Examining standardized cognitive assessments in an elderly cross-cultural sample: The role of cultural and literacy bias

Abstract—The number of elderly ethnic minorities is expected to grow in the ensuing decades. As populations age, it is imperative that proper and valid neuropsychological assessments be given. Previous research has shown that some cognitive tests for the elderly may in fact exhibit potential forms of cultural and linguistic bias in which certain cultural sub-groups are given a degree of disadvantage on these assessments.

Aims and Research Questions
The present study investigated whether several commonly used screening tools and assessments for Mild Cognitive Impairment (MCI) and Alzheimer’s disease were cross-culturally appropriate and valid for an elderly U.K. South Asian ethnic minority sample. The cognitive assessments included the Cross-linguistic naming test (CLNT), Mini-ACE, Visual Working Memory Binding Test (VWMBT), and the Rowland Universal Dementia Assessment Scale (RUDAS). This research first tested if there were significant differences in the four assessment scores between groups. In addition, this study determined if either acculturation measured with the Multi-Ethnic Acculturation Scale (MEAS) or English proficiency measured with a self-rated scale were associated with the four respective assessments.

Method
Both South Asian and British participants (N=34) were assessed using a cognitive test battery at the University of Edinburgh. The four cognitive tests in the battery included the CLNT, Mini-ACE, VWMBT, and RUDAS assessments.

Results
The non-parametric Mann-Whitney U test indicated significant differences in scores between the South Asian and British groups for the Cross-linguistic naming test (U = 218.0, p = .002), Mini-ACE (U = 201.5, p = .039), and the VWMBT Binding task (U = 217.0, p = .009). However, no significant differences between the two groups were found for the VWMBT Perception task (U = 137.0, p = .698), VWMBT Shape Only task (U = 163.0, p = .470) or for the RUDAS (U = 158.0, p = .577) assessment. Spearman’s Rho correlations and linear regression both revealed that English proficiency and acculturation variables were associated with the Cross-linguistic naming test ( = .442, p = .003 and  = .029, p = .001, respectively) and Mini-ACE ( = 2.55, p = .001 and  = .103, p = .033, respectively). No associations were found between these variables and any of the tasks on the VWMBT or for the RUDAS assessment.

Conclusion
Given the differences in mean rank scores between the groups, the CLNT, Mini-ACE assessment, and VWMBT Binding task, these measures may be biased against South Asian ethnic minorities. However, as the results do not evince any difference in mean ranks scores for the VWMBT Perception task, VWMBT Shape Only task, and RUDAS assessment, there is an absence of evidence found for bias in these measures.