Neuropsychological Measures in the Arab World: A Systematic Review

Beyond the heart: Cognitive and verbal outcomes in Arab children with congenital heart diseases

BACKGROUND

This study investigates how congenital heart diseases (CHD) characteristics and interventions affect cognitive and verbal skills in Arab children, while also uncovering previously unexplored connections between these skills and the quality of life (QoL) scores as perceived by both children and parents.

METHODS

A cross-sectional study was conducted in Jordan, involving 62 children with CHD aged 6-16. Data were collected through standardized intelligence tests (namely The Raven's Progressive Matrices Test and The Wechsler Intelligence Scale for Children) and QoL assessments.

RESULTS

Sex, disease severity, cyanosis, CHD defect status, conducted operations, and types of interventions did not significantly influence cognitive scores. However, a significant difference was observed in Wechsler's scores between cyanotic and non-cyanotic children (p < .01) and between severe and moderate cases (p = .01). Further, a significant positive correlation was identified between Wechsler's Scores and QoL reported by parents (r = 0.33, p < .01). This correlation was particularly pronounced in the social and school functioning dimensions of QoL.

CONCLUSIONS

This study highlights the need for personalized care approaches for children with CHDs based on their individual characteristics. While cognitive abilities did not directly correlate with children's QoL reports, a significant positive correlation between verbal skills and QoL reported by parents underscores the importance of effective communication in assessing a child's overall well-being. Future research should further examine the cognitive development in this population, employing neurocognitive investigations and longitudinal studies to gain a deeper understanding of their cognitive profiles and trajectories.

The Frequency of Neuropsychiatric Sequelae After Traumatic Brain Injury in the Global South: A systematic review and meta-analysis

This study aimed to assess the prevalence of neuropsychiatric sequelae following traumatic brain injury (TBI) among the Western Asian, South Asian and African regions of the global south. All studies on psychiatric disturbances or cognitive impairment following TBI conducted (until August 2021) in the 83 countries that constitute the aforementioned regions were reviewed; 6 databases were selected for the literature search. After evaluating the articles using the Joanna Briggs Institute guidelines, the random effects model was used to estimate the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), TBI-related sleep disturbance (TBI-SD), obsessive-compulsive disorder (OCD) and cognitive impairment. Of 56 non-duplicated studies identified in the initial search, 27 were eligible for systematic review and 23 for meta-analysis. The pooled prevalence of depression in 1,882 samples was 35.35%, that of anxiety in 1,211 samples was 28.64%, that of PTSD in 426 samples was 19.94%, that of OCD in 313 samples was 19.48%, that of TBI-SD in 562 samples was 26.67% and that of cognitive impairment in 941 samples was 49.10%. To date, this is the first critical review to examine the spectrum of post-TBI neuropsychiatric sequelae in the specified regions. Although existing studies lack homogeneous data due to variability in the diagnostic tools and outcome measures utilised, the reported prevalence rates are significant and comparable to statistics from the global north.

Pattern of cognitive impairment among community-dwelling elderly in Egypt and its relation to socioeconomic status

BACKGROUND

Cognitive decline is one of the aging health problems that strongly affects daily functioning and quality of life of older adults and threatens their independence. The aim of this study was to assess the prevalence and pattern of cognitive impairment (CI) among community-dwelling elderly in Egypt and the contribution of socioeconomic status to inequality in cognitive impairment.

METHODS

A cross-sectional study involved 470 community-dwelling elderly aged 60 years or older living in Kafr El-Sheikh Governorate, Egypt. Subjects were recruited from home visits, geriatric clubs, and outpatient clinics. The Montreal Cognitive Assessment tools (MoCA & MoCA-B) were used to assess the prevalence of cognitive impairment, Hachinski ischemic score (HIS) to investigate the type of cognitive impairment, Ain Shams Cognitive Assessment (ASCA) tool to assess the pattern of specific cognitive domain affection, and an Egyptian socioeconomic status (SES) scale to classify the SES of the study participants.

RESULTS

The prevalence of cognitive impairment was 50.2% distributed as 37.7% for mild cognitive impairment (MCI) and 12.5% for dementia. The most common type of cognitive impairment was the degenerative type (47.9%). Pattern of specific domain affection among cognitively impaired subjects ranged from 94% for visuospatial function to 12.7% for abstraction. Cognitive impairment was significantly higher with increasing age, female sex, marital status (single or widow), low education, higher number of comorbidities, and positive family history of cognitive impairment (p < 0.001). Also, cognitive impairment was concentrated mainly among participants with low socioeconomic score (p < 0.001).

CONCLUSION

In Egypt, cognitive impairment is significantly prevalent and concentrated among those who are in low socioeconomic status. Patients with mild CI were more than those with dementia, and the most common type of CI was the degenerative type. Increasing educational level of low SES population and improving their access to healthcare services are highly recommended to improve the inequity of cognitive impairment.

Morphosyntactic skills in Arabic-speaking children with autism spectrum disorder: Evidence from error patterns in the sentence repetition task

Background and aims

Although autism spectrum disorder (ASD) has not traditionally been associated with morphosyntactic impairments, some children with ASD manifest significant difficulties in this domain. Sentence Repetition (SRep) tasks are highly reliable tools for detecting morphosyntactic impairment in different languages and across various populations, including children with ASD. This study is among the first to evaluate morphosyntactic abilities of Palestinian-Arabic (PA) speaking children using a PA SRep task.

Methods

A total of 142 PA-speaking children, aged 5-11, participated in the study: 75 children with typical language development (TLD) and 67 children with ASD. The PA SRep task targeted morphosyntactic structures of varying complexity (simple subject-verb-object [SVO] sentences, biclausal sentences, wh-questions, relative clauses). Children's accuracy scores were assessed across these structures and error patterns encompassing morphosyntactic and pragmatic aspects were analyzed.

Results

Two subgroups of ASD emerged: 43% showed age-appropriate language skills (ASD  +  NL) pairing up with TLD peers, while 57% showed signs of morphosyntactic impairment (ASD  +  LI). Children in both groups exhibited a higher frequency of morphosyntactic errors than pragmatic ones. Children with ASD  +  LI showed difficulties with producing complex morphosyntactic structures, such as relative clauses and object wh-questions. Error analysis revealed that children in the ASD  +  LI group produced sentence fragments and simplified constructions when complex structures were targeted.

Conclusions

The current study extends the cross-linguistic evidence of the heterogeneity of morphosyntactic profiles in children with ASD to Arabic-speaking children. Error analysis indicates that poor morphosyntax, rather than pragmatics, challenges children's performance on the SRep task.

Implications

Our results emphasize the importance of comprehensive language assessment in children with ASD and underscore the need for tailored intervention plans targeting impaired morphosyntactic structures in some children with ASD.

Adaptation and initial validation of the Arabic version of the Word Memory Test (WMTARB)

BACKGROUND

The feigning of cognitive impairment is common in neuropsychological assessments, especially in a medicolegal setting. The Word Memory Test (WMT) is a forced-choice recognition memory performance validity test (PVT) which is widely used to detect noncredible performance. Though translated to several languages, this was not done for one of the most common languages, Arabic. The aim of the current study was to evaluate the convergent validity of the Arabic adaptation of the WMT (WMT_ARB) among Israeli Arabic speakers.

METHODS

We adapted the WMT to Arabic using the back-translation method and in accordance with relevant guidelines. We then randomly assigned healthy Arabic speaking adults (N = 63) to either a simulation or honest control condition. The participants then performed neuropsychological tests which included the WMT_ARB and the Test of Memory Malingering (TOMM), a well-validated nonverbal PVT.

RESULTS

The WMT_ARB had high split-half reliability and its measures were significantly correlated with that of the TOMM (p < .001). High concordance was found in classification of participants using the WMT_ARB and TOMM (specificity = 94.29% and sensitivity = 100% using the conventional TOMM trial 2 cutoff as gold standard). As expected, simulators' accuracy on the WMT_ARB was significantly lower than that of honest controls. None of the demographic variables significantly correlated with WMT_ARB measures.

CONCLUSION

The WMT_ARB shows initial evidence of reliability and validity, emphasizing its potential use in the large population of Arabic speakers and universality in detecting noncredible performance. The findings, however, are preliminary and mandate validation in clinical settings.

Development of the Arabic Health Measures database: a bibliometric analysis of Arabic health-related measures

Background

To develop an open-access database of Arabic health measures intended for use by researchers and healthcare providers, along with a bibliometric analysis of the measures included in the database.

Methods

A search was conducted up to 31 December 2021 in PubMed, Embase, CINAHL, SAGE, Springer and Elsevier for published articles or abstracts with keywords “Arabic” AND “translation”, “adaptation” OR “validation”. Information on the measure and the methodology used in the study was then entered into a database. An open-access platform was developed to allow users to search for measures according to their needs. A bibliometric analysis of the articles and measures was then conducted.

Results

A total of 894 publications met the inclusion criteria. The articles discussed 716 measures that were developed using participants from at least 38 countries. The number of measures for adults was five times that for children. Mental health was the most frequent construct assessed (11.5%), followed by “function/disability” measures (10.6%). The majority of measures (54%) required 5 minutes or less to complete. Approximately 17% of the tools were available directly from the article. Saudi Arabia and Lebanon had the greatest number of publications, with 217 (23%) and 114 (12%), respectively. The majority of the publications included reporting of the validation and reliability of the instruments (64% and 56%, respectively).

Conclusions

There is a paucity of research on the quantity and quality of Arabic health measures. Similar to previous reviews, we found the number of publications on Arabic measures to be limited in comparison to those in English; however, it is encouraging that the number of publications appears to have increased steadily over the past decade. While we found the majority of publications reported on psychometric testing, we are unable to comment on the quality of the methodology used, and further investigation into this area is recommended. As the Arabic Health Measures database will facilitate the search for health instruments that have published data on their development, this will increase their visibility and use in research and clinical settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-022-00890-7.

Assessing meaning violations in Syrian refugees: A mixed-methods cross-cultural adaptation of the Global Meaning Violations Scale-ArabV

Refugees are disproportionately affected by extreme traumatic events that can violate core beliefs and life goals (i.e., global meaning) and cause significant distress. This mixed-methods study used an exploratory sequential design to assess meaning violations in a sample of Syrian refugees living in Portugal. For this purpose, we cross-culturally adapted the Global Meaning Violations Scale (GMVS) for use with Arabic-speaking refugees. In total, 43 war-affected Syrian adults participated in the two-phase study. Participants completed measures of trauma and narrated violations as they filled out the newly adapted GMVS-ArabV. GMVS-ArabV validity evidence based on response processes was investigated through Phase 1 focus groups (FGs; n = 2), whereas data from Phase 2 cognitive interviews (n = 38) were used to preliminarily explore the measure's internal structure through descriptive statistics as well as culture- and trauma-informed content evidence through thematic analysis. The results suggested highest goal (M = 3.51, SD = 1.46) and lowest belief (M = 2.38, SD = 1.59) violations of educational goals and religious beliefs, respectively. Themes related to stressors, item formulation, response scale, and the global meaning construct suggested that (a) beliefs and goals can be differentially violated by different stressors; (b) much like war trauma, including torture, daily stressors can additionally shatter pretrauma global meaning; and (c) refugees reappraise meaning and suffer violations anew throughout their migration journeys. The GMVS-ArabV offers a promising tool for exploring shattered cognitions in refugees and informs evidence-based approaches to trauma recovery and psychological adjustment in postmigration settings (the Arabic abstract and keywords are available in the Supplementary Materials).

Development of inhibition and working memory in school-age Moroccan children

Studies regarding executive functions (EFs) in children rarely focus on populations of North Africa countries. In this context, this research aimed to adapt EFs tests to the Moroccan context and provide preliminary normative data on the development of inhibitory control and working memory (WM). In addition, the executive performance of school-age Moroccan children was examined, as well as the effects of gender, parents' education level and multilingualism. The sample included 115 children at age 7 to 12 from Fes city. Results showed that the translation and adaptation steps were sufficient for the cross-cultural adaptation of the tasks. In addition, an overall effect of age on inhibition and WM performances was found, whereas gender and parents' education level showed non-significant effects. Multilingualism effects had a partial positive influence on EFs, with improved scores on a few executive tasks for multilingual children compared to their bilingual peers. Overall, results suggest that EFs in school-age Moroccan children operate on relatively homogeneous development trajectories, marked by improvements that differ according to tasks. As neuropsychological tools and normative data are still lacking in Morocco, this study helps better understand EFs development of children in this country.

Adaptation and Preliminary Validation of the Arabic Version of the Role Checklist Version 3 (RCv3)

Arab occupational therapists are in need either to develop their own outcome measures or to translate well-known outcome measures to their culture. The objective of this study was to translate, cross-culturally adapt, and validate preliminarily the Role Checklist Version 3 (RCv3) into Arabic language. The translation and cross-cultural adaptation process of the RCv3 into Arabic language was conducted in four main steps: (a) forward translation, (b) back translation, (c) expert panel review process, and (d) psychometric testing (Validity). The expert panel established the face validity and the content validity of the Arabic RCv3. Pilot testing was conducted, and the utility and content validity of the tool were confirmed. The final version of the Arabic RCv3 is now available for use in the Arab countries. However, further psychometric properties including reliability and responsiveness of this tool is warranted, thus supporting its wide use and proper application.

Cultural Bias in Intelligence Assessment Using a Culture-Free Test in Moroccan Children

OBJECTIVE

Previous research has shown that cognitive tests can lead to misclassification when applying non-representative norms to measure cognitive performance. The objective of this study was to investigate whether this misclassification also occurs with a non-verbal so-called "culture-free" intelligence test administered to different age groups.

METHOD

The intelligence of a sample of healthy Moroccan children (N = 147) ages 7, 9, and 11 was assessed using the Coloured Raven's Progressive Matrices (CPM). Raw scores were used to study age differences, as well as misclassifications when applying the norms of three countries culturally different from Morocco (United Kingdom, Spain, and Oman).

RESULTS

Intelligence performance was not within the normal range when non-representative norms were applied to the Moroccan raw scores. Misclassifications accounted for a large percentage of the participants that supposedly displayed intelligence deficits, especially when applying the British norms. Up to 15.68% of the healthy children fell within the "intellectually impaired" range, and up to 62.5% fell "below average," with these percentages especially higher at older ages.

CONCLUSIONS

Our findings confirm that "culture-free" tests should be adapted to each culture and applied together with their culture's specific norms to prevent misclassification and allow for a better, unbiased neuropsychological assessment.

Differences in Neuropsychological Performance between Refugee and Non-Refugee Children in Palestine

Neuropsychological studies on refugee children are scarce, but there are even less in the case of Palestinian children. This work aims to study the neuropsychological performance of Palestinian refugee children in Palestine compared to other Palestinian children living outside refugee camps. A comprehensive Neuropsychological battery was administrated to 584 Palestinian school children (464 refugees and 120 non-refugees) aged 6, 7, and 8 years old. Results showed that non-refugee children outperformed refugee children in sustained attention, verbal comprehension, verbal memory, and visual memory. This study is the first to have performed a comprehensive neuropsychological assessment, based on a standardized and validated battery with the Palestinian refugee children. It supports professionals in their evaluation of neurodevelopment and neuropsychological alterations in refugee and non-refugee children in Palestine.

General description of cognitive deficits in schizophrenia and assessment tools in Lebanon: A scoping review

Many cognitive functions are affected in schizophrenia patients, particularly memory, attention, motor skills, executive function, and social cognition. Cognitive assessment is one of the best indicators of the functional and social prognosis of schizophrenic patients. In Lebanon, no study has yet examined the assessment of cognitive functions in patients with neurological or psychiatric diseases. This review aims to provide an overview of the cognitive profiles of schizophrenia and describe the different cognitive tests used in Lebanon. The MEDLINE/PubMed database was used to conduct a literature review covering all studies related to cognition in psychosis patients from 1990 until March 2021. This screening resulted in 97 articles focused on cognition in psychiatric patients or cognitive tests in schizophrenia and required an in-depth analysis. The majority of measures developed to evaluate cognition in patients with schizophrenia were from Western countries, most of which are long and complex and may require several hours to administer. The number of neuropsychological tests available in Arab countries is unknown, although it is likely to be limited compared to what is available in Western countries. In Lebanon, some neuropsychological batteries have been locally used to assess cognition without being translated and validated to be adapted to the Lebanese sociocultural context. Clinicians in Lebanon underestimate the extent of cognitive impairment in schizophrenia patients as they have limited options, using untranslated tests or using translations that have not been validated. Future studies should target the development and adaptation of instruments that predict and measure cognition and functional ability.

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Many cognitive functions are generally impaired in patients with schizophrenia

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The number of neuropsychological tests available in Arab countries is unknown

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In Lebanon, some neuropsychological batteries have been used to assess cognition without being translated and validated

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Few studies conducted in Lebanon have used neurocognitive tests among schizophrenia.

Psychological Tests in Arabic: A Review of Methodological Practices and Recommendations for Future Use

Mental health research among Arabic speakers is increasing, and with it the need to assess psychopathology of Arabic-speaking populations, including natives, refugees, and immigrants. However, major challenges include the unavailability of appropriate Arabic tools, and the difficulty of judging whether available tools are appropriate. Critical judgment of psychometric tools is important, because they are used for high stake decisions such as clinical outcomes and diagnoses. We identified Arabic-language tests that measure constructs related to mental illness and health, critically analyzed their methodologies, and provided broad recommendations for future research. We conducted a systematic search query using four online databases and followed step-wise exclusions. We identified 115 articles published between January 1998 and August 2019 which produced 138 Arabic tests to screen or diagnose or plan treatment for psychological disorders. More than 80% of tests were translated or adapted from English using methods that are not comparable with the latest standards. Methods of establishing validity, reliability, and equivalence, were also limited, with one quarter not reporting reliability, and the majority using only one source of validity evidence. There is much room for improvement when making decisions about translation or adaptation designs, as well as conducting and reporting psychometric evidence.

Development of executive functions in Lebanese children

The current study focused on adapting EF tests for children to the Arabic language and examine the developmental trajectories of a sample of school-aged Lebanese children in four domains of EF (inhibition, flexibility, working memory, and planning). It also focused on examining the effects of gender and parental education level on EF performance. The study population included 100 Lebanese children aged from 6 to 12-years old who were grouped and comparable for age, gender, and parental level of education. Results revealed a main effect of age and level of education of parents while the effect of gender was non-significant.

Arabic translation and cross-cultural adaptation of the Sport Concussion Assessment Tool 5 (SCAT5)

The aim was to create a Modern Standard Arabic SCAT5 version for different Arabic dialects. This translation and cross-cultural adaptation was performed in eight stages: initial translations, reconciliation of translations and cultural adaptation, back translation, appraisal of back translations, validation of the translation, review and adjustment by reconciliation committee, pretesting in 12 football players and document finalisation. As an alternative to the problematic Months In Reverse Order Test (MIROT) in Arabic, the Serial 3s test (32 Arabic and 30 English participants), the Days of the Week Backwards test (DWBT), and the 'Adding Serial 3s' test were tested (30 English and 30 Arabic participants) for accuracy, difficulty and time of completion. The Arabic SCAT5 was similar and comparable to the original English version (7-point Likert scales =< 2). Testing of the pre-final version of the Arabic SCAT5 took 20.4 (SD 3.4) and 17.7 (SD 3.0) minutes respectively to complete and was found acceptable in terms of clarity, understandability, grammatical correctness and coherence. The Arabic Serial 3s test (subtraction version) was unsuitable due to high completion time, low pass rate and high difficulty perception [time = 47.2 (SD 28.0) s; accuracy = 55.2%; difficulty = 3.2 (SD 1.1)]. The Arabic DWBT was too fast and undemanding for concentration testing [time = 4.6 (SD 1.5) s; accuracy = 90%; difficulty = 1.1 (SD 0.3)]. The Adding Serial 3s tests produced similar completion times [18.4 (SD 6.8) vs. 21.1 (SD 5.3), p = 0.088], accuracy (100%) and self-rated difficulty [English = 2.0 (SD 0.7) vs. Arabic-speaking participants = 2.1 (SD 0.8), p = 0.512] and was therefore adopted to replace the MIROT. This culturally adapted Arabic-SCAT5 questionnaire is the first concussion assessment tool available for Arabic-speaking healthcare providers and athletes. Sport Concussion Assessment Tool 5 (SCAT5). Biol Sport. 2021;38(1):129-144.

A model of cognitive evaluation battery for diagnosis of mild cognitive impairment and dementia in educated and illiterate Egyptian elderly people

Background

The high illiteracy rates in the North African and Middle Eastern region make direct cognitive testing challenging. Validated instruments for dementia in Arabic language are lacking specially those targeting low-educated subjects.

Objectives

The aim of this study was to develop a cognitive evaluation battery suitable for both educated and illiterate Egyptian elderly people.

Design

A cross-sectional study was conducted. Setting: Ain-Shams University geriatric and ophthalmology wards, geriatrics outpatient clinic, and geriatric clubs. Participants: 159 male and female participants aged ≥ 60 years were recruited.

Measurements

Cut-off points were determined according to DSM-IV criteria for dementia and MMSE scores which divided the participants into 3 quadrants as normal, having mild cognitive impairment and having dementia then application of the new battery test was done.

Results

Test re-test reliability ranged from adequate to high in most of its tests with r ≥ 0.7. There was a statistical significance between all battery tests when divided into normal and dementia according to DSM IV criteria except in digit span forward length, digit span backward length, stimulus cue of confrontation naming and judgment. Means and standard deviations were calculated for each battery subset, for the whole sample, for low-educated group and group with > 9 years education according to three quadrants of MMSE.

Conclusion

A new valid and reliable neurocognitive evaluation battery that can differentiate between normal, mild cognitive impairment, and dementia in both educated and illiterate subjects under the name of Ain Shams Cognitive Assessment (ASCA) scale is now available.

Diagnostic performance and cutoff value for the clock drawing test, semantic verbal fluency, and the short Boston Naming Test in community-dwelling educated older adults with neurocognitive disorders

Background

Little is known regarding the standardized neuropsychological tests available in Arabic. The aim is to determine the diagnostic performance and the best cutoff value for the clock drawing test (CDT), animal category test of semantic verbal fluency (VF), and the short form of the Boston Naming Test (BNT) in identifying patients with mild and major neurocognitive disorders among community-dwelling educated Egyptian older adults using Arabic versions of those tests. Community-dwelling educated male and female older adults aged 60 years or older. Successive patients were attending the outpatient geriatrics clinic at the Ain Shams University Hospital during a 12-month study period from January to December 2016. The study was approved by the ethics committee of the Faculty of Medicine, Ain Shams University, Cairo, Egypt. Informed consent to participate in the study was received from each participant and/or his/her next of kin. Patients and/or their next of kin who declined to participate were excluded, as were those who refused to complete the assessment.

A two-step protocol was followed. Step 1: Participants were divided into three groups according to DSM-V diagnostic criteria for neurocognitive disorders. The assessment of cognitive function included Mini-Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR), patient’s current functional status regarding basic and instrumental activities of daily living by the Blessed Dementia Scale (BDS), and patient detailed history and examination based on protocol five of the CERAD assessment packet.

Step 2: The application of the Arabic versions of ELokl et al. 2001 VF test, the BNT, and the CD by a clinical psychologist blinded to the initial assessment results.

Results

In current study, AUC for CD, VF, and BN are 0.807, 0.77, and 0.753 respectively for mild NCD and 0.884, 0.877, and 0.839 respectively for major NCD while cutoff values for CD, VF, and BN are 2, 12, and 14 respectively for mild NCD and 2, 9, and 13 respectively for major NCD.

Conclusion

Verbal fluency, clock drawing, and Boston naming showed reasonable diagnostic performance in educated Egyptian elderly and should be considered separately or in combination for the assessment of cognitive function. Further research is warranted.

Predictive value and changes of miR-34a after concurrent chemoradiotherapy and its association with cognitive function in patients with nasopharyngeal carcinoma

This study explored the changes and predictive value of miR-34a in nasopharyngeal carcinoma (NPC) after concurrent chemoradiotherapy (CCRT), and its association with cognitive function. Fifty NPC patients admitted to Shunde Hospital, and another fifty healthy individuals were assigned into treated group and control group, respectively. Patients in the treated group received 3 courses of CCRT. The relative expression of miR-34a in the two groups was detected, and the cognitive function of patients was assessed. Diagnostic and predictive values of miR-34a in advanced NPC were analyzed. The expression of miR-34a in the control group was significantly higher than that in the treated group (t=13.364, P<0.001), with an area under the curve (AUC) of 0.979. The expression of miR-34a was significantly upregulated after treatment (t=4.559, P<0.001). After treatment, there were 32 complete remission (CR) patients and 18 partial remission (PR) patients. According to efficacy, CR patients were classified as significant group and PR patients as general group. The expression of miR-34a in the significant group was higher than that in the general group before treatment (t=4.704, P<0.001), with an AUC of 0.852. The Montreal Cognitive Assessment (MoCA) score was significantly decreased after treatment (t=13.042, P<0.001). The expression of miR-34a was positively correlated with the MoCA score after treatment, that is, MoCA score gradually increased with the upregulation of miR-34a expression (r=0.379, P=0.006). There is a positive correlation between miR-34a and cognitive function of patients. Moreover, the expression of miR-34a can be used as a potential predictor of the efficacy of CCRT in patients with NPC.

A Systematic Review of Neuropsychological Tests for the Assessment of Dementia in Non-Western, Low-Educated or Illiterate Populations

OBJECTIVE

Neuropsychological tests are important instruments to determine a cognitive profile, giving insight into the etiology of dementia; however, these tests cannot readily be used in culturally diverse, low-educated populations, due to their dependence upon (Western) culture, education, and literacy. In this review we aim to give an overview of studies investigating domain-specific cognitive tests used to assess dementia in non-Western, low-educated populations. The second aim was to examine the quality of these studies and of the adaptations for culturally, linguistically, and educationally diverse populations.

METHOD

A systematic review was performed using six databases, without restrictions on the year or language of publication.

RESULTS

Forty-four studies were included, stemming mainly from Brazil, Hong Kong, Korea, and considering Hispanics/Latinos residing in the USA. Most studies focused on Alzheimer's disease (n = 17) or unspecified dementia (n = 16). Memory (n = 18) was studied most often, using 14 different tests. The traditional Western tests in the domains of attention (n = 8) and construction (n = 15), were unsuitable for low-educated patients. There was little variety in instruments measuring executive functioning (two tests, n = 13), and language (n = 12, of which 10 were naming tests). Many studies did not report a thorough adaptation procedure (n = 39) or blinding procedures (n = 29).

CONCLUSIONS

Various formats of memory tests seem suitable for low-educated, non-Western populations. Promising tasks in other cognitive domains are the Stick Design Test, Five Digit Test, and verbal fluency test. Further research is needed regarding cross-cultural instruments measuring executive functioning and language in low-educated people.

Standardization of an Arabic-Language Neuropsychological Battery for Epilepsy Surgical Evaluations

OBJECTIVES

This study provides a standardized Arabic language neuropsychological test battery and tests its ability to distinguish patients with left and right hemisphere epileptic foci who are candidates for surgical resection.

METHODS

An Arabic language battery of 15 tests was developed based on the neuropsychological test battery used at the Johns Hopkins Hospital for surgical evaluation of patients undergoing temporal lobe resection. With modifications where culturally required, 11 tests were translated to Arabic by the principal investigator and back-translated by two bilingual health professionals; four tests were available in Arabic and added to the battery. The battery was administered to 21 Arabic-speaking patients with left temporal epileptic foci, 21 with right temporal epileptic foci, and 46 neurologically and psychiatrically healthy adults.

RESULTS

Nearly all the Arabic test versions were capable of differentiating healthy controls and the temporal lobe epilepsy (TLE) groups. Tests known to distinguish left and right temporal lobectomy candidates, such as wordlist memory and prose recall, were able to do so as accurately as the English versions. Also, a roughly "culturally free" task (the Baltimore Board) and a newly developed version of the Boston Naming Test demonstrated some sensitivity to left temporal lobe involvement.

CONCLUSIONS

Arabic-language neuropsychological tests for epilepsy surgical evaluations are made available, demonstrate cultural sensitivity and clinical validity, and require further psychometric property and normative research. (JINS, 2019, 25, 761-771).

Neuropsychological Assessment: Past and Future

Neuropsychological assessment tools are the staple of our field. The development of standardized metrics sensitive to brain-behavior relationships has shaped the neuropsychological questions we can ask, our understanding of discrete brain functions, and has informed the detection and treatment of neurological disorders. We identify key turning points and innovations in neuropsychological assessment over the past 40-50 years that highlight how the tools used in common practice today came to be. Also selected for emphasis are several exciting lines of research and novel approaches that are underway to further probe and characterize brain functions to enhance diagnostic and treatment outcomes. We provide a brief historical review of different clinical neuropsychological assessment approaches (Lurian, Flexible and Fixed Batteries, Boston Process Approach) and critical developments that have influenced their interpretation (normative standards, cultural considerations, longitudinal change, common metric batteries, and translational assessment constructs). Lastly, we discuss growing trends in assessment including technological advances, efforts to integrate neuropsychology across disciplines (e.g., primary care), and changes in neuropsychological assessment infrastructure. Neuropsychological assessment has undergone massive growth in the past several decades. Nonetheless, there remain many unanswered questions and future challenges to better support measurement tools and translate assessment findings into meaningful recommendations and treatments. As technology and our understanding of brain function advance, efforts to support infrastructure for both traditional and novel assessment approaches and integration of complementary brain assessment tools from other disciplines will be integral to inform brain health treatments and promote the growth of our field. (JINS, 2017, 23, 778-790).