpretation of PROMs can be affected by differential item functioning (DIF), which occurs when subgroups of patients with the same underlying health status respond to and interpret questions about their health status differently. This study aims to determine whether NDDI-E items exhibit DIF and to identify subgroups of PWE that exhibit DIF in NDDI-E items. Data were from the Calgary Comprehensive Epilepsy Program database, a clinical registry of adult PWE in Calgary, Canada. A tree-based partial credit model based on recursive partitioning (PCTree) was used to identify subgroups that exhibit DIF on NDDI-E items using patients' characteristics as covariates. Differences in the identified subgroups were characterized using multinomial logistic regression. Of the 1,576 patients in this cohort, 806 (51.1%) were female, and the median age was 38.0 years. PCTree identified four patient subgroups defined by employment status, age, and sex. Subgroup 1 were unemployed patients ≤ 26 years old, subgroup 2 were unemployed patients > 26 years, subgroup 3 were employed females, while subgroup 4 were employed male patients. The subgroups exhibited significant differences on education level, comorbidity index scores, marital status, type of epilepsy, and driving status. PWE differed in their interpretation and responses to questions about their depression symptoms, and these differences were a function of sociodemographic and clinical characteristics.

Measurement invariance and differential item functioning of the functionality appreciation scale (FAS) in Colombia and Spain

The Functionality Appreciation Scale (FAS) is increasingly used in diverse national and linguistic contexts. However, limited work has assessed the extent to which the instrument demonstrates measurement invariance and differential item functioning (DIF) across nations and respondent characteristics. Here, we examined measurement invariance and DIF of the FAS using archival data from adults in Colombia (Mebarak et al., 2023) and Spain (Zamora et al., 2024). Participants included 1420 (women n = 804, men n = 616) respondents from Colombia and 838 (women n = 415, men n = 423) respondents from Spain who completed translations of the FAS. Confirmatory factor analysis supported a unidimensional structure of the FAS in both national groups. Additionally, the FAS achieved full measurement invariance (up to latent mean invariance) across both groups. We also found that the FAS lacked DIF as a function of age, body mass index (BMI), and gender identity across both national groups. Older participants (relative to younger participants), men (relative to women), and participants with lower BMIs (relative to those with higher BMIs) had higher FAS scores. These results support the notion that the FAS is measuring a common underlying construct across these national groups and respondent characteristics.

Generalisability of the Barthel Index and the Functional Independence Measure: robustness of disability measures to Differential Item Functioning

Purpose Differential Item Functioning (DIF), an item malfunctioning, causes Differential Test Functioning (DTF), thus biasing questionnaire measures. The current study evaluates the relationship between DIF and DTF for the Barthel Index and the Functional Independence Measure, likely the most used disability measures. The aim is to understand under which conditions DIF can be ignored as its DTF is negligible. Methods A simulation study was run. Disability measures were obtained for the Barthel Index and FIM motor domain using Rasch analysis with previously published item calibrations. Several DIF scenarios have been assessed. DTF was tolerable if ≤0.50 logits. Results Simulations showed that the larger the DIF, the larger the DTF and that, keeping the overall DIF constant, the total number of items with DIF does not affect DTF. DIF of the items with the lowest or highest calibrations is the most dangerous. The DIF of central items should be so massive to matter in DTF terms that it is unlikely to happen in practice. The FIM robustness to DIF is better than that of the Barthel Index. Conclusions The FIM and the Barthel Index show remarkable robustness to DIF. Thanks to this feature, sample invariant, generalisable disability measures are available.

Uncovering measurement bias: Differential item functioning by income in the Couples Satisfaction Index.

Relationship satisfaction is among the most popular constructs in family science. As the study of families and romantic couples continues to include more diverse samples, it is imperative to ensure the measures scholars use do not significantly vary in psychometric quality across groups. The goal of this study was to examine the psychometric utility of the four-item Couples Satisfaction Index (CSI-4; Funk & Rogge, 2007) for individuals across the income spectrum. This study uses data from the National Couples' Health and Time Study, which sampled married and cohabiting adults in the United States from late 2020 to early 2021. Differential item functioning in the CSI-4 was assessed based on income (N = 3,497) using item response theory. For individuals experiencing lower incomes, the CSI-4 demonstrated differential functioning compared to their more affluent peers, with a bias against individuals experiencing lower incomes equating to average scores 1.38 units lower than higher income participants on the CSI-4 despite having the same true levels of relationship satisfaction. Differential item functioning was less pronounced when comparing item performance of lower- and middle-income participants, equating to lower income participants scoring .21 units lower than middle-income individuals despite having the same true levels of relationship satisfaction. While advancing diversity in family science, researchers should employ psychometric methods to understand how measures perform across groups, which will help prevent the misinterpretation of statistical bias as real group differences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reexamining gender differences and the transdiagnostic boundaries of various conceptualizations of perseverative cognition.

Research examining gender differences in perseverative cognition (repetitive, negative, and difficult-to-control thoughts) has focused on depressive rumination and internalizing syndromes. This study examines the transdiagnostic role of depressive rumination, anger rumination, and repetitive negative thinking across gender on internalizing and externalizing symptoms. Utilizing an ethnoracially diverse sample (33% Black, 35% Latinx, 32% White non-Hispanic) of n = 1,187 young adults (49.5% women), we found equivalent instrument functioning across gender for depressive rumination (specifically brooding), anger rumination, and internalizing problems. Differential item functioning was found for repetitive negative thinking and externalizing problems; partial metric and scalar invariance were established for repetitive negative thinking, and partial metric invariance was established for externalizing problems. After accounting for bias in measurement, women engaged in more perseverative cognition, though effects were small for brooding and anger rumination and large for repetitive negative thinking. Different types of perseverations were positively associated with internalizing and externalizing symptoms across gender. Perseverative cognition may be a transdiagnostic mechanism beyond internalizing problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Linguistic and cultural validation of symptom questionnaire for visual dysfunctions (SQVD) for psychometric analysis in the Chinese context.

The Spanish scale symptom questionnaire for visual dysfunctions (SQVD) was sinicized and tested for reliability and validity in the Chinese context, employing both classical measurement theory and item response theory. A meticulous translation was conducted using the modified Brislin translation model, with input from experts for cross-cultural debugging and in-depth review. Following a pre-survey study, the Chinese version of the SQVD was finalized. A convenience sampling method was used to select 270 patients from the target group and 252 valid questionnaires were successfully collected. The Rasch model was employed to assess response category functionality, fit statistics, unidimensionality, person and item reliability, separation, targeting, and differential item functioning. Classical test theory was applied to evaluate internal consistency and retest reliability, supplemented by correlation analysis. Job characteristic curves were also plotted to assess diagnostic accuracy. The Chinese SQVD conformed to a unidimensional structure with excellent reliability and validity. Person and item reliabilities were 0.85 and 0.99, respectively, indicating, high stability. Person and item separation indices were 2.37 and 11.54, respectively, signifying strong differentiation ability. Retest reliability was 0.917, further emphasizing the stability of the scale. The area under the receiver operating characteristic curve was 0.908 (95% CI: 0.854, 0.962), with a cutoff value of 7.5 and Youden index of 0.733, highlighting the scale's high diagnostic accuracy. The translated and culturally adapted Chinese SQVD demonstrated excellent psychometric properties. With streamlined items, short assessment time, and high efficiency, the scale is a stable and reliable clinical tool for detecting a variety of conditions related to refractive, regulatory, and binocular vision dysfunction.

Myths about suicide - validating the Hungarian version of the Literacy of Suicide Scale (H-LOSS) on a community sample

BackgroundSuicide was exceptionally high in Hungary in the last century. According to Eurostat, Hungary ranks second in the EU in death by suicide and was among the few countries where the suicidal tendencies increased in 2020. Primary tasks of suicide prevention programs are to develop suicide literacy and dispel myths and misconceptions about suicide. Therefore, the goal of our research was the Hungarian validation of the 26-item Literacy of Suicide Scale (LOSS). Methods: 749 people (382 female (51.0%), 364 male (48.6%), 3 identify as non-binary or other (0.4%); 4 identifying as transgender (0.5%)) participated in our online cross-sectional survey with a mean age of 32.4 years (SD = 14.5 years). The H-LOSS questionnaire was adapted using the 2PL (two-parameter logistic) model with WLSE (weighted least squares) estimation in item response theory method, similarly to the original English version.ResultsScale unidimensionality was confirmed. Model fit indices and internal reliability indicators were acceptable. Item infit and outfit values were adequate, item discrimination values were within range, but one item had extremely high and three items had extremely low item difficulty parameters. Few items had differential item functioning by age, gender and own suidice attempt.ConclusionsThe H-LOSS scale deemed to be appropriate for assessing suicide literacy in Hungarian speaking samples.

Examining measures of schizotypy for gender and racial bias using item response theory and differential item functioning

Schizotypy involves schizophrenia-like traits and symptoms, with the Wisconsin Schizotypy Scales (WSS) being frequently used in previous research. There is some evidence that schizophrenia-spectrum symptom levels, including when using the WSS, might vary both by gender and by race and ethnicity. However, previous research has rarely examined to what extent the WSS show gender and racial bias. Further, this has not been previously examined for the Cognitive Slippage Scale, a measure of disorganized schizotypy. In this study, we examined biases for a subset of items from the WSS in a large sample of undergraduate students (n = 21,829). Using item response theory to test for levels of differential item functioning (DIF), we found some evidence of problematic DIF for all scales, including for negative, positive, and disorganized schizotypy scales. There was evidence of problematic DIF especially by gender and for Black and Multiracial participants. Overall, the current results suggest that gender and/or racial bias on these scales should be an important consideration in using these scales and our results could have implications for assessment of schizophrenia-spectrum symptoms.

Improving outcome measures in late onset Pompe disease: Modified Rasch-Built Pompe-Specific Activity scale.

The Rasch-Built Pompe-Specific Activity (R-PAct) scale is a patient-reported outcome measure specifically designed to quantify the effects of Pompe disease on daily life activities, developed for use in Dutch- and English-speaking countries. This study aimed to validate the R-PAct for use in other countries. Four other language versions (German, French, Italian, and Spanish) of the R-PAct were created and distributed among Pompe patients (≥16 years old) in Germany, France, Spain, Italy, and Switzerland and pooled with data of newly diagnosed patients from Australia, Belgium, Canada, the Netherlands, New Zealand, the USA, and the UK and the original validation cohort (n = 186). The psychometric properties of the scale were assessed by exploratory factor analysis and Rasch analysis. Data for 520 patients were eligible for analysis. Exploratory factor analysis suggested that the items separated into two domains: Activities of Daily Living and Mobility. Both domains independently displayed adequate Rasch model measurement properties, following the removal of one item ("Are you able to practice a sport?") from the Mobility domain, and can be added together to form a "higher order" factor as well. Differential item functioning (DIF)-by-language assessment indicated DIF for several items; however, the impact of accounting for DIF was negligible. We recalibrated the nomogram (raw score interval-level transformation) for the updated 17-item R-PAct scale. The minimal detectable change value was 13.85 for the overall R-PAct. After removing one item, the modified-R-PAct scale is a valid disease-specific patient-reported outcome measure for patients with Pompe disease across multiple countries.

An interplay between cross-cultural and psychometric factors in the Montreal Cognitive Assessment: Experience from the language of a small nation

The present study aimed to test the hypothesis that the total word length on the Memory subtest of the Czech version of the MoCA, which is 12 syllables compared to the English version of 7 syllables, would have a significant effect on Delayed Recall scores compared to the newly created well-balanced version of the test (further MoCA-WLE). In the original Czech version of MoCA, we replaced the 12-syllable word list in the Memory subtest with a 7-syllable list (MoCA-WLE) to make it equivalent to the standard English version in this respect. We analyzed data from 83 participants in the original MoCA group (70.63 ± 7.01 years old, 14.61 ± 3.17 years of education, 30.12% males) and 83 participants in the MoCA-WLE group (70.72 ± 6.95 years old, 14.93 ± 3.48 years of education, 30.12% males). We did not find evidence for a significant word-length effect in the original MoCA versus MoCA-WLE Delayed Recall in either the Mann–Whitney U test (W = 3418.0, p = .932) or multilevel binomial regression (b = 0.10, 95% posterior probability interval [−0.46, 0.68]). The present study shows cross-cultural limits in the adaptation of the test material. The results underline the caveats of such an approach to test adaptation. Fortunately, 12-syllables in the MoCA Memory Czech version versus the original 7-syllable list did not show a detectable word-length effect. We did not find evidence for differential item functioning or cultural item bias. The original MoCA Czech version is psychometrically comparable to the original English version.