Examining the Vietnamese Montreal cognitive assessment in healthy and moderate-to-severe traumatic brain injury populations

Objective: There have been attempts to modify the Montreal Cognitive Assessment (MoCA), a brief cognitive screening tool, for use across several Asian countries, but evidence to support the utility of these translations has been limited, particularly for the Vietnamese translation of the MoCA (MoCA-V). This two-part study aimed to evaluate the MoCA-V in a Vietnamese sample. Methods: In the first stage, we examined the relationships between the MoCA-V subscales and common neuropsychological tests among healthy Vietnamese adults (n = 129) and individuals with moderate-to-severe traumatic brain injury (n = 80). In the second stage, we explored the relationship of TBI status (TBI vs non-TBI) and demographic variables to MoCA-V performance and investigated the optimal cut-off score of the MoCA-V using the two samples combined. Results: The MoCA-V Attention, Language, and Executive Function subscales were correlated with the Digit Span Test, Verbal Fluency Test, and Trail Making Test, respectively, across healthy participants and participants with TBI. Global performance on the MoCA-V was predicted by TBI status, education, and age. Our ROC analysis revealed that a cut-off score of 22 offered the best sensitivity (76.3%) and specificity (71.3%) trade-off for identifying cognitive impairment as measured by the MoCA-V. Conclusions: In addition to identifying a cut-off score for cognitive screening, the findings provide support for the validity of the examined MoCA-V subscales and for the MoCA-V's ability to distinguish TBI survivors vs controls. These results may pave the way for larger-scale investigations of the MoCA-V and for the development of more neuropsychological batteries in Vietnamese.

Incorporating Intersectionality in Neuropsychology: Moving the Discipline Forward

OBJECTIVE

Intersectionality is the interface between a person's identities in relation to social systems and institutional discrimination. The concept has generated much interest in psychology for understanding societal inequities and providing culturally informed services to minoritized patients but has yet to be incorporated in clinical neuropsychology. This omission is unfortunate as it is argued that appreciating the impact of institutional discrimination on minoritized groups can enhance our understanding of brain organization and functioning and bolster access to competent neuropsychological services to minoritized patients. The purpose of this article is to illustrate how intersectionality is germane to the discipline of clinical neuropsychology and to make recommendations for infusing it into the practice.

METHOD

Theories and findings in cultural neuroscience are summarized to provide a theoretical background for understanding how the environment can impact brain development and organization. The literature on disparities in education, economics, and health disparities between Whites and minoritized groups was reviewed for institutional biases that place minoritized groups at a disadvantage. These topics were selected due to their known impact on brain organization and cognition. This was followed by a similar review for access to competent neuropsychological assessments for minoritized patients.

RESULTS

There is a confluence of institutional discriminatory processes that contribute to disparities in education attainment, economic status, health disparities, and accessibility to culturally informed neuropsychological services. Perceived discrimination has significant health and cognitive ramifications.

CONCLUSIONS

Intersectionality is germane to appreciating brain functioning and providing competent services to minoritized patients. Recommendations were made to incorporate intersectionality in clinical neuropsychology.

Associations Between Country where Education is Obtained and Cognitive Functioning Among South American and Caribbean Older Adults Living in the U.S

The increasing prevalence of AD among Hispanics calls for a need for examining factors that affect cognitive functioning and risk of AD among Hispanic older adults. The current study examined cognitive functioning among older Hispanic adults living in the U.S. from two Hispanic regions, South America and the Caribbean, in relation to the country where education was obtained. Participants (n = 139) were stratified into groups based on Hispanic education region and diagnostic categories: cognitively normal and amnestic MCI (aMCI). Results of Pearson correlations showed that among Hispanic Americans in general, there were significant positive correlations between the country of education to performance on measures of episodic, verbal, and word list tests. When examined separately by region and diagnosis, only cognitively normal (CN) South Americans showed significant relationships between country of education and cognitive functioning in these areas. Results of general linear models controlling for education identified differences in neuropsychological performance between groups with the CN groups demonstrating better performance than the aMCI groups within each region. Overall, it was evident that relationships between years of education obtained outside of the U.S. and cognitive functioning were not similar among individuals from these two disparate Spanish speaking regions. This is the first study to examine the country where education was obtained among individuals from countries located in different regions with different cultures that may influence their education and cognitive development throughout life. Findings contribute to the cross-cultural neuropsychological literature in understanding factors that are unique to Hispanic older adults at risk for developing AD.

Neurocognitive Profiles Associated With Limited English Proficiency in Cognitively Intact Adults

OBJECTIVE

The objective of the present study was to examine the neurocognitive profiles associated with limited English proficiency (LEP).

METHOD

A brief neuropsychological battery including measures with high (HVM) and low verbal mediation (LVM) was administered to 80 university students: 40 native speakers of English (NSEs) and 40 with LEP.

RESULTS

Consistent with previous research, individuals with LEP performed more poorly on HVM measures and equivalent to NSEs on LVM measures-with some notable exceptions.

CONCLUSIONS

Low scores on HVM tests should not be interpreted as evidence of acquired cognitive impairment in individuals with LEP, because these measures may systematically underestimate cognitive ability in this population. These findings have important clinical and educational implications.

Examining the cross-cultural validity of the test of memory malingering and the Rey 15-item test

OBJECTIVE

This study was designed to investigate the cross-cultural validity of two freestanding performance validity tests (PVTs), the Test of Memory Malingering - Trial 1 (TOMM-1) and the Rey Fifteen Item Test (Rey-15) in Romanian-speaking patients.

METHODS

The TOMM-1 and Rey-15 free recall (FR) and the combination score incorporating the recognition trial (COMB) were administered to a mixed clinical sample of 61 adults referred for cognitive evaluation, 24 of whom had external incentives to appear impaired. Average scores on PVTs were compared between the two groups. Classification accuracies were computed using one PVT against another.

RESULTS

Patients with identifiable external incentives to appear impaired produced significantly lower scores and more errors on validity indicators. The largest effect sizes emerged on TOMM-1 (Cohen's d = 1.00-1.19). TOMM-1 was a significant predictor of the Rey-15 COMB ≤20 (AUC = .80; .38 sensitivity; .89 specificity at a cutoff of ≤39). Similarly, both Rey-15 indicators were significant predictors of TOMM-1 at ≤39 as the criterion (AUCs = .73-.76; .33 sensitivity; .89-.90 specificity).

CONCLUSION

Results offer a proof of concept for the cross-cultural validity of the TOMM-1 and Rey-15 in a Romanian clinical sample.

Cross-Cultural Comparison of Rural Healthy Adults: Russian and American Groups

OBJECTIVE

The Russian-speaking population is among the largest European-born in the U.S., yet Russian-American cross-cultural research is scarce. Two studies compared neuropsychological test performance in Russian and American urban adults. However, rural populations of the two nations have never been compared. Cross-cultural neuropsychological differences in rural populations might present differently than in urban dwellers. The present study provides a cross-sectional comparison of neuropsychological test performance in Russian and American rural adults.

METHODS

Neuropsychological test performance of 51 American (67% female) and 52 Russian (60% female) healthy rural adults age 18-89 was compared using t-test with Bonferroni correction for education-adjusted z-scores for the following tests: Rey Complex Figure Test (RCFT), Rey Auditory Verbal Learning Test (RAVLT), Trail Making Test A and B (TMT A&B), Stroop Neuropsychological Screening Test, Benton Judgment of Line Orientation Test (JLO), Brief Visuospatial Memory Test-Revised (BVMT-R), Color Trails Test 1 and 2 (CTT 1&2), WMS-IV Logical Memory Test (LMT), WAIS-IV Digit Span Forward (DSF) and Backward Test (DSB), and Symbol Digit Modalities Test (SDMT).

RESULTS

Age and sex distribution did not differ in the two groups, but the Russian group was more highly educated. The American group outperformed the Russian group on TMT B, CTT 2, recognition trials of RCFT, BVMT-R, LMT, and on DSF.

CONCLUSIONS

Cultural differences in attitudes to timed activities, experience with timed tests and multiple-choice format, attention to details, and length of digit-words that put differential demand on short-term memory in Russian and in English may mediate observed between-group differences.

Factors Associated with Māori Performance on the WAIS-IV

Neuropsychological tests are routinely used to assess Māori, the indigenous people of New Zealand, yet very few investigations of the psychometric properties of these tests with this population have been conducted. This paper focuses on factors that may impact performance of Māori adults on neuropsychological testing. The Wechsler Adult Intelligence Scale-IV (WAIS-IV) was administered to a sample of 284 Māori stratified for age (between 16 years and 90 years) and gender in order to establish a Māori normative data set. The sample who primarily spoke English as their first language were recruited from a range of urban, regional and rural areas in New Zealand to obtain representation of the main Māori Iwi (tribes). Analysis of test results suggests acculturation, education, income, and, "a culturally positive experience" may have accounted for some of the variance in test performance.

Normative data for Farsi-speaking Iranians in the United States on measures of executive functioning

As the Farsi-speaking Iranian population continues to grow in the United States, examination of their cognitive performance is an imperative first step to providing this group with culturally competent services. Thirty-six healthy primarily Farsi-speaking Iranian adults completed Farsi-translated and adapted versions of three frequently used measures of executive/subcortical functioning: Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), and Color Trails Test (CTT). Participants' performance on each measure was compared to published normative data resulting in 0-85% of cognitively and medically healthy individuals being classified as impaired depending on the executive/subcortical test score examined, with the highest impairment rates for specific WCST outcome scores. These findings raise questions for the use of published norms with Farsi-speaking Iranians residing in the US. The present study provided normative data from this group of Farsi-speaking Iranians on the Farsi-translated and adapted versions of the WCST, TMT, and CTT.