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Nielsen TR, Franzen S, Watermeyer T, Jiang J, Calia C, Kjærgaard D, Bothe S, Mukadam N. Interpreter-mediated neuropsychological assessment: Clinical considerations and recommendations from the European Consortium on Cross-Cultural Neuropsychology (ECCroN). Clin Neuropsychol 2024:1-31. [PMID: 38588670 DOI: 10.1080/13854046.2024.2335113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE With increasing international migration, societies have become increasingly diverse worldwide. Although neuropsychological assessment is influenced by several diversity characteristics, language barriers have repeatedly been identified as one of the main challenges to cross-cultural neuropsychological assessment in migrant populations. Importantly, neuropsychologists are often required to conduct interpreter-mediated neuropsychological assessments without any graduate training or continuing education on the topic. To address this gap, the objective of this paper is to provide guidelines for interpreter-mediated neuropsychological assessment. METHOD A European Consortium on Cross-Cultural Neuropsychology (ECCroN) task force conducted a conceptual literature review and provided recommendations for good practice and working principles to inform the preparation and administration of interpreter-mediated assessments. RESULTS ECCroN takes the position that it is the responsibility of neuropsychologists, as well as the institutions or organizations that employ them, to ensure effective communication between themselves and their patients. This may be accomplished by preparing for an interpreter-mediated assessment by engaging an appropriate interpreter, which in most circumstances will be a professional in-person interpreter speaking the same language(s) or dialect(s) as the patient, and considering practical, language, and cross-cultural issues. During the assessment, reasonable steps should be taken to proactively manage the proceedings and adopt a communication style that facilitates effective patient-directed communication, and when interpreting test data and determining formulations and diagnoses, the limitations of interpreter-mediated assessment should be carefully considered. CONCLUSION Adhering to the provided recommendations and working principles may help neuropsychologists provide competent interpreter-mediated neuropsychological assessments to linguistically diverse patients.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sanne Franzen
- Department of Neurology & Alzheimer Center, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tamlyn Watermeyer
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Clara Calia
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Daniel Kjærgaard
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Søren Bothe
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- DIGNITY - Danish Institute Against Torture, Copenhagen, Denmark
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Yasa Kostas R, Kostas K, MacPherson SE, Wolters MK. Semantic verbal fluency in native speakers of Turkish: a systematic review of category use, scoring metrics and normative data in healthy individuals. J Clin Exp Neuropsychol 2024; 46:272-301. [PMID: 38904178 DOI: 10.1080/13803395.2024.2331827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 03/07/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Semantic verbal fluency (SVF) is a widely used measure of frontal executive function and access to semantic memory. SVF scoring metrics include the number of unique words generated, perseverations, intrusions, semantic cluster size and switching between clusters, and scores vary depending on the language the test is administered in. In this paper, we review the existing normative data for Turkish, the main metrics used for scoring SVF data in Turkish, and the most frequently used categories. METHOD We conducted a systematic review of peer-reviewed papers using Medline, EMBASE, PsycInfo, Web of Science, and two Turkish databases, TR-Dizin and Yok-Tez. Included papers contained data on the SVF performance of healthy adult native speakers of Turkish, and reported the categories used. Versions of the SVF that required participants to alternate categories were excluded. We extracted and tabulated demographics, descriptions of groups, metrics used, categories used, and sources of normative data. Studies were assessed for level of detail in reporting findings. RESULTS 1400 studies were retrieved. After deduplication, abstract, full text screening, and merging of theses with their published versions, 121 studies were included. 114 studies used the semantic category "animal", followed by first names (N = 14, 12%). All studies reported word count. More complex measures were rare (perseverations: N = 12, 10%, clustering and switching: N = 5, 4%). Four of seven normative studies reported only word count, two also measured perseverations, and one reported category violations and perseverations. Two normative studies were published in English. CONCLUSIONS There is a lack of normative Turkish SVF data with more complex metrics, such as clustering and switching, and a lack of normative data published in English. Given the size of the Turkish diaspora, normative SVF data should include monolingual and bilingual speakers. Limitations include a restriction to key English and Turkish databases.
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Affiliation(s)
| | - Kahraman Kostas
- Department of Computer Science, Heriot-Watt University, Edinburgh, UK
| | - Sarah E MacPherson
- Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Maria K Wolters
- School of Informatics, University of Edinburgh, Edinburgh, UK
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Torkpoor R, Frolich K, Londos E, Nielsen TR. Diagnostic Accuracy of the Swedish Version of the Multicultural Cognitive Examination for Cognitive Assessment in Swedish Memory Clinics. J Alzheimers Dis 2024; 97:715-726. [PMID: 38143364 PMCID: PMC10836550 DOI: 10.3233/jad-230998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Cognitive assessment for foreign-born individuals is suboptimal. The Multicultural Cognitive Examination (MCE) was developed for use in culturally, linguistically and educationally diverse populations. The MCE includes the Rowland Universal Dementia Assessment Scale (RUDAS) and performs assessment of memory, verbal fluency, and visuospatial function. OBJECTIVE To compare the psychometric properties of the Swedish version of the Multicultural Cognitive Examination (MCE-S) with the Swedish versions of the RUDAS (RUDAS-S), the Mini-Mental State Examination (MMSE-SR), and the Clock Drawing Test (CDT), and to explore the ability of the MCE-S test to differentiate patients with and without dementia in a multicultural population. METHODS 117 outpatients at four memory clinics were tested using the MCE-S to complement the routine cognitive assessment. RESULTS Significant differences between patients with and without dementia were observed for all MCE-S components. There were significant differences between foreign-born and Swedish-born patients in the MMSE-SR, but not in the MCE-S or the RUDAS-S. The MCE-S, had good diagnostic performance for detecting dementia (AUC, 0.82), and was at least as good as the RUDAS-S alone (AUC, 0.79). The MCE-S also distinguished Alzheimer's disease (AD) from non-AD dementia. Contrary to expectations, the MCE-S was also at least as good as the MMSE-SR among the Swedish-born patients. CONCLUSIONS The MCE-S is adequate for detecting dementia in both foreign-born and Swedish-born populations. Based on the cultural diversity of general society, adapted cognitive tests that can be used for everyone are practical and beneficial for both patients and health-care professionals. Further studies are needed within primary care.
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Affiliation(s)
- Rozita Torkpoor
- Department of Clinical Sciences Malmö, Cognitive Disorder Research Unit, Lund University, Malmö, Sweden
- Memory Clinic, Skane University Hospital, Malmö, Sweden
| | - Kristin Frolich
- Department of Clinical Sciences Malmö, Cognitive Disorder Research Unit, Lund University, Malmö, Sweden
| | - Elisabet Londos
- Department of Clinical Sciences Malmö, Cognitive Disorder Research Unit, Lund University, Malmö, Sweden
- Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - T. Rune Nielsen
- Danish Dementia Research Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Nielsen TR, Staios M. Clinical Utility of WAIS-IV Matrix Reasoning Among Adult Low Educated Recent Immigrants; A Note of Caution. Arch Clin Neuropsychol 2023; 38:976-982. [PMID: 36702784 DOI: 10.1093/arclin/acad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/16/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To examine the clinical utility of Wechsler Adult Intelligence Scale-IV (WAIS-IV) Matrix Reasoning in limited educated recently arrived immigrants in Denmark. METHOD Participants were 64 limited educated (0-9 years' education) independently living adult immigrants primarily from Middle Eastern and Sub-Saharan African countries who completed WAIS-IV Matrix Reasoning as well as demographic, and medical questionnaires. RESULTS Thirty-eight participants (59%) scored more than two standard deviations below the Scandinavian mean (scaled score < 4). Performances were significantly associated with years of education but not with occupational status, years of residence in Denmark, or Danish language skills. The most common error types were repetition errors (15.84%) and incomplete correlate errors (10.47%), with a strong trend for a higher proportion of repetition errors in participants with <5 years of education. CONCLUSIONS The findings indicate that WAIS-IV Matrix Reasoning underestimates cognitive functioning in limited educated recently arrived immigrants, thus calling its clinical utility into question.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Mathew Staios
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
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Nielsen TR, Vinnner P. Cognitive assessment of literacy learning difficulties in adult non- or low-literate second language learners. Scand J Psychol 2023. [PMID: 36773002 DOI: 10.1111/sjop.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/19/2022] [Accepted: 01/21/2023] [Indexed: 02/12/2023]
Abstract
The population of non- or low-literate adult immigrants studying a new language is large and growing in many countries. The aim of this study was to develop and validate a new instrument for the assessment of cognitive impairment that may hinder literacy learning in adult non- or low-literate L2 learners, the Cognitive Assessment of Literacy Learning Difficulties (CALL), in a language center setting. This was a case-control study in which the CALL was validated in adult non- or low-literate students, or students who were not literate in the Latin alphabet, in nine Danish language centers. Educator classification of students with very slow progression in learning basic Danish literacy was used as a benchmark for literacy learning difficulties. Classification was further based on the number of lessons participants had required to pass tests during Danish language program levels. An acceptable discriminative validity (AUC 0.76; specificity 0.94, sensitivity 0.64) for literacy learning difficulties (n = 32) versus schooling and sex matched control participants (n = 28) was found. In comparison, years of formal schooling had an AUC of 0.58. Age had a small effect on the ability of the CALL to predict literacy learning difficulties (OR = 1.097, p = 0.013), whereas sex and years of schooling did not. CALL was found to be a valid instrument for identification of cognitive impairment that may hinder literacy learning in adult non- or low-literate L2 learners in a Danish language center setting.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pernille Vinnner
- Danish Agency for International Recruitment and Integration (SIRI), Ministry of Immigration and Integration, Copenhagen, Denmark
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Abstract
OBJECTIVES We investigated the utility of traditional neuropsychological tests in older uneducated/illiterate individuals without dementia to determine the possibility that they are likely not appropriate for this group. METHODS We assessed the neuropsychological performance of 1122 older adults [≥65 years old; mean age: 74.03 (SD = 5.46); mean education: 4.76 (SD = 2.5) years; women: n = 714], in the context of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population-based study conducted in Greece. RESULTS We based our analyses on three groups: high-functioning/cognitively healthy (i.e., without dementia) uneducated/illiterate individuals (n = 80), high-functioning/cognitively healthy educated/literate individuals (n = 932), and low-functioning/cognitively impaired educated/literate individuals (presumably with dementia; n = 110). We used binary regression analyses with Bonferroni correction to investigate whether test performance differentiated uneducated/illiterate from educated/literate individuals. Models were adjusted for age and sex; raw test scores were the predictor variables. The uneducated/illiterate cohort was at a disadvantage relative to the healthy educated/literate group on all variables but verbal memory recognition and consolidation, congruent motor responses, and phonological fluency clustering (p > .002). Moreover, only word list learning immediate and delayed free recall and delayed cued recall differentiated the high-functioning/cognitively healthy uneducated/illiterate from the low-functioning/cognitively impaired educated/literate group, favoring the former (p's < .002). CONCLUSIONS Our findings suggest that only particular verbal memory test variables are fair in determining whether older uneducated/illiterate individuals have functional/cognitive impairment suggestive of a neurodegenerative process. On all other neuropsychological variables, this cohort was at a disadvantage. Therefore, we highlight the need for identifying appropriate methods of assessment for older uneducated/illiterate individuals.
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Franzen S. Cross-cultural neuropsychological assessment in Europe: Position statement of the European Consortium on Cross-Cultural Neuropsychology (ECCroN). Clin Neuropsychol 2021; 36:546-557. [PMID: 34612169 DOI: 10.1080/13854046.2021.1981456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Over the past decades European societies have become increasingly diverse. This diversity in culture, education, and language significantly impacts neuropsychological assessment. Although several initiatives are under way to overcome these barriers - e.g. newly developed and validated test batteries - there is a need for more collaboration in the development and implementation of neuropsychological tests, such as in the domains of social cognition and language. To address these gaps in cross-cultural neuropsychological assessment in Europe, the European Consortium on Cross-Cultural Neuropsychology (ECCroN) was established in 2019. ECCroN recommends taking a broad range of variables into account, such as linguistic factors, literacy, education, migration history, acculturation and other cultural factors. We advocate against race-based norms as a solution to the challenging interpretation of group differences on neuropsychological tests, and instead support the development, validation, and standardization of more widely applicable/cross-culturally applicable tests that take into account interindividual variability. Last, ECCroN advocates for an improvement in the clinical training of neuropsychologists in culturally sensitive neuropsychological assessment, and the development and implementation of guidelines for interpreter-mediated neuropsychological assessment in diverse populations in Europe. ECCroN may impact research and clinical practice by contributing to existing theoretical frameworks and by improving the assessment of diverse individuals across Europe through collaborations on test development, collection of normative data, cross-cultural clinical training, and interpreter-mediated assessment.
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Affiliation(s)
- Sanne Franzen
- Department of Neurology, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
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Özbek M, Bohn A, Berntsen D. A tale of two cultural life scripts: do young second-generation Turkish immigrants versus young Danes in Denmark perceive life through different cultural lenses? Memory 2021; 29:778-792. [PMID: 34196255 DOI: 10.1080/09658211.2021.1948576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cultural life scripts refer to the shared expectations as to the order and timing of life events in a prototypical life course within a given culture or subculture. Immigration is a significant transition that often implies a change in cultural context, which may change people's views about a normative life. However, research on cultural life scripts in the context of immigration has been limited. We addressed this gap by examining the cultural life scripts of 33 young second-generation Turkish immigrants and 33 young Danes in Denmark, pairwise-matched on age, gender, and education, along with their subjective well-being and acculturation level. Both groups reported mostly positive life script events expected to occur in early adulthood and their individual life scripts generally had a positive outlook. In contrast to earlier studies, we found no evidence of lower subjective well-being or greater normativity of the cultural life script in the immigrant group. Moreover, the acculturation level of the Turkish group correlated positively with their subjective well-being, suggesting that adapting at least to some degree to the daily life of the host country is associated with well-being of second-generation immigrants.
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Affiliation(s)
- Müge Özbek
- Center on Autobiographical Memory Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
| | - Annette Bohn
- Center on Autobiographical Memory Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
| | - Dorthe Berntsen
- Center on Autobiographical Memory Research, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
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Araujo NB, Nielsen TR, Laks J. Recall of Pictures Test included in the European Cross-Cultural Neuropsychological Test Battery. ACTA ACUST UNITED AC 2021; 43:225-227. [PMID: 33237256 PMCID: PMC8023163 DOI: 10.1590/1516-4446-2020-1558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Narahyana B Araujo
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Thomas R Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Jerson Laks
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Programa de Pós-Graduação em Biomedicina Translacional (Biotrans), Universidade do Grande Rio (Unigranrio), Duque de Caxias, RJ, Brazil
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Nitrini R, Caramelli P, Brucki SMD, Yassuda MS. The memory test of the Brief Cognitive Screening Battery is the same as the Recall of Pictures Test of the European Cross-Cultural Neuropsychological Test Battery. ACTA ACUST UNITED AC 2021; 43:224-225. [PMID: 33146346 PMCID: PMC8023149 DOI: 10.1590/1516-4446-2020-1520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Paulo Caramelli
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Sonia Maria Dozzi Brucki
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Mônica Sanches Yassuda
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Gerontologia, Escola de Artes, Ciências e Humanidades, USP, São Paulo, SP, Brazil
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Ortega LV, Aprahamian I, Martinelli JE, Cecchini MA, Cação JDC, Yassuda MS. Diagnostic Accuracy of Usual Cognitive Screening Tests Versus Appropriate Tests for Lower Education to Identify Alzheimer Disease. J Geriatr Psychiatry Neurol 2021; 34:222-231. [PMID: 32969281 DOI: 10.1177/0891988720958542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The accuracy of commonly used screening tests for Alzheimer's disease (AD) has not been directly compared to those that could be more appropriate for lower schooling. OBJECTIVE To compare the diagnostic accuracy of usual screening tests for AD with instruments that might be more appropriate for lower schooling among older adults with low or no literacy. METHODS The study included a clinical sample of 117 elderly outpatients from a Geriatric Clinic classified as literate controls (n = 39), illiterate controls (n = 30), literate AD (n = 30) and illiterate AD (n = 18). The tests were compared as follows: Black and White versus Colored Figure Memory Test; Clock Drawing Test versus Clock Reading Test; Verbal Fluency (VF) animal versus grocery category; CERAD Constructional Praxis versus Stick Design Test. RESULTS The means of literate and illiterate controls did not differ in the Black and White Figure Memory Test (immediate recall), Colored Figure Memory Test (delayed recall), Clock Reading Test and VF animals and grocery categories. The means of the clinical groups (controls versus AD), in the 2 schooling levels, differed significantly in most of the tests, except for the CERAD Constructive Praxis and the Stick Design Test. Diagnostic accuracy was not significantly different between the compared tests. CONCLUSION Commonly used screening tests for AD were as accurate as those expected to overcome the education bias in a sample of older adults with lower or no education.
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Affiliation(s)
- Luciane Viola Ortega
- 67791Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Ivan Aprahamian
- Division of Geriatrics, Department of Internal Medicine, 146840Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - José Eduardo Martinelli
- Division of Geriatrics, Department of Internal Medicine, 146840Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Mário Amore Cecchini
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Mônica Sanches Yassuda
- 67791Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil.,School of Arts, Sciences and Humanities, 28133University of São Paulo (USP), São Paulo, Brazil
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Al-Jawahiri F, Nielsen TR. Effects of Acculturation on the Cross-Cultural Neuropsychological Test Battery (CNTB) in a Culturally and Linguistically Diverse Population in Denmark. Arch Clin Neuropsychol 2021; 36:381-393. [PMID: 31942602 DOI: 10.1093/arclin/acz083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/01/2019] [Accepted: 12/12/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Assessment of individuals from diverse ethnic backgrounds is a major challenge in current clinical neuropsychology as most neuropsychological tests are biased by linguistic, educational, and cultural differences. The aim of this study was to examine the effects of acculturation on the newly developed European Cross-Cultural Neuropsychological Test Battery. METHOD The study was a cross-sectional study carried out in Copenhagen, Denmark. Neuropsychological test performances of a Danish sample were compared to a culturally and linguistically diverse sample, and the effects of a number of acculturation variables were assessed using group comparisons, correlation analyses, and regression analyses. RESULTS A total of 152 participants were included in the study: 26 were native-born monolingual Danes and 126 had culturally and linguistically diverse backgrounds: 66 were immigrants from Turkey, 41 from Poland, and 19 from former Yugoslavia. In direct comparison, the only significant difference between the Danish and culturally and linguistically diverse samples was found on Animal Fluency. However, within the culturally and linguistically diverse sample, higher and lower acculturated groups significantly differed on several measures. The main associations between neuropsychological test performance and acculturation variables were found on measures loading on processing speed and executive function. CONCLUSIONS Overall, only limited effects of acculturation were found on the European Cross-Cultural Neuropsychological Test Battery. However, administering cross-cultural measures in the preferred language may not be sufficient to resolve challenges in cross-cultural assessment of processing speed and executive function as concept of speed and speeded performance is highly culture dependent.
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Affiliation(s)
| | - T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
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Nitrini R, Bucki SMD, Yassuda MS, Fichman HC, Caramelli P. The Figure Memory Test: diagnosis of memory impairment in populations with heterogeneous educational background. Dement Neuropsychol 2021; 15:173-185. [PMID: 34345358 PMCID: PMC8283874 DOI: 10.1590/1980-57642021dn15-020004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/19/2021] [Indexed: 12/02/2022] Open
Abstract
Diagnosis of cognitive impairment is usually difficult in low-educated individuals. The Brief Cognitive Screening Battery (BCSB) was designed as a screening tool for the evaluation of cognitive impairment in low-educated individuals, but it may also be used for evaluating individuals with high educational level. OBJECTIVES To perform a narrative review analyzing the origin of the BCSB, to report all studies that have used the Figure Memory Test (FMT) of the BCSB, and to demonstrate that it is a useful battery for regions where populations have heterogeneous educational background. METHODS We performed a search in PubMed, SciELO, and LILACS using the terms "Brief Cognitive Screening Battery" and "Brief Cognitive Battery". RESULTS We obtained 49 papers from PubMed, 32 from SciELO, and 28 from LILACS. After the exclusion of duplicate papers, 54 publications were obtained; five more studies were included from previous knowledge of the authors. Twenty-four papers were related to the impact of education on performance, diagnostic accuracy, cutoff scores and normative studies. The delayed recall of the FMT showed the best accuracy for the diagnosis of dementia with a cutoff score of ≤5 in different education levels. In 35 papers, the FMT of the BCSB was used in clinical studies with different settings, from outpatient memory clinics to epidemiological studies and evaluation of Amazon river basin dwelling individuals, and it was always considered to be easy to apply. CONCLUSIONS The FMT of the BCSB is an easy and short tool for the diagnosis of dementia in populations with heterogeneous educational background.
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Affiliation(s)
- Ricardo Nitrini
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo ‒ São Paulo, SP, Brazil
| | | | - Mônica Sanches Yassuda
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo ‒ São Paulo, SP, Brazil
- Gerontology, School of Arts, Sciences and Humanities, Universidade de São Paulo ‒ São Paulo, SP, Brazil
| | - Helenice Charchat Fichman
- Department of Psychology, Pontifícia Universidade Católica do Rio de Janeiro ‒ Rio de Janeiro, RJ, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Group, Faculdade de Medicina, Universidade Federal de Minas Gerais ‒ Belo Horizonte, MG, Brazil
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Nielsen TR. Effects of Illiteracy on the European Cross-Cultural Neuropsychological Test Battery (CNTB). Arch Clin Neuropsychol 2020; 34:713-720. [PMID: 30272111 DOI: 10.1093/arclin/acy076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/16/2018] [Accepted: 08/30/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Test performances of illiterate and literate immigrants were compared to investigate the effects of illiteracy on the European Cross-cultural Neuropsychological Test Battery (CNTB), and associations between test performance and participant characteristics were examined. METHOD Participants were 20 illiterate and 21 literate middle-aged and older Turkish immigrants (50-85 years) matched by age and gender that completed the CNTB as well as a number of demographic and medical questionnaires. RESULTS No significant group differences or correlations between education, acculturation or health characteristics and test performances were found on 10 of 16 measures. Illiteracy status and participant characteristics affected measures of mental processing speed, executive function, and visuoconstruction. CONCLUSIONS The preliminary findings suggest that several of the measures in the CNTB may be valid for assessment of cognitive functioning in people who are illiterate when applied using available normative data. However, these findings need to be replicated in larger samples.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
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Ortega LDFV, Aprahamian I, Borges MK, Cação JDC, Yassuda MS. Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 77:279-288. [PMID: 31090809 DOI: 10.1590/0004-282x20190024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/18/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). OBJECTIVE To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. METHODS Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. RESULTS We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. CONCLUSION For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.
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Affiliation(s)
- Luciane de Fátima Viola Ortega
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Gerontologia, Campinas SP, Brasil
| | - Ivan Aprahamian
- Faculdade de Medicina de Jundiaí, Grupo de Investigação em Multimorbidades e Saúde Mental em Idosos, Disciplina de Geriatria e Gerontologia, Jundiaí SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil
| | - Marcus Kiiti Borges
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil
| | - João de Castilho Cação
- Faculdade de Medicina de São José do Rio Preto, Unidade de Geriatria, São José do Rio Preto SP, Brasil
| | - Mônica Sanches Yassuda
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Gerontologia, Campinas SP, Brasil.,Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brasil
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16
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Araujo NB, Nielsen TR, Barca ML, Engedal K, Marinho V, Deslandes AC, Coutinho ES, Laks J. Brazilian version of the European Cross-Cultural Neuropsychological Test Battery (CNTB-BR): diagnostic accuracy across schooling levels. ACTA ACUST UNITED AC 2020; 42:286-294. [PMID: 32130401 PMCID: PMC7236160 DOI: 10.1590/1516-4446-2019-0539] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/14/2019] [Indexed: 12/02/2022]
Abstract
Objective: To translate, establish the diagnostic accuracy, and standardize the Brazilian Portuguese version of the European Cross-Cultural Neuropsychological Test Battery (CNTB) considering schooling level. Methods: We first completed an English-Brazilian Portuguese translation and back-translation of the CNTB. A total of 135 subjects aged over 60 years – 65 cognitively healthy (mean 72.83, SD = 7.71; mean education 9.42, SD = 7.69; illiterate = 25.8%) and 70 with Alzheimer’s disease (AD) (mean 78.87, SD = 7.09; mean education 7.62, SD = 5.13; illiterate = 10%) – completed an interview and were screened for depression. The receiver operating characteristic (ROC) analysis was used to verify the accuracy of each CNTB test to separate AD from healthy controls in participants with low levels of education (≤ 4 years of schooling) and high levels of education (≥ 8 years of schooling). The optimal cutoff score was determined for each test. Results: The Recall of Pictures Test (RPT)-delayed recall and the Enhanced Cued Recall (ECR) had the highest power to separate AD from controls. The tests with the least impact from schooling were the Rowland Universal Dementia Assessment Scale (RUDAS), supermarket fluency, RPT naming, delayed recall and recognition, and ECR. Conclusions: The Brazilian Portuguese version of the CNTB was well comprehended by the participants. The cognitive tests that best discriminated patients with AD from controls in lower and higher schooling participants were RPT delayed recall and ECR, both of which evaluate memory.
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Affiliation(s)
- Narahyana B Araujo
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Thomas R Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Maria L Barca
- Norwegian National Unit for Aging and Health, Vestfold County Hospital, Toensberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Knut Engedal
- Norwegian National Unit for Aging and Health, Vestfold County Hospital, Toensberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Valeska Marinho
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Andrea C Deslandes
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Evandro S Coutinho
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Jerson Laks
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Programa de Pós-Graduação em Biomedicina Translacional (Biotrans), Universidade do Grande Rio (Unigranrio), Duque de Caxias, RJ, Brazil
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17
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Tan YW, Burgess GH, Green RJ. The effects of acculturation on neuropsychological test performance: A systematic literature review. Clin Neuropsychol 2020; 35:541-571. [DOI: 10.1080/13854046.2020.1714740] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Yi Wen Tan
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Gerald H. Burgess
- Salomons Institute for Applied Psychology Canterbury, Christ Church University, Canterbury, United Kingdom
| | - Robin J. Green
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
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18
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Statucka M, Cohn M. Origins Matter: Culture Impacts Cognitive Testing in Parkinson's Disease. Front Hum Neurosci 2019; 13:269. [PMID: 31440150 PMCID: PMC6694800 DOI: 10.3389/fnhum.2019.00269] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022] Open
Abstract
Cognitive decline is common in Parkinson’s disease (PD), and precise cognitive assessment is important for diagnosis, prognosis, and treatment. To date, there are no studies in PD investigating cultural bias on neuropsychological tests. Clinical practice in multicultural societies such as, Toronto Canada where nearly half of the population is comprised of first generation immigrants, presents important challenges as most neuropsychological tools were developed in Anglosphere cultures (e.g., USA, UK) and normed in more homogeneous groups. We examine total scores and rates of deficits on tests of visuoperceptual/visuospatial, attention, memory, and executive functions in Canadians with PD born in Anglosphere countries (n = 248) vs. in Canadians with PD born in other regions (International group; n = 167). The International group shows lower scores and greater rates of deficits on all visuoperceptual and some executive function tasks, but not on attention or memory measures. These biases are not explained by demographic and clinical variables as groups were comparable. Age at immigration, years in Canada, and English proficiency also do not account for the observed biases. In contrast, group differences are strongly mediated by the Historical Index of Human Development of the participants’ country of birth, which reflects economic, health, and educational potential of a country at the time of birth. In sum, our findings demonstrate lasting biases on neuropsychological tests despite significant exposure to, and participation in, Canadian culture. These biases are most striking on visuoperceptual measures and non-verbal executive tasks which many clinicians still considered to be “culture-fair” despite the growing evidence from the field of cross-cultural neuropsychology to the contrary. Our findings also illustrate that socio-development context captures important aspects of culture that relate to cognition, and have important implications for clinical practice.
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Affiliation(s)
- Marta Statucka
- Krembil Brain Institute, Toronto Western Hospital UHN, Toronto, ON, Canada
| | - Melanie Cohn
- Krembil Brain Institute, Toronto Western Hospital UHN, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
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19
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Nielsen TR, Antelius E, Waldemar G. Cognitive Advantages in Adult Turkish Bilingual Immigrants - a Question of the Chicken or the Egg. J Cross Cult Gerontol 2019; 34:115-129. [PMID: 31119462 DOI: 10.1007/s10823-019-09375-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A number of studies suggest both cognitive disadvantages and advantages of bilingualism. In the current study, it is attempted to provide an account of the cognitive advantages associated with bilingualism in a Turkish immigrant population in Denmark.The total sample consisted of 71 middle-aged and older adults born and raised in Turkey who had migrated to Denmark in their teenage years or later. All participants were assessed with a neuropsychological test battery and degree of Turkish-Danish bilingualism was estimated via rater assessment according to a three-point scale. Associations between bilingualism and cognitive function were established for five cognitive domains: executive function, memory, language, visuospatial function and speed. Analysis of covariance was used to estimate the independent association between bilingualism and cognitive function for each cognitive domain. Covariates included education, gender, ethnicity, and proportion of life lived in Denmark. In unadjusted analyses, greater degree of bilingualism was associated with better executive functioning (p < .001), visuospatial functioning (p = .002) and speed (p < .001). However, in analyses adjusted for covariates only executive functioning (p = .01) and task switching ability (p = .01) remained significant, while a trend for better memory function was found in those with a high degree of bilingualism (p = .07).The current study indicates that bilingual Turkish immigrants have better executive functioning and episodic memory compared to Turkish immigrant monolinguals. Whether this is due to the effects of bilingualism or reflects inherent cognitive abilities in those able to acquire bilingualism in later life remains to be resolved.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Center, Department of Neurology, Neuroscience Center, University of Copenhagen, Rigshospitalet, section 6922, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark.
| | - Eleonor Antelius
- Center for Dementia Research, Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Gunhild Waldemar
- Danish Dementia Research Center, Department of Neurology, Neuroscience Center, University of Copenhagen, Rigshospitalet, section 6922, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
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20
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Nielsen TR, Segers K, Vanderaspoilden V, Beinhoff U, Minthon L, Pissiota A, Bekkhus-Wetterberg P, Bjørkløf GH, Tsolaki M, Gkioka M, Waldemar G. Validation of a brief Multicultural Cognitive Examination (MCE) for evaluation of dementia. Int J Geriatr Psychiatry 2019; 34:982-989. [PMID: 30901493 DOI: 10.1002/gps.5099] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 03/17/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aims of this study were to present the psychometric properties of a newly designed cognitive screening instrument, the Multicultural Cognitive Examination (MCE), and to compare it with the Rowland Universal Dementia Assessment Scale (RUDAS) in a multicultural population. METHODS The study was a Western European cross-sectional multicenter study. The MCE consists of four components evaluating separate cognitive functions and was constructed by adding measures of memory, verbal fluency, and visuospatial function to the RUDAS to create a scale with 0 to 100 points. RESULTS A total of 66 patients with dementia and 123 cognitively intact participants were included across six memory clinics; 96 had minority ethnic background, and 93 had majority ethnic background. Moderate to large differences were present between patients with dementia and control participants on all MCE components. The MCE significantly improved diagnostic accuracy compared with using the RUDAS alone, with area under the curves of .918, .984, and .991 for the RUDAS, MCE composite, and demographically corrected composite scores, respectively. Diagnostic accuracy of the MCE did not significantly differ between minority and majority ethnic groups. Across MCE subcomponents, patients with Alzheimer's disease (AD) dementia performed significantly poorer on the memory component compared with those with non-AD dementia. CONCLUSIONS The MCE is a brief cross-cultural cognitive screening instrument that expands evaluation of the cognitive functions covered by the RUDAS, does not require any specialized training, and may be useful for classification of mild dementia or dementia subtypes.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Segers
- Department of Neurology, Brugmann University Hospital, Brussels, Belgium
| | | | - Ulrike Beinhoff
- Ambulantes Gesundheitszentrum der Charité GmbH, Berlin, Germany
| | - Lennart Minthon
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Anna Pissiota
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Peter Bekkhus-Wetterberg
- Memory Clinic, Oslo University Hospital Ullevål and Norwegian Center for Minority Health Research, Oslo University Hospital, Oslo, Norway
| | - Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Magda Tsolaki
- 1st Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mara Gkioka
- 1st Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gunhild Waldemar
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
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21
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Yassuda MS, Carthery-Goulart MT, Cecchini MA, Cassimiro L, Fernandes KD, Baradel RR, Garcia RB, Nitrini R, Della Sala S, Parra MA. Free Recall of Bound Information Held in Short-Term Memory is Unimpaired by Age and Education. Arch Clin Neuropsychol 2019; 35:165-175. [DOI: 10.1093/arclin/acz015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/07/2019] [Accepted: 03/14/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
It has been challenging to identify cognitive markers to differentiate healthy brain aging from neurodegeneration due to Alzheimer’s disease (AD) that are not affected by age and education. The Short-Term Memory Binding (STMB) showed not to be affected by age or education when using the change detection paradigm. However, no previous study has tested the effect of age and education using the free recall paradigm of the STMB. Therefore, the objective of this study was to investigate age and education effects on the free recall version of the STMB test under different memory loads.
Methods
126 healthy volunteers completed the free recall STMB test. The sample was divided into five age bands and into five education bands for comparisons. The STMB test assessed free recall of two (or three) common objects and two (or three) primary colors presented as individual features (unbound) or integrated into unified objects (bound).
Results
The binding condition and the larger set size generated lower free recall scores. Performance was lower in older and less educated participants. Critically, neither age nor education modified these effects when compared across experimental conditions (unbound v. bound features).
Conclusions
Binding in short-term memory carries a cost in performance. Age and education do not affect such a binding cost within a memory recall paradigm. These findings suggest that this paradigm is a suitable cognitive marker to differentiate healthy brain aging from age-related disease such as AD.
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Affiliation(s)
- Mônica Sanches Yassuda
- Department of Neurology, School of Medicine, University of São Paulo, Avenida Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil
- Gerontology, School of Arts, Sciences and Humanities, University of São Paulo. Avenida Arlindo Bettio, São Paulo, Brazil
| | - Maria Teresa Carthery-Goulart
- Department of Neurology, School of Medicine, University of São Paulo, Avenida Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil
- Center for Mathemathics, Computing and Cognition, Federal University of ABC, Avenida dos Estados, Santo André, São Paulo, Brazil
| | - Mario Amore Cecchini
- Department of Neurology, School of Medicine, University of São Paulo, Avenida Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil
| | - Luciana Cassimiro
- Department of Neurology, School of Medicine, University of São Paulo, Avenida Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil
| | - Katarina Duarte Fernandes
- Center for Mathemathics, Computing and Cognition, Federal University of ABC, Avenida dos Estados, Santo André, São Paulo, Brazil
| | - Roberta Roque Baradel
- Center for Mathemathics, Computing and Cognition, Federal University of ABC, Avenida dos Estados, Santo André, São Paulo, Brazil
| | - Ricardo Basso Garcia
- Faculty of Philosophy, Sciences and Languages of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, School of Medicine, University of São Paulo, Avenida Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil
| | - Sergio Della Sala
- Human Cognitive Neuroscience, Psychology, The University of Edinburgh, Old College, South Bridge, Edinburgh, UK
| | - Mario Alfredo Parra
- Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh Campus, Edinburgh, UK
- Universidad Autónoma del Caribe, Calle 90 # 46-112, Barranquilla, Colombia
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22
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Nielsen TR, Segers K, Vanderaspoilden V, Beinhoff U, Minthon L, Pissiota A, Bekkhus-Wetterberg P, Bjørkløf GH, Tsolaki M, Gkioka M, Waldemar G. Validation of a European Cross-Cultural Neuropsychological Test Battery (CNTB) for evaluation of dementia. Int J Geriatr Psychiatry 2019; 34:144-152. [PMID: 30246268 DOI: 10.1002/gps.5002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 09/08/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aims of this study were to establish the diagnostic accuracy of the European Cross-Cultural Neuropsychological Test Battery (CNTB) for dementia in different ethnic populations in Western Europe, to examine its ability to differentiate cognitive impairment profiles for dementia subtypes, and to assess the impact of demographic variables on diagnostic properties. METHODS The study was a Western European cross-sectional multi-center study. A total of 66 patients with dementia and 118 cognitively intact participants were included across six memory clinics; 93 had ethnic minority background and 91 had ethnic majority background. Tests in the CNTB cover global cognitive function, memory, language, executive functions, and visuospatial functions. RESULTS Significant differences with moderate to large effect sizes were present between patients with dementia and control participants on all CNTB measures. Area under the curves (AUC) ranged from .62 to .99 with a mean AUC across all measures of .83. Comparison of ethnic minority and majority groups generally revealed higher sensitivity in the minority group but no significant difference in the mean AUC's across all measures (.84 vs78, P = .42). Comparison of impairment profiles for patients with Alzheimer's disease (AD) and non-AD dementia revealed that AD patients were significantly more impaired on the memory domain, whereas patients with non-AD dementia were more impaired on the executive functions domain. CONCLUSIONS The CNTB was found to have promising cross-cultural diagnostic properties for evaluation of dementia in the targeted minority and majority populations and could represent a valid cross-cultural alternative to other well-established neuropsychological test batteries when assessing patients from these populations.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Segers
- Department of Neurology, Brugmann University Hospital, Brussels, Belgium
| | | | - Ulrike Beinhoff
- Ambulantes Gesundheitszentrum der Charité GmbH, Berlin, Germany
| | - Lennart Minthon
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Anna Pissiota
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Peter Bekkhus-Wetterberg
- Memory Clinic, Oslo University Hospital Ullevål and Norwegian Center for Minority Health Research, Oslo University Hospital, Oslo, Norway
| | | | - Magda Tsolaki
- 1st Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mara Gkioka
- 1st Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gunhild Waldemar
- Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark
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Nielsen TR, Segers K, Vanderaspoilden V, Bekkhus-Wetterberg P, Minthon L, Pissiota A, Bjørkløf GH, Beinhoff U, Tsolaki M, Gkioka M, Waldemar G. Performance of middle-aged and elderly European minority and majority populations on a Cross-Cultural Neuropsychological Test Battery (CNTB). Clin Neuropsychol 2018; 32:1411-1430. [DOI: 10.1080/13854046.2018.1430256] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T. Rune Nielsen
- Danish Dementia Research Center, Department of Neurology, The Neuroscience Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Kurt Segers
- Department of Neurology, Brugmann University Hospital, Brussels, Belgium
| | | | - Peter Bekkhus-Wetterberg
- Memory Clinic, Oslo University Hospital Ullevål, Oslo, Norway
- Norwegian Center for Minority Health Research, Oslo University Hospital, Oslo, Norway
| | - Lennart Minthon
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Anna Pissiota
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ulrike Beinhoff
- Ambulantes Gesundheitszentrum der Charité GmbH, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Magda Tsolaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mara Gkioka
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gunhild Waldemar
- Danish Dementia Research Center, Department of Neurology, The Neuroscience Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Xu H, Zhang Y, Wu B. Association between migration and cognitive status among middle-aged and older adults: a systematic review. BMC Geriatr 2017; 17:184. [PMID: 28818064 PMCID: PMC5561610 DOI: 10.1186/s12877-017-0585-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/09/2017] [Indexed: 12/22/2022] Open
Abstract
Background This study aimed to synthesize the current literature examining the association between migration and cognitive function among middle-aged and older adults. Methods We used the PRISMA as a guideline for this systematic review and searched the following databases: PubMed, CINAHL, EMBASE, and Global Health. Results Twenty-five published studies were included. Twenty-two studies were focused on international migrants, while only 3 studied internal migrants. Fourteen studies were conducted in the United States, followed by UK (n = 2), Israel (n = 2), India (n = 2) and other countries like Canada and Australia. Some studies showed that middle-aged and older migrants demonstrated poorer cognitive function comparing to non-migrants in hosting places; while other studies indicated no association between migration and cognitive function. A higher level of acculturation was associated with better performance on cognitive function tests among migrants. Conclusion It is unclear how or whether migration and cognitive function are related. The quality of current literature suffered from methodological deficiencies. Additional research is needed to examine the linkages using more comprehensive measures of migration and cognitive function.
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Affiliation(s)
- Hanzhang Xu
- Duke University School of Nursing, Durham, NC, USA. .,Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA.
| | - Yinan Zhang
- Chinese Center for Health Education, Beijing, China
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, NY, USA
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25
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Nielsen TR, Waldemar G. Knowledge and perceptions of dementia and Alzheimer's disease in four ethnic groups in Copenhagen, Denmark. Int J Geriatr Psychiatry 2016; 31:222-30. [PMID: 26040575 DOI: 10.1002/gps.4314] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/04/2015] [Accepted: 05/08/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Older people from ethnic minorities are underrepresented in dementia care. Some of the determinants of access to care are knowledge and perceptions of dementia, which may vary between ethnic groups in the population. The aims of this study were to compare knowledge and perceptions of dementia and Alzheimer's disease (AD) among four ethnic groups in Copenhagen, Denmark, and to assess the influence of education and acculturation. METHODS Quantitative survey data from 260 participants were analyzed: 100 native Danish, and 47 Polish, 51 Turkish, and 62 Pakistani immigrants. Knowledge and perceptions of dementia and AD were assessed with the Dementia Knowledge Questionnaire (DKQ) supplemented with two questions from the Alzheimer's Disease Awareness Test (ADAT). Knowledge and perceptions of dementia and AD in the four groups were compared, and the influence of education and acculturation was assessed. RESULTS Group differences were found on the DKQ total score as well as all sub-domains. Turkish and Pakistani people were most likely to hold normalizing and stigmatizing views of AD. Level of education and acculturation had limited influence on dementia knowledge, accounting for 22% of the variance at most and had only minor influence on perceptions of AD. CONCLUSIONS Lacking knowledge and certain perceptions of dementia and AD may hamper access to services in some ethnic minority groups. Ongoing efforts to raise awareness that dementia and AD are not part of normal aging, particularly among Turkish and Pakistani communities, should be a high priority for educational outreach.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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26
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Majlesi AR, Plejert C. Embodiment in tests of cognitive functioning: A study of an interpreter-mediated dementia evaluation. DEMENTIA 2016; 17:138-163. [DOI: 10.1177/1471301216635341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ali Reza Majlesi
- Center for Dementia Research, Linköping University, Sweden; Stockholm University, Sweden
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27
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Nielsen TR, Waldemar G. Effects of literacy on semantic verbal fluency in an immigrant population. AGING NEUROPSYCHOLOGY AND COGNITION 2016; 23:578-90. [DOI: 10.1080/13825585.2015.1132668] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- T. Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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28
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Plejert C, Antelius E, Yazdanpanah M, Nielsen TR. ‘There’s a letter called ef’ on Challenges and Repair in Interpreter-Mediated Tests of Cognitive Functioning in Dementia Evaluations: A Case Study. J Cross Cult Gerontol 2015; 30:163-87. [DOI: 10.1007/s10823-015-9262-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Neuropsychological tests for assessment of healthy ethnic minority elderly population. Int Psychogeriatr 2013; 25:1203-4. [PMID: 23432805 DOI: 10.1017/s1041610213000100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
I read with great interest the paper “Comparison of performance on three neuropsychological tests in healthy Turkish immigrants and Danish elderly” authored by Nielsen et al. (2012) in International Psychogeriatrics. In their study, 73 Turkish with lower educational level and 36 Danish older subjects were assessed on the Recall of Pictures Test (RPT), Clock Reading Test (CRT), and supermarket fluency (SF). They found significant effects of age and years of education on the Turkish performance, and significant differences between the Turkish and Danish samples on the CRT and SF performances, but not on the RPT. Despite these differences in performance, the authors suggested that these three tests are important neuropsychological instruments for the assessment of dementia in ethnic minority people. As the elderly population is increasing globally, the need for reliable cross-cultural measures suitable to assess this population at risk to develop dementia is also growing. In particular, normative data need to be appropriated ethnically and in terms of educational level, for example, to determine valid cut-offs for mild cognitive impairment (MCI) and patients with dementia. I would like to provide evidence on further neuropsychological instruments sensitive to memory and language deficits for different ethnic groups of Portuguese-speaking Brazilian individuals within the large geographical area of Brazil. Although they all speak Portuguese, they are of different ethnic background and therefore differ in their educational levels significantly. We assessed 411 healthy older subjects (61 to 85 years old and 0 to 17 years of education) from different states in Brazil on the Hopkins Verbal Learning Test – Revised (HVLT-R; Brandt and Benedict, 2001), a verbal episodic memory test, and on the Brief Visuospatial Memory Test – Revised (BVMT-R; Benedict, 1997), a visuospatial episodic memory test (Miotto et al., 2012). The results showed a significant influence of age on both tests, as well as in the original American normative data. Education also showed significant influence on the results, possibly due to the different levels of education of the sample, including illiterate subjects. Gender had no influence on subjects' tests results.
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Nielsen TR, Jørgensen K. Visuoconstructional abilities in cognitively healthy illiterate Turkish immigrants: a quantitative and qualitative investigation. Clin Neuropsychol 2013; 27:681-92. [PMID: 23379740 DOI: 10.1080/13854046.2013.767379] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Assessment of visuospatial function is an integral part of most neuropsychological assessments and is frequently assessed by visuoconstructional tests. A significant impact of limited schooling and illiteracy has been found on numerous neuropsychological tests and it can be difficult to interpret test results from illiterate individuals. In this study, quantitative and qualitative aspects of performance of elderly cognitively healthy illiterate and literate Turkish immigrants were compared on five commonly used visuoconstructional tests. Significantly poorer performances of illiterate compared to literate subjects were found in copying of two- and three-dimensional geometric designs, and in Clock Drawing Test performance. A systematic qualitative analysis found lacking three-dimensionality, "curved angles", omissions, distorted relation between elements, and spatial disorganization to be common error types in illiterate subjects. Performances were not found to be influenced by duration of residence in Denmark or level of acculturation. The results warrant caution in the interpretation of visuoconstructional test performances in illiterate subjects, as they can easily be misinterpreted as signs of cognitive dysfunction.
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Affiliation(s)
- T Rune Nielsen
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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