The test lasts 10 minutes and is given a score out of 30. 31 This tool was developed by Nasreddine et al, 31 and is currently used to aid physicians primarily in detecting MCI, a state that can progress to dementia. The Montreal Cognitive Assessment (MoCA) is a cognitive test, developed to screen and assess for dementia and MCI. 25, 26, 30The Montreal Cognitive Assessment 28, 29 With developing and piloting new cognitive tests not being the most feasible solution, adapting existing cognitive tests for different languages and cultures has been proposed. 28, 29 However, this has still been shown to reduce the sensitivity and specificity. To ensure that all five dimensions of cross-cultural equivalence are maintained, solutions such as altering cut-off scores of cognitive tests for different ethnic minorities and non-English-speaking groups has been suggested. These are content equivalence (the questions of the test are culturally relevant to the cultural context of the person being assessed), criterion equivalence (after accounting for culture, the test as a whole still assesses for dementia and MCI) and conceptual equivalence (after accounting for culture, the individual test questions still accurately assess the cognitive domains they were meant to at the original level of difficulty). However, without accounting for cultural differences as well, there is still a loss of three of the five dimensions. accurate translation of questions) are retained through simply translating the cognitive test into a target language. language the test is administered in) and semantic equivalence (once translated, the meanings of the test questions are the same as the original test questions, e.g. In the context of cognitive tests for dementia and MCI technical equivalence (how the test is administered is culturally appropriate for the person being assessed, e.g. 27 These dimensions are content, conceptual, criterion, semantic and technical equivalence, and should be maintained by tests when they are adapted for different language and culture backgrounds. 25, 26įlaherty et al 27 explored this in their research on the five dimensions of cross-cultural equivalence that can be used to minimise cultural bias and measurement errors in cross-cultural testing. 23 Therefore, when assessing for dementia, cultural bias can significantly affect the validity of these cognitive tests. Ethnic minorities may not be familiar with Western concepts such as questions about the Western calendar, Western names or Western historical and general knowledge, which are used for assessing cognitive domains such as orientation, language and memory tasks. However, translation alone does not address these increased rates of false positive and false negative scores that may also arise from cultural differences. To overcome this issues, cognitive tests are often translated into target languages. Therefore, when administering cognitive tests to ethnic minorities, there is reduced sensitivity and specificity we see higher instances of false positive scores (where dementia or MCI is incorrectly detected by the test in a cognitively healthy person) and false negative scores (where a person's dementia or MCI is not detected by the test) within ethnic minorities compared with their English-speaking European counterparts. 18 However, a key limitation of cognitive tests available to us is that they are designed for people from European cultures, fluent in the English language. 16, 17Cognitive testing in ethnic minoritiesįor an early and accurate diagnosis of dementia, the use of cognitive tests in the diagnostic process is vital. 13– 15 Furthermore, ethnic minorities are more likely to come from low socioeconomic backgrounds, which is associated with their likelihood of developing dementia. 10, 12 They are highly susceptible to risk factors known to increase the likelihood of dementia, showing higher prevalence for diseases and conditions such as diabetes, heart disease, hypertension and obesity. These older ethnic minorities are at particularly high risk for receiving a diagnosis of dementia. 10 Whereas previously many ethnic minorities would return to their home country as they grew older, many people from minority backgrounds who migrated in between the 1950s and 1970s as young adults are now choosing to permanently reside in the UK in their old age. In countries such as the UK, there is also a growing ageing ethnic minority population. Currently, there are an estimated 88 languages other than English spoken in the UK, with over 8% of the population not having English as a first language, and over 864 000 people struggling or unable to speak it. Because of the impact of globalisation, many Western countries, including the UK, have formed significant ethnic minority populations currently 14% of the UK population identify as an ethnic minority, 8 and this is estimated to increase to 20% by 2051.
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