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Tsai S, Ma S, Nielsen TR, Calia C. Assessment of Dementia in Minority Ethnic Groups in Scotland: Results of a Survey of Cognitive Specialists. Alzheimer Dis Assoc Disord 2024; 38:85-90. [PMID: 38315885 DOI: 10.1097/wad.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Minority ethnic groups (MEGs) in Europe receive suboptimal dementia evaluation, yet related research in Scotland is lacking. This research examined the evaluation of dementia in MEGs in Scotland and compared it with previous research to highlight the changes in the clinical evaluation of dementia over the decade. DESIGN AND SETTING A self-administered survey was created online and emailed to 14 Heads of the boards under the Scottish National Health Service and dementia-associated settings and organizations. RESULTS Most surveyed centers (85.6%) received MEG referrals. Although 92.9% of the centers used professional translators when needed, 85.7% thought assessing dementia in MEGs was difficult, mostly due to the suitability of test instruments and rating scales and patients' linguistic abilities. Very few found their skills to be good in evaluating MEGs. There was no mention of specialized dementia services for MEGs. CONCLUSIONS The lack of culturally appropriate instruments and specialized dementia services reveals that the services are not ready to meet the demand for evaluating patients from diverse cultural and language backgrounds. Inadequate clinical evaluation may lead to misdiagnoses. Therefore, although significant work has been carried out in the past few years, improvements must be continued to enhance the current practices and apply suitable evaluation methods for MEGs.
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Affiliation(s)
- Somying Tsai
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, Edinburgh, UK
| | - Shuning Ma
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, Edinburgh, UK
| | - Thomas Rune Nielsen
- Department of Psychology, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Clara Calia
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, Edinburgh, UK
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Pattillo M, Stieglitz S, Angoumis K, Gottlieb N. Racism against racialized migrants in healthcare in Europe: a scoping review. Int J Equity Health 2023; 22:201. [PMID: 37770879 PMCID: PMC10540333 DOI: 10.1186/s12939-023-02014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Racism is frequently mentioned as a social determinant of migrants' health and a barrier to health services. However, in the European context, racism and its impact on racialized migrants' access to healthcare is remarkably under-researched. This scoping review makes a first step toward filling this void by mapping the existing literature on racial and ethnic discrimination against racialized migrants in healthcare in Europe, identifying evidence gaps, and offering recommendations for future research on this topic. METHODS Following PRISMA guidelines, four databases were searched for empirical studies published in English between 1992 and 2022. Studies were included if they report findings on manifestations, experiences and/or impacts of racial or ethnic discrimination against racialized migrants in a healthcare setting in a European country. They were summarized by study characteristics (geographical scope, study design, research question and measures) and research findings were synthesized. RESULTS Out of 2365 initial hits, 1724 records were included in the title/abstract-screening, 87 records in the full text-screening, and 38 records in the data extraction. For many country and healthcare contexts, evidence on racism in healthcare is lacking. Most studies apply an explorative qualitative research design; comparability and generalizability of research results are low. Our analysis furthermore shows a near-exclusive research focus on racism on the interpersonal level as compared to institutional and structural levels. Our synthesis of study results identifies three interrelated ways in which racism manifests in and impacts migrants' healthcare: 1) general anti-migration bias, 2) health- and healthcare-related prejudice, and 3) differential medical treatment. CONCLUSIONS Our review underscores how racism reinforces inequities in healthcare access and quality for racialized migrants. It also highlights the need for more research on racism in Europe across a greater scope of country contexts, healthcare settings and migrant/racialized categories in order to understand specific forms of racism and capture race as a context-contingent social construct. It is critical that future research includes the consideration of individual-level racism as embedded in racism on institutional and structural levels. Methods and insights from other disciplines may help to critically examine concepts in light of underlying historical, sociopolitical and socioeconomic processes and structures, and to improve methods for researching racialization and racism in healthcare.
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Affiliation(s)
- Mia Pattillo
- Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10021, USA
| | - Sigsten Stieglitz
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Konstantinos Angoumis
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany
| | - Nora Gottlieb
- Bielefeld School of Public Health, Universitätsstrasse 25, 33615, Bielefeld, Germany.
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3
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The Naming Assessment in Multicultural Europe (NAME): Development and Validation in a Multicultural Memory Clinic. J Int Neuropsychol Soc 2023; 29:92-104. [PMID: 35039100 DOI: 10.1017/s135561772100148x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Traditional naming tests are unsuitable to assess naming impairment in diverse populations, given the influence of culture, language, and education on naming performance. Our goal was therefore to develop and validate a new test to assess naming impairment in diverse populations: the Naming Assessment in Multicultural Europe (NAME). METHOD We carried out a multistage pilot study. First, we generated a list of 149 potentially suitable items - e.g. from published cross-linguistic word lists and other naming tests - and selected those with a homogeneous age of acquisition and word frequency across languages. We selected three to four colored photographs for each of the 73 remaining items; 194 controls selected the most suitable photographs. Thirteen items were removed after a pilot study in 15 diverse healthy controls. The final 60-item test was validated in 39 controls and 137 diverse memory clinic patients with subjective cognitive impairment, neurological/neurodegenerative disease or psychiatric disorders in the Netherlands and Turkey (mean age: 67, SD: 11). Patients were from 15 different countries; the majority completed primary education or less (53%). RESULTS The NAME showed excellent reliability (Spearman-Brown coefficient: 0.95; Kuder-Richardson coefficient: 0.94) and robust correlations with other language tests (ρ = .35-.73). Patients with AD/mixed dementia obtained lower scores on most (48/60) NAME items, with an area under the curve of 0.88. NAME scores were correlated with age and education, but not with acculturation or sex. CONCLUSIONS The NAME is a promising tool to assess naming impairment in culturally, educationally, and linguistically diverse individuals.
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Riedel O, Braitmaier M, Langner I. Dementia in health claims data: The influence of different case definitions on incidence and prevalence estimates. Int J Methods Psychiatr Res 2022:e1947. [PMID: 36168670 DOI: 10.1002/mpr.1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The epidemiology of dementia subtypes including Alzheimer's disease (AD) and vascular dementia (VD) and their reliance on different case definitions ("algorithms") in health claims data are still understudied. METHODS Based on health claims data, prevalence estimates (per 100 persons), incidence rates (IRs, per 100 person-years), and proportions of AD, VD, and other dementias (oD) were calculated. Five algorithms of increasing strictness considered inpatient/outpatient diagnoses (#1, #2), antidementia drugs (#3) or supportive diagnostics (#4, #5). RESULTS Algorithm 1 detected 213,409 cases (#2: 197,400; #3: 48,688; #4: 3033; #5: 3105), a prevalence for any dementia of 3.44 and an IR of 1.39 (AD: 0.80/0.21, VD: 0.79/0.31). The prevalence decreased by algorithms for any dementia (#2: 3.19; #3: 0.75; #4: 0.04; #5: 0.05) as did IRs (#2: 1.13; #3: 0.18; #4: 0.05, #5: 0.05). Algorithms 1-2, and 4-5 revealed similar proportions of AD (23.3%-26.6%), VD (19.9%-23.2%), and oD (53.1%-53.8%), algorithm 3 estimated 45% (AD), 12.1% (VD), and 43.0% (oD). CONCLUSIONS Health claims data show lower estimates of AD than previously reported, due to markedly lower prevalent/incident proportions of patients with corresponding codes. Using medication in defining dementia potentially improves estimating the proportion of AD while supportive diagnostics were of limited use.
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Affiliation(s)
- Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Malte Braitmaier
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Ingo Langner
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Torkpoor R, Frolich K, Nielsen RT, Londos E. Diagnostic Accuracy of the Swedish Version of the Rowland Universal Dementia Assessment Scale (RUDAS-S) for Multicultural Cognitive Screening in Swedish Memory Clinics. J Alzheimers Dis 2022; 89:865-876. [PMID: 35964182 PMCID: PMC9535584 DOI: 10.3233/jad-220233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: The number of people with a migration background and dementia is increasing in Europe. All patients with suspected dementia have the right to an appropriate cognitive assessment and correct diagnosis for optimal treatment and support. Rowland Universal Dementia Assessment Scale (RUDAS) cognitive screening instrument is less affected by language, culture, and educational background, and adapted for use in multicultural populations. Objective: To compare the diagnostic accuracy of RUDAS-S to the Swedish version of Mini-Mental State Examination (MMSE-SR) for detecting dementia in a multicultural group of outpatients in Swedish memory clinics. Methods: We tested 123 outpatients (36 nonnative Swedish), in 4 memory clinics in Southern Sweden with RUDAS-S to supplement the usual cognitive assessment. Results: RUDAS-S had moderate to good diagnostic performance for detecting dementia in a multicultural population in Sweden, with an area under the receiver operating characteristic curve (AUC) of 0.81. At a cutoff score <25 its sensitivity was 0.92, specificity 0.60, and accuracy 76%. The AUC for the MMSE-SR was 0.79. At a cutoff score <23 its sensitivity was 0.65, specificity 0.81, and accuracy 73%. Conclusion: RUDAS-S is at least as accurate as MMSE-SR for detecting dementia in memory clinics in Sweden and can be used for all patients undergoing a cognitive assessment, irrespective of their cultural, language, and educational background. However, there is a need for other cross-cultural cognitive tests to complement RUDAS-S to extend cognitive examination.
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Affiliation(s)
- Rozita Torkpoor
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.,Memory Clinic, Skane University Hospital, Malmö, Sweden
| | - Kristin Frolich
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Rune T Nielsen
- Danish Dementia Research Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.,Memory Clinic, Skane University Hospital, Malmö, Sweden
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Torkpoor R, Fioretos I, Essén B, Londos E. “I Know Hyena. Do you Know Hyena?” Challenges in Interpreter-Mediated Dementia Assessment, Focusing on the Role of the Interpreter. J Cross Cult Gerontol 2022; 37:45-67. [PMID: 35258799 PMCID: PMC8930958 DOI: 10.1007/s10823-021-09439-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 10/25/2022]
Abstract
AbstractDementia assessment requires functional communication and interaction between healthcare professionals and the patient being assessed. These can be affected by the requirement for an interpreter to communicate with the patient. The purpose of this study was to elucidate the interactions between patient, healthcare professionals and interpreter, focusing on the role of the interpreter and the challenges that may arise in interpreter-mediated dementia assessment. The study had an ethnographic design in which the data consisted of audio and video recordings of 19 dementia assessments conducted in the presence of an interpreter. The data were analyzed using the constant comparative method. The results showed that the interpreter could affect the patient’s performance and results during the dementia assessment. The interpreter could alter the meaning and content of what was communicated, sometimes change information and instructions exchanged between the patient and healthcare professionals, could avoid interpreting everything being said, and occasionally made their own corrections to what was being communicated. This occurred mainly because of the interpreter’s lack of linguistic skills and the interpreter failing to adhere to the ethical guidelines governing their profession. These challenges could also occur when the interpreter was not familiar with the context of dementia assessment. Alterations made by the interpreter to what was being communicated could lead to incorrect evaluation of the patient’s cognitive abilities and health status. This, in turn, may lead to misjudgment of the patient’s remaining resources and symptoms and their required treatment and support.
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Affiliation(s)
- Rozita Torkpoor
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
- Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - Ingrid Fioretos
- Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Birgitta Essén
- International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden
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Lynnerup C, Rossing C, Sodemann M, Ryg J, Pottegård A, Nielsen D. Health care professionals' perspectives on medication safety among older migrants with cognitive impairment exposed to polypharmacy – A qualitative explorative study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100128. [PMID: 35478514 PMCID: PMC9032447 DOI: 10.1016/j.rcsop.2022.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Older migrants with cognitive impairment exposed to polypharmacy constitute a vulnerable group of patients. To our knowledge, evidence on medication safety among this patient group with multiple risk factors is lacking. Objectives To explore the perspectives of health care professionals on medication safety among older migrants with cognitive impairment taking five or more medications daily. Methods A total of 34 health care professionals (general practitioners and hospital-, community pharmacy-, and home care staff) participated in the study, comprising nine focus groups and one semi-structured interview, and shared their perspectives on medication safety among older migrants with cognitive impairment exposed to polypharmacy. The analysis was inspired by Revsbæk and Tanggaard's “Analyzing in the Present” and was followed by systematic text condensation. Results Three main themes emerged: (i) the importance of relationships in medication safety, (ii) culture and finances as risk factors, and (iii) the health care system as a risk factor. Subthemes and codes were related within and across main themes and revealed a high level of complexity within the barriers to medication safety. Some of these barriers were closely related to characteristics of this specific patient group, while others were more general barriers that also affected other patient groups. Participants found that these more general problems were complicated further by language barriers and cognitive impairment when working with this patient group. Conclusion Health care professionals across various sectors and professions experienced several barriers that threatened medication safety among older migrants with cognitive impairment exposed to polypharmacy. Closer collaboration between health care professionals, patients, and relatives is required to improve medication safety.
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Affiliation(s)
- Camilla Lynnerup
- Migrant Health Clinic - Research Unit for Infectious Diseases, Odense University Hospital, Odense C, Denmark
- Centre for Global Health, University of Southern Denmark, Odense C, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense, Denmark
- University of Southern Denmark, Odense C, Denmark
- Corresponding author at: Migrant Health Clinic, Odense University Hospital, J.B. Winsløws Vej 4, DK-5000 Odense C, Denmark.
| | | | - Morten Sodemann
- Migrant Health Clinic - Research Unit for Infectious Diseases, Odense University Hospital, Odense C, Denmark
- Centre for Global Health, University of Southern Denmark, Odense C, Denmark
- University of Southern Denmark, Odense C, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense C, Denmark
| | - Anton Pottegård
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Dorthe Nielsen
- Migrant Health Clinic - Research Unit for Infectious Diseases, Odense University Hospital, Odense C, Denmark
- Centre for Global Health, University of Southern Denmark, Odense C, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense C, Denmark
- University of Southern Denmark, Odense C, Denmark
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Risk factors, ethnicity and dementia: A UK Biobank prospective cohort study of White, South Asian and Black participants. PLoS One 2022; 17:e0275309. [PMID: 36223334 PMCID: PMC9555673 DOI: 10.1371/journal.pone.0275309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/14/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Our knowledge of the effect of potentially modifiable risks factors on people developing dementia is mostly from European origin populations. We aimed to explore if these risk factors had similar effects in United Kingdom (UK) White, South Asian and Black UK Biobank participants recruited from 2006-2010 and followed up until 2020. METHODS We reviewed the literature to 25.09.2020 for meta-analyses identifying potentially modifiable risk factors preceding dementia diagnosis by ≥10 years. We calculated prevalence of each identified risk factor and association with dementia for participants aged ≥55 at registration in UK Biobank. We calculated hazard ratios using Cox regression for each risk factor, stratified by ethnic group, and tested for differences using interaction effects between each risk factor and ethnicity. FINDINGS We included education, hearing loss, hypertension, obesity, excess alcohol consumption, physical inactivity, smoking, high total cholesterol, depression, diabetes, social isolation, and air pollution as risks. Out of 294,162 participants, there were 287,806 White, 3590 South Asian and 2766 Black people, followed up for up to 14.8 years, with a total follow-up time of 3,392,095 years. During follow-up, 5,972 people (2.03%) developed dementia. Risk of dementia was higher in Black participants than White participants (HR for dementia compared to White participants as reference 1.43, 95% CI 1.16-1.77, p = 0.001) but South Asians had a similar risk. Association between each risk factor and dementia was similar in each ethnic group with no evidence to support any differences. INTERPRETATION We find that Black participants were more likely to develop dementia than White participants, but South Asians were not. Identified risk factors in White European origin participants had a similar effect in Black and South Asian origin participants. Volunteers in UK Biobank are not representative of the population and interaction effects were underpowered so further work is needed.
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Sagbakken M, Ingebretsen R, Spilker RS. How to adapt caring services to migration-driven diversity? A qualitative study exploring challenges and possible adjustments in the care of people living with dementia. PLoS One 2020; 15:e0243803. [PMID: 33351820 PMCID: PMC7755196 DOI: 10.1371/journal.pone.0243803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Research on how services can be adapted to meet the needs of people with dementia with an immigrant or minority ethnic background is scarce. Several approaches have been discussed: offering services adapted to language and culture, adding bilingual staff to mainstream services, and providing cultural awareness and sensitivity training to health personnel in mainstream services. This study seeks to develop more knowledge of challenges and possible adjustments related to receive and provide public care for people living with dementia with an immigrant or minority ethnic background. METHODS AND MATERIALS Through a qualitative design, including 19 single interviews, 3 dyad interviews and 16 focus groups with older immigrants, relatives of immigrants with dementia, and health personnel, we explored experiences and perceptions related to receive and provide care for people with immigrant backgrounds living with dementia in Norway. The analysis were conducted inspired by Kvale and Brinkmann's three contexts of interpretations. RESULTS Challenges related to language and communication were emphasized as the most fundamental barrier to provide adjusted care; exemplified through cases of isolation and agitation among patients not able to communicate. Care services framed by the majority culture creates feelings of alienation and exclusion. Not having access to specific types of food and the possibility to listen to songs, music, literature or TV programs representing a familiar and homely context may prevent use of public dementia care. Findings also point to differences in moral views regarding life-prolonging treatment in advanced stages of dementia. CONCLUSION This study argues that to be able to address challenges related to migration-driven diversity one needs holistic care services that addresses individual as well as socio-cultural needs. A linguistically and culturally diverse workforce may represent an important resource, potentially reducing some of the problems related to communication. On a structural level, it seems necessary to allocate more time and resources, including the use of interpreters, when assessing and getting to know persons with dementia with another linguistic and cultural background. However, shared language does not guarantee understanding. Rather, one needs to become familiar with each person's way of being ill, on a cultural and individual level, including changes occurring living with progressive dementia. Getting to know a person and his/her family will also facilitate the possibility to ensure a more familiar and homely context. Thus, continuity in relation to language and culture is important, but continuity in relations may be equally important ensuring that people with dementia receive equitable care.
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Affiliation(s)
- Mette Sagbakken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Reidun Ingebretsen
- Norwegian Social Research (NOVA), OsloMet - Oslo Metropolitan University, Oslo, Norway
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Giebel C. "Current dementia care: what are the difficulties and how can we advance care globally?". BMC Health Serv Res 2020; 20:414. [PMID: 32398073 PMCID: PMC7218536 DOI: 10.1186/s12913-020-05307-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia is a growing global public health concern, with post-diagnostic care often very limited. Depending on where people live, both within a country and depending on high-, middle-, and low-income countries, they might also face barriers in accessing the right care at the right time. Therefore, it is important to highlight recent evidence on the facilitators and barriers to dementia care, but also evidence on how to move dementia care forward. MAIN TEXT Current dementia care is subject to several inequalities, including living in rural regions and being from a minority ethnic background. Evidence in this collection highlights the issues that both people living with dementia and unpaid carers are facing in accessing the right care, with evidence from Australia, Canada, Uganda, to the Netherlands, and further afield. Providing improved dementia-specific training to health care professionals and supporting medication and reablement interventions have been identified as possible ways to improve dementia care for all. CONCLUSIONS This special issue focuses on recent evidence on inequalities in dementia care across the globe and how dementia care can be advanced in various areas.
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Affiliation(s)
- Clarissa Giebel
- National Institute of Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC), Liverpool, UK.
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.
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Narme P, Maillet D, Palisson J, Le Clésiau H, Moroni C, Belin C. How to Assess Executive Functions in a Low-Educated and Multicultural Population Using a Switching Verbal Fluency Test (the TFA-93) in Neurodegenerative Diseases? Am J Alzheimers Dis Other Demen 2019; 34:469-477. [PMID: 30827122 PMCID: PMC10653371 DOI: 10.1177/1533317519833844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few neuropsychological tests are available to assess executive dysfunction in low-educated and multicultural populations. To address this issue, the TFA-93, a switching verbal fluency test to assess cognitive flexibility, was administered to 70 healthy controls, 57 patients with a clinical diagnosis of Alzheimer's disease, and 21 with a clinical diagnosis of a neurodegenerative disease associated with frontal disorders. Most of the participants were low-educated and nonnative French speakers. The TFA-93 comprises 2 categorical fluency tasks (animals and fruits) and a fluency task in which participants have to switch between animals and fruits. Correct responses and errors were collected, and a flexibility index expressed the switching cost. Results showed that correct responses were lower, and the switching cost was greater in both patient groups. In low-educated and multicultural populations, the TFA-93 seems to be a good alternative to assess flexibility compared to the standard neuropsychological tools based on academic abilities.
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Affiliation(s)
- Pauline Narme
- Equipe Neuropsychologie du Vieillissement (EA 4468), Institut de Psychologie, Université Paris Descartes, Boulogne-Billancourt, France
- Laboratoire Mémoire, Cerveau et Cognition (EA 7536), Institut de Psychologie, Université Paris Descartes, Boulogne-Billancourt, France
| | - Didier Maillet
- Service de Neurologie, Hôpital Saint-Louis APHP, Université Paris Diderot, Paris, France
- Laboratoire PSITEC, EA 4072, UFR de psychologie, Université de Lille, Pont de Bois, Villeneuve d’Ascq, France
| | - Juliette Palisson
- Unité Fonctionnelle Mémoire et Maladies Neurodégénératives, Service de Neurologie, CHU Avicenne, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny, France
| | - Hervé Le Clésiau
- Centre d’Examens de Santé de la Caisse primaire d’Assurance Maladie de la Seine-Saint-Denis, Bobigny, France
| | - Christine Moroni
- Laboratoire PSITEC, EA 4072, UFR de psychologie, Université de Lille, Pont de Bois, Villeneuve d’Ascq, France
| | - Catherine Belin
- Equipe Neuropsychologie du Vieillissement (EA 4468), Institut de Psychologie, Université Paris Descartes, Boulogne-Billancourt, France
- Service de Neurologie, Hôpital Saint-Louis APHP, Université Paris Diderot, Paris, France
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Franzen S, van den Berg E, Kalkisim Y, van de Wiel L, Harkes M, van Bruchem-Visser RL, de Jong FJ, Jiskoot LC, Papma JM. Assessment of Visual Association Memory in Low-Educated, Non-Western Immigrants with the Modified Visual Association Test. Dement Geriatr Cogn Disord 2019; 47:345-354. [PMID: 31319408 PMCID: PMC6878732 DOI: 10.1159/000501151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neuropsychological tests are influenced by culture, language, level of education, and literacy, but there are few cognitive tests of which the applicability in ethnic minority populations has been studied. OBJECTIVES The aim of this study was to assess the reliability and validity of the Visual Association Test (VAT), a test of visual association memory, in a non-Western, low-educated memory clinic population. Additionally, a modified version of the VAT using colored photographs instead of line drawings was studied (mVAT). METHOD Both the original VAT and the mVAT were administered to non-Western immigrants (n = 73) from 2 multicultural memory clinics in Rotterdam, The Netherlands, and a control sample of non-demented Turkish elderly (n = 14) with low education levels (32 and 29% illiterate, respectively). RESULTS Both the VAT and the mVAT were able to discriminate persons with and without dementia (area under the curve: VAT, 0.77-0.88; mVAT, 0.85-0.95). The mVAT had more homogeneous item difficulty levels than the VAT. Administration of parallel versions of the VAT and the mVAT within the same person revealed higher scores on the mVAT (Z = -3.35, p = 0.001). CONCLUSIONS The mVAT is a reliable and valid measure of memory in non-Western immigrants. Clinicians and researchers should be aware that the memory performance of immigrants may be systematically underestimated when using tests with black-and-white line drawings, such as the original VAT.
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Affiliation(s)
- Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands,
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Yuled Kalkisim
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Department of Medical Psychology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Lotte van de Wiel
- Department of Medical Psychology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Marleen Harkes
- Department of Geriatric Medicine, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Frank Jan de Jong
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lize C. Jiskoot
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janne M. Papma
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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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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Tillmann J, Just J, Schnakenberg R, Weckbecker K, Weltermann B, Münster E. Challenges in diagnosing dementia in patients with a migrant background - a cross-sectional study among German general practitioners. BMC FAMILY PRACTICE 2019; 20:34. [PMID: 30803438 PMCID: PMC6388491 DOI: 10.1186/s12875-019-0920-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/14/2019] [Indexed: 11/10/2022]
Abstract
Background Diagnosing dementia, a syndrome affecting 35.6 million people worldwide, can be challenging, especially in patients with a migrant background. Language barriers and language-based diagnostic tools, cultural differences in the perception of the syndrome as well as restricted access to healthcare can influence medical care. For the first time in Germany, this study investigates whether German general practitioners (GPs) feel prepared to meet the diagnostic needs of these patient groups and whether there are challenges and support needs. Methods A cross-sectional study among a random sample of 982 general practitioners in Germany was conducted from October 2017 to January 2018 (response rate: 34.5%). A self-developed, written, standardised questionnaire was used. Descriptive statistics as well as multiple logistic regression analyses were performed using data of 326 GPs. Results Ninety-six percent of GPs reported having experienced barriers at least once. Uncertainties in diagnosing dementia in patients with a migrant background were indicated by 70.9%. There was no significant association between uncertainties in diagnosing dementia and GPs’ sociodemographic characteristics. The most frequently reported barriers were language barriers that affected or prevented diagnostics (89.3%) and information deficits in patients with a migrant background (59.2%). Shameful interaction or lack of acceptance of the syndrome was also common (55.5%). A demand for more information about the topic was expressed by 70.6% of GPs. Conclusions Public health measures supporting GPs in their interaction with patients with a migrant background as well as information and services for dementia patients are needed. Efforts to facilitate access to interpreting services and to focus on people with a migrant background in healthcare are necessary. Trial registration German Clinical Trials Register: DRKS00012503, date of registration: 05/09/2017 (German Institute of Medical Documentation and Information. German Clinical Trials Register (DRKS) 2017). Clinical register of the study coordination office of the University hospital of Bonn: ID530, date of registration: 05/09/2017 (Universitätsklinikum Bonn. Studienzentrum. UKB-Studienregister 2017).
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Affiliation(s)
- Judith Tillmann
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany.
| | - Johannes Just
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany
| | - Rieke Schnakenberg
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany.,Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, Medical Faculty of the University of Bonn, Bonn, Germany
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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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Sagbakken M, Spilker RS, Nielsen TR. Dementia and immigrant groups: a qualitative study of challenges related to identifying, assessing, and diagnosing dementia. BMC Health Serv Res 2018; 18:910. [PMID: 30497459 PMCID: PMC6267848 DOI: 10.1186/s12913-018-3720-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/15/2018] [Indexed: 01/12/2023] Open
Abstract
Background Along with the ageing of the general population, Europe’s migrant populations are also ageing, thus posing new challenges for dementia care services, particularly if the services are to be adjusted to persons with different linguistic and cultural backgrounds. From the perspective of health professionals, this study aims to explore challenges involved in identifying, assessing and diagnosing people with cognitive impairment/dementia who have different linguistic and cultural backgrounds. Methods Research on health professionals experiences regarding the management of dementia among immigrants is scarce and qualitative methods was used to address the objective of the study. Using qualitative in-depth interviews and focus-group discussions, we sought to gather participants’ experiences regarding the diagnostic process for immigrants with dementia. The material was analysed and interpreted based on Kvale and Brinkmann’s descriptions of three different contexts of interpretation: self-understanding, critical common-sense understanding, and theoretical understanding. Results Health professionals described how families could attribute symptoms of dementia to processes of normal ageing, while others saw the symptoms as something shameful; both instances delayed or hindered help-seeking. Many clinicians had limited experience with older immigrants suffering from dementia, and general practitioners (GPs) in particular experienced difficulties assessing dementia due to language barriers and difficulties related to the involvement of the family or an interpreter. The findings illustrate challenges in assessment, such as unfamiliarity with test situations among those being assessed and lack of knowledge regarding appropriate diagnostic tools among health professionals. Lack of continuity and poor information exchange in the chain of care seem to reinforce many of these challenges. Conclusions Detection, treatment and care may be improved if primary care professionals strengthen their cross-cultural competences. Training in communication skills and in the use of cross-cultural assessment tools may help build competence and confidence when assessing and caring for people with different cultural and linguistic backgrounds. Closer collaboration among families, nurses in home-based services, dementia teams, and GPs may facilitate close monitoring of a patient over time. Such collaboration requires sufficient information exchange during transitions in the chain of care, continuity among health professionals, and a shared understanding of the goals for treatment and care. Electronic supplementary material The online version of this article (10.1186/s12913-018-3720-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mette Sagbakken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Pilestredet 32, 0130, Oslo, Norway.
| | - Ragnhild Storstein Spilker
- Norwegian Center for Migration and Minority Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213, Oslo, Norway
| | - T Rune Nielsen
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Section 6922 Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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Barriers in providing primary care for immigrant patients with dementia: GPs' perspectives. BJGP Open 2018; 2:bjgpopen18X101610. [PMID: 30723796 PMCID: PMC6348325 DOI: 10.3399/bjgpopen18x101610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/04/2018] [Indexed: 12/02/2022] Open
Abstract
Background Dementia rates are growing rapidly in all regions of the world. In the Netherlands, the incidence of dementia among older immigrants will increase twice as fast compared with the native older population. It, therefore, needs special attention. Aim To describe the barriers for providing primary care to immigrant patients (Turkish, Moroccan and Surinamese) with dementia from the perspectives of GPs. Design & setting A mixed-method study, consisting of an online survey and focus groups. Method An online survey was performed among 76 GPs working in the four biggest cities of the Netherlands. The barriers to providing primary care for immigrants with dementia were identified. Subsequently, three focus groups were carried out among 17 primary care physicians to discuss this topic further, and identify possible solutions and recommendations to improve dementia care. Results GPs experience many obstacles in the care for the immigrant patient with dementia, namely in the diagnostic process, early detection, and assessment of care needs. Strong collaboration between primary care, community care organisations, specialised memory clinics, and municipalities is needed to optimise healthcare information provision, the availability of culturally sensitive facilities, and the enhancement of healthcare professionals' training and education. Conclusion Important barriers were identified and recommendations were formulated for future healthcare policy. To be prepared and guarantee optimal care for the rising number of immigrant patients with dementia, recommendations should be implemented and effectiveness should be evaluated as soon as possible.
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Wilkinson T, Ly A, Schnier C, Rannikmäe K, Bush K, Brayne C, Quinn TJ, Sudlow CLM. Identifying dementia cases with routinely collected health data: A systematic review. Alzheimers Dement 2018; 14:1038-1051. [PMID: 29621480 PMCID: PMC6105076 DOI: 10.1016/j.jalz.2018.02.016] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022]
Abstract
Introduction Prospective, population-based studies can be rich resources for dementia research. Follow-up in many such studies is through linkage to routinely collected, coded health-care data sets. We evaluated the accuracy of these data sets for dementia case identification. Methods We systematically reviewed the literature for studies comparing dementia coding in routinely collected data sets to any expert-led reference standard. We recorded study characteristics and two accuracy measures—positive predictive value (PPV) and sensitivity. Results We identified 27 eligible studies with 25 estimating PPV and eight estimating sensitivity. Study settings and methods varied widely. For all-cause dementia, PPVs ranged from 33%–100%, but 16/27 were >75%. Sensitivities ranged from 21% to 86%. PPVs for Alzheimer's disease (range 57%–100%) were generally higher than those for vascular dementia (range 19%–91%). Discussion Linkage to routine health-care data can achieve a high PPV and reasonable sensitivity in certain settings. Given the heterogeneity in accuracy estimates, cohorts should ideally conduct their own setting-specific validation.
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Affiliation(s)
- Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland; Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland.
| | - Amanda Ly
- Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland
| | - Christian Schnier
- Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland
| | - Kristiina Rannikmäe
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland; Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland
| | - Kathryn Bush
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland; Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland
| | - Carol Brayne
- Institute of Public Health, Cambridge University, Cambridge, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Cathie L M Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland; Usher Institute of Population Health Sciences and Informatics, Nine Bioquarter, Edinburgh, Scotland; UK Biobank, Coordinating Centre, Stockport, UK
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Stock S, Ihle P, Simic D, Rupprecht C, Schubert I, Lappe V, Kalbe E, Tebest R, Lorrek K. [Prevalence of dementia of insured persons with and without German citizenship : A study based on statuatory health insurance data]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:404-411. [PMID: 29487974 DOI: 10.1007/s00103-018-2711-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Elderly people with a non-German background are a fast growing population in Germany. OBJECTIVES Is administrative prevalence of dementia and uptake of nursing-home care similar in the German and non-German insured? MATERIALS AND METHODS Based on routine data, administrative prevalence rates for dementia were calculated for 2013 from a full census of data from one large sickness fund. Patients with dementia (PWD) were identified via ICD-10 codes (F00; F01; F03; F05; G30). RESULTS Administrative prevalence of dementia was 2.67% in the study population; 3.06% in Germans, and 0.96% in non-Germans (p value <0.001). Age and sex adjusted prevalence was comparable in the insured with and without German citizenship, except in women aged 80-84 (17.2 vs. 15.4) and for men in the age groups 80-84 (16.5 vs. 14.2), 85-89 years (23.4 vs. 21.5), and above 90 years of age (32.3 vs. 26.3). Standardized to the population of all investigated insured, 31.4% of all Germans with dementia had no longterm care entitlement vs. 35.5% of all patients without German citizenship. Of German patients, 55.1% were institutionalized vs. 39.5% of all patients without German citizenship. CONCLUSIONS There was a higher prevalence of dementia in the very old insured without German citizenship compared to those with German citizenship, especially in men. Non-Germans showed lower uptake of nursing home care compared to Germans. Additionally, Germans had slightly higher nursing care entitlements. It should be investigated further how much of the difference is due to underdiagnosis, cultural differences, or lack of adequate diagnostic work-up.
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Affiliation(s)
- Stephanie Stock
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Uniklinik Köln (AöR), Gleueler Straße 176-178, 50935, Köln, Deutschland.
| | - Peter Ihle
- PMV Forschungsgruppe, Universität zu Köln, Köln, Deutschland
| | - Dusan Simic
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Uniklinik Köln (AöR), Gleueler Straße 176-178, 50935, Köln, Deutschland
| | - Christoph Rupprecht
- Stabsbereich Politik - Gesundheitsökonomie - Presse, AOK Rheinland/Hamburg, Düsseldorf, Deutschland
| | - Ingrid Schubert
- PMV Forschungsgruppe, Universität zu Köln, Köln, Deutschland
| | - Veronika Lappe
- PMV Forschungsgruppe, Universität zu Köln, Köln, Deutschland
| | - Elke Kalbe
- Medizinische Psychologie, Neuropsychologie und Gender Studies, Centrum für Neuropsychologische Diagnostik und Intervention (CeNDI), Uniklinik Köln (AöR), Köln, Deutschland
| | - Ralf Tebest
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Uniklinik Köln (AöR), Gleueler Straße 176-178, 50935, Köln, Deutschland
| | - Kristina Lorrek
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Uniklinik Köln (AöR), Gleueler Straße 176-178, 50935, Köln, Deutschland
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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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Stevnsborg L, Jensen-Dahm C, Nielsen TR, Gasse C, Waldemar G. Inequalities in Access to Treatment and Care for Patients with Dementia and Immigrant Background: A Danish Nationwide Study. J Alzheimers Dis 2016; 54:505-14. [DOI: 10.3233/jad-160124] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Lea Stevnsborg
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Jensen-Dahm
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas R. Nielsen
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christiane Gasse
- National Centre for Register-Based Research, Aarhus University, School of Business and Social Sciences, Aarhus, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Diaz E, Kumar BN, Engedal K. Immigrant patients with dementia and memory impairment in primary health care in Norway: a national registry study. Dement Geriatr Cogn Disord 2015; 39:321-31. [PMID: 25823461 DOI: 10.1159/000375526] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Immigrants comprise a growing proportion of the elderly population. However, knowledge about the diagnosis and management of dementia and memory impairment among immigrants is scarce in Norway and elsewhere. AIMS To compare proportions of Norwegians and immigrants aged ≥50 years with a diagnosis of dementia or memory impairment in primary health care and to study the demographic characteristics, utilization of primary health care services and pharmacological treatment of Norwegians and immigrants with either of the two diagnoses in 2008. METHOD This is a registry-based study using linked data at the individual level from 4 national Norwegian registers. RESULTS A significantly lower proportion of immigrants, especially those from other than high-income countries, had a diagnosis of dementia or memory impairment. Among patients with such diagnoses, anti-dementia medication was purchased 20-50% more often by Norwegians than by immigrants, although the differences remained significant only for immigrants from other than high-income countries after adjustment for several variables. CONCLUSION The lower proportions of immigrants with a dementia diagnosis and lower proportions of patients receiving treatment might indicate a lower prevalence or milder forms of dementia among immigrants. However, the cultural validity of the assessment tools, linguistic barriers and challenges for general practitioners should be further investigated.
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Affiliation(s)
- Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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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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Nielsen TR, Andersen BB, Gottrup H, Lützhøft JH, Høgh P, Waldemar G. Validation of the Rowland Universal Dementia Assessment Scale for multicultural screening in Danish memory clinics. Dement Geriatr Cogn Disord 2014; 36:354-62. [PMID: 24022429 DOI: 10.1159/000354375] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive screening test that was developed to detect dementia in multicultural populations. The RUDAS has not previously been validated in multicultural populations outside of Australia. The aim of this study was to evaluate the diagnostic accuracy of the RUDAS in a multicultural sample of patients referred to Danish memory clinics. METHODS Data were collected from 137 consecutive patients (34 with an immigrant background) in three Danish memory clinics. All patients were given the RUDAS as a supplement to the standard diagnostic workup. RESULTS Diagnostic accuracy for the RUDAS [area under the curve (AUC) = 0.838] was similar to that of the Mini-Mental State Examination (MMSE; AUC = 0.840). The cutoff score with the best balance of sensitivity, specificity and accuracy was <24/30 for the RUDAS (sensitivity 0.69, specificity 0.80) and <25/30 for the MMSE (sensitivity 0.76, specificity 0.83). In contrast to the MMSE, regression analyses revealed that the RUDAS was unaffected by factors related to the patients' immigrant backgrounds. CONCLUSION The RUDAS showed high specificity and proved to be less affected by cultural and linguistic factors than the MMSE, making it a particularly valuable tool when screening for cognitive impairment in elderly multicultural patient populations.
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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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Abstract
This article discusses major themes in recent transcultural psychiatric research in the Nordic countries from 2008 to 2011: (a) epidemiological studies of migration, (b) indigenous populations, and (c) quality of psychiatric care for migrants. Over the past several decades, the populations of the Nordic countries, Denmark, Finland, Norway, and Sweden, which were relatively homogeneous, have become increasingly culturally diverse. Many migrants to Nordic countries have been exposed to extreme stress, such as threats of death and/or torture and other severe social adversities before, during, and after migration, with potential effects on their physical, mental, social, and spiritual health. Growing interest in transcultural issues is reflected in the level of scientific research and clinical activity in the field by Nordic physicians, psychologists, social scientists, demographers, medical anthropologists, as well as other clinicians and policy planners. Research includes work with migrants and indigenous minorities in the Nordic countries, as well as comparisons with mental health in postconflict countries. We conclude by suggesting future directions for transcultural psychiatry research and providing guidelines for the education and training of future clinicians in the Nordic countries.
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Salem LC, Andersen BB, Nielsen TR, Stokholm J, Jørgensen MB, Rasmussen MH, Waldemar G. Overdiagnosis of dementia in young patients - a nationwide register-based study. Dement Geriatr Cogn Disord 2013. [PMID: 23208125 DOI: 10.1159/000345485] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the quality of the diagnostic evaluation and the validity of dementia diagnoses in young patients established in routine clinical practice. The aim of this study was to investigate the validity of the diagnosis of dementia registered in the Danish nationwide hospital registers in young patients. METHODS Two hundred patients were randomly selected from 891 patients <65 years registered with a dementia diagnosis for the first time in 2008. The patients' medical records were reviewed to evaluate if they fulfilled ICD-10 and/or DSM-IV criteria for dementia and current clinical criteria for specific dementia subtypes. RESULTS A registered diagnosis was found to be correct in only 59%. A misdiagnosis of dementia occurred primarily in patients with depression or alcohol abuse. CONCLUSION Our results suggest that dementia is overregistered and overdiagnosed in young patients. This may be due to a different symptom profile of dementia in young patients, lack of knowledge among clinical physicians and the wide range of conditions which may be misinterpreted as dementia.
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Affiliation(s)
- L C Salem
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Jensen NK, Norredam M, Priebe S, Krasnik A. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark. BMC FAMILY PRACTICE 2013; 14:17. [PMID: 23356401 PMCID: PMC3568406 DOI: 10.1186/1471-2296-14-17] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022]
Abstract
Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care.
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Affiliation(s)
- Natasja Koitzsch Jensen
- The Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark.
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NIELSEN TR, VOGEL A, GADE A, WALDEMAR G. Cognitive testing in non-demented Turkish immigrants - comparison of the RUDAS and the MMSE. Scand J Psychol 2012; 53:455-60. [DOI: 10.1111/sjop.12018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Religa D, Spångberg K, Wimo A, Edlund AK, Winblad B, Eriksdotter-Jönhagen M. Dementia diagnosis differs in men and women and depends on age and dementia severity: data from SveDem, the Swedish Dementia Quality Registry. Dement Geriatr Cogn Disord 2012; 33:90-5. [PMID: 22433665 DOI: 10.1159/000337038] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2012] [Indexed: 02/04/2023] Open
Abstract
AIMS We examine the dementia assessment with focus on age and gender differences. METHODS Data from the national quality database, Swedish Dementia Registry (SveDem), including 6,937 dementia patients diagnosed during 2007-2009 at memory clinics were used. We have studied the use of investigations for dementia diagnostics such as cognitive tests, blood and cerebrospinal fluid analyses, electroencephalography, radiological examinations and assessments of functions. Severity of cognitive impairment was assessed with the Mini Mental State Examination (MMSE). RESULTS There was a significant decrease in the number of total tests used in the elderly group (>75 years) when compared with the middle-aged group (65-75 years) and younger patients (<65 years). The oldest group was examined with 4 of 11 possible tests, the middle-aged group had 5/11 tests performed and the youngest age group 6/11 tests. There was also a significant gender difference in the diagnostic workup, however, mostly attributable to age. The number of tests positively correlated with the level of cognition assessed by the MMSE. CONCLUSION We show here for the first time the impact of age, gender and MMSE score on the dementia diagnostic workup in a large memory clinic patient population in one country.
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Affiliation(s)
- Dorota Religa
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Comparison of performance on three neuropsychological tests in healthy Turkish immigrants and Danish elderly. Int Psychogeriatr 2012; 24:1515-21. [PMID: 22717281 DOI: 10.1017/s1041610212000440] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Appropriate neuropsychological tests for cross-cultural assessment of dementia in elderly ethnic and linguistic minorities are generally lacking in Europe. The aim of this study was to investigate the cross-cultural applicability of the Recall of Pictures Test (RPT), Clock Reading Test (CRT), and supermarket fluency (SF) in samples of Turkish immigrants and Danish elderly. METHODS Samples of Turkish immigrants and Danish elderly were recruited from the Greater Copenhagen area. All participants were screened for factors known to affect cognitive test performance. Those who were included in the study underwent an approximately two-hour assessment, where the RPT, CRT, and SF were applied as a part of a comprehensive battery of neuropsychological tests. RESULTS A total of 109 elderly participants were included in the study: 73 Turkish and 36 Danish. Significant differences were found between the Turkish and Danish samples in CRT and SF performances, but not in any of the RPT measures. Age and acculturation level were the only demographic variables with significant impact on test performances. Performance data for the three tests are presented as percentiles. CONCLUSIONS Although small differences were observed between the Turkish and Danish samples on the CRT and SF, we consider the three tests to be important neuropsychological tests for assessment of dementia in elderly patients from ethnic minority migrant populations.
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