Comparative study of the cognitive performance of Greek Australian and Greek national elderly: Implications for neuropsychological practice

Exploring How Sociocultural Factors Affect the Experience of Completing Neuropsychological Assessments Within Older Greek-Australians

OBJECTIVE

The field of cultural neuropsychology has grown exponentially over the last three decades. With a limited culturally informed evidence base to guide neuropsychological practice, the acceptability of existing paradigms has been called into question when applied to culturally diverse and educationally disadvantaged groups. This qualitative study aimed to explore the experiences of Greek Australian older adults who underwent a cognitive assessment to better understand potential barriers and facilitators to engagement and to improve neuropsychological assessment outcomes.

METHOD

Semi-structured interviews were developed to explore cultural attitudes and contextual factors relating to neuropsychological assessment. Interviews were conducted by Greek-speaking neuropsychologists using a sample of 10 healthy elderly Greek Australians following the completion of a comprehensive neuropsychological assessment. Data were analyzed using a phenomenological design within a critical realist framework.

RESULTS

Analysis revealed the emergence of three broad themes: sociocultural factors, experiences within the broader medical system, and the assessment experience. Engagement with cognitive assessment was influenced by several factors, including rapport building, understanding of the assessment, and use of inappropriate tests. Furthermore, level and quality of education, sex differences, language barriers, acculturation, previous experiences of prejudice, anxiety, and a preference for Greek-speaking clinicians were additional factors reported to affect the client experience and validity of assessment outcomes.

CONCLUSION

Neuropsychological assessment is, in part, affected by culturally reinforced attitudes. Failing to adjust the relationship between the clinician and client, test environment, style of communication, and the use of culturally inappropriate tests is likely to affect the validity of assessment outcomes.

Comparing the cognitive functioning of middle-aged and older foreign-origin population in Estonia to host and origin populations

Background

In migration and health research, the healthy migrant effect has been a common finding, but it usually pertains to specific contexts only. Existing findings are inconsistent and inconclusive regarding the cognitive functioning of the (aging) foreign-origin population relative to the populations of their host and sending countries. Moreover, this comparison is an understudied design setting.

Objective

We analyze the outcomes and associations of cognitive functioning outcomes of the non-institutionalized middle-aged and older population, comparing the Russian-origin population in Estonia with Estonians in Estonia and Russians in Russia in a cross-sectional design. We aim to estimate the (long-term) effects of migration on cognitive functioning in later life, contextualizing the findings in previous research on the healthy migrant effect.

Data and methods

We use data from face-to-face interviews conducted within the SHARE Estonia (2010-2011) and SAGE Russia (2007-2010) surveys. Respondents aged 50+ living in urban areas were grouped by self-identified ethnicity, including 2,365 Estonians, 1,373 Russians in Estonia, and 2,339 Russians in Russia (total N = 6,077). Cognitive functioning was measured using a 25-percentile cut-off threshold for the results of two cognition outcomes - immediate recall and verbal fluency - and the odds of impairment were estimated using binary logistic regression.

Results

Russian men and women living in Estonia have significantly higher odds of impairment in immediate recall than Estonian men and women, though they do not differ from Russians in Russia in the final adjusted models. The differences between all groups are non-significant if age at migration is considered. There are no significant differences between the groups in verbal fluency.

Conclusion

Contrary to the commonly found healthy migrant effect, the middle-aged and older foreign-origin population in Estonia fares initially worse than the native population in the immediate recall outcome, but does not differ from their sending country population, possibly due to Russia's higher mortality rate and therefore the selective survival of healthier people. Different results depending on the cognitive functioning outcome suggest that migration may affect temporary memory more than crystallized knowledge. However, there are no differences between the groups if defined based on age at migration, which suggests that the age profile differences explain most of the groups' differences in cognitive functioning.

Immigration Transition and Cognitive Symptoms During Menopausal Transition

Many studies have been conducted to investigate the effect of cultural influences on menopausal symptoms; however, associations between immigration transition and cognitive symptoms have rarely been uncovered. This secondary analysis aimed to determine these associations among 1,054 midlife women in the United States using the data from two national Internet surveys. The surveys included multiple questions on immigration transition, health and menopausal status, and the Cognitive Symptom Index for Midlife Women. The data analysis was performed using descriptive and inferential statistics including hierarchical multiple regression analyses. Nonimmigrants had larger numbers and higher severity scores of total cognitive symptoms than immigrants (p < .001). Immigration status explained 1.28% of the total variances in the total numbers and 1.46% of the total variances in the total severity scores of total cognitive symptoms (p < .001). The study supported significant associations between immigration transition and cognitive symptoms of women at midlife.

Review of the strengths and difficulties questionnaire translated into languages spoken by children and adolescents of refugee background

The Strengths and Difficulties Questionnaire (SDQ), routinely used to screen for children's and adolescents' emotional and behavioural problems, has been translated into at least 80 languages. As children of refugee background are particularly vulnerable to mental health problems resulting from their refugee experiences, this review examines whether SDQs translated into languages spoken by major refugee groups are validated and culturally equivalent to the original SDQ and sensitive to change following interventions. No reviewed studies of translated SDQs reported on challenges in achieving conceptual and linguistic equivalence in translation. Factor analysis predominantly showed structural inequivalence with the original 5-factor model, suggesting translated SDQ subscales may measure different constructs. Predictive equivalence findings tended to show somewhat higher sensitivity for detecting disorder than the original SDQ's low sensitivity, and somewhat lower specificity. Outcome studies yielded equivocal results with refugee and immigrant groups. SDQ items do not detect the psychological sequelae of trauma; hence it is recommended that the SDQ be used with caution to screen refugee children, with a follow-up clinical interview for verification. Cross-cultural qualitative research is needed into parents' and adolescents' interpretation of translated SDQ items.

Association between migration and cognitive status among middle-aged and older adults: a systematic review

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.

Validation of the K6/K10 Scales of Psychological Distress and Their Optimal Cutoff Scores for Older Koreans

This study aims to assess the psychometric properties of the Korean versions of the Kessler 6 and 10 (K-K6/K10) to validate the two scales in relation to the Korean versions of the Geriatric Depression Scale-Short Form (K-GDS-SF) and the Center for Epidemiological Studies Depression Scale (K-CES-D) and to propose optimal cutoff scores appropriate for the elderly Korean population ( n = 331). Psychometric performance was assessed with sensitivity, specificity, receiver operating characteristic curves, and area under the receiver operating characteristic curve. Cutoff scores were estimated from the Youden index, the closest-to-(0,1), and the balanced score. This study found that the K-K6 and K-K10 appeared to be robust screening tools, with the K-CES-D and K-GDS-SF as reference measures. The cutoff scores for the Korean senior population are proposed to be 12/13 for the K-K6 and 20/21 for the K-K10. This study indicates that the K6 and K10 can be valid and reliable screening tools of psychological distress for Korean seniors and may also be used among the Korean American elderly in the United States for both clinical and research purposes.

Diagnostic memory assessment in Italian-born Australians

BACKGROUND

In many English-speaking countries neuropsychological assessment of non-English speakers is often performed in English or through an interpreter. Relying on interpreters often involves unstandardized and ad hoc translations of tests which may limit valid assessment.

METHODS

In a sample of 75 Italian-born elderly Australians from the general community (48 women and 27 men, aged 56-90 years) we administered standardized and normed psychological tests in both English (WMS-III, WAIS-III, BNT, Schonell Graded Word Reading Test) and Italian (Milan Overall Dementia Assessment, MODA). We examined the hypothesis that long-term retrieval ability assessed in English is primarily influenced by cognitive abilities assessed in Italian and by English language competence.

RESULTS

Regression analysis showed that the strongest predictor of long-term retrieval in English was long-term retrieval in Italian (R2 = 0.229, F(72) = 29.12, p<0.01). After inclusion of an estimate of general cognitive ability in Italian, English language competence failed to add significantly to variance explained in memory tested in English (p > 0.05).

CONCLUSIONS

Results of the present study support the view that long-term retrieval memory is not significantly affected by second language proficiency after control of cognitive ability assessed in Italian. As a consequence, if an Italian-born elder Australian with English as a second language scores poorly on a diagnostic memory test, this result may be due to cognitive impairment rather than language issues. If, instead, we attribute poor performance to language competence, an increased risk of false negative diagnosis may arise.

Neuropsychological testing of culturally and linguistically diverse individuals: the case of Greek-speaking individuals

PURPOSE OF REVIEW

The aim of this review is to update clinicians and researchers regarding neuropsychological tools that have been normed in Greece, thereby assisting them to improve diagnostic accuracy when undertaking neuropsychological assessment of Greek-speaking individuals.

RECENT FINDINGS

A growing number of neuropsychological tests of cognition have been normed in the healthy Greek adult population and the findings reported in the English-language literature. Neuropsychological Greek normative studies have revealed performance differences in Greek speakers. In general, research findings indicate that population-specific norms are required for accurate neuropsychological assessment of the Greek adult population.

SUMMARY

Validating neuropsychological tests of cognition in healthy Greek adults improves clinicians' and researchers' ability to accurately assess, diagnose and manage Greek individuals with cognitive disorders. Normative studies in Greek-speaking clinical populations and studies examining performance differences between native Greek speakers and the Greek diaspora are directions for future research.