Assessment of cognitive
function in Southeast Asia: the
Problem of Cultural Diversity
Sofia Amarra R.D.,Ph.D.
Date
TM Components of Mental Status (Mitrushina et.al. 1999) MOOD & AFFECT PERCEPTION & CONTENT/PROCESS OF THOUGHT T
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COGNITIVE STATUS ABILITY AREAS -­‐  A9en<on -­‐  Memory -­‐  Spa<al and Language func<ons -­‐  Processing speed -­‐  Problem-­‐solving -­‐  Abstract reasoning -­‐  Judgment Neuropsychological assessment of cognitive
function
Methods
Applications
•  Unstructured questioning
•  Evaluation of cognitive
dysfunction
•  Administration of
structured screening
instruments (performancebased method)
–  Mini-Mental State
Examination (MMSE)
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–  Dementia of Alzheimer’s type
vs. vascular dementia
•  Evaluation of employability
and to determine disability
•  Identify cognitive strengths
and weaknesses in
functional status
Administration of structured instruments
to assess cognitive function
•
Battery approach for test administration
–  A variety of cognitive ability areas tested
–  More than one test per ability area
–  Tests consist of well-validated, reliable, standardized measures that help to
elucidate and quantify behavioral changes that may have resulted from brain or CNS
injury
•
Normative comparison for test results
–  Performance compared to reference groups of the same age, sex, race, educational
attainment
Limitation: most tests were developed in Western societies
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Common model to adapt tests for cross-cultural
neuropsychological assessment
•  Take an existing and much-used measure from
one culture and language and translate into a
second culture and language
•  2 Approaches used to ensure fidelity
–  Back-translation
–  Committee approach
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Culture and cognitive performance
•  Culture - Shared learned meanings and behaviors
that are transmitted within the context of social
activity for purposes of promoting individual/
societal adjustment, growth & development
•  Environmental adaptation = aspect of intelligence
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Cross-­‐cultural differences in cogni<on Episodic memory Wang 2004 in Zaroff et.al. 2014 •  Chinese children –  Episodic memories reflected the role of the child in a social context •  U.S. children –  Episodic memories focused on their own roles, preferences and feelings Visual cogni8ve processing Goh et.al. (2013) •  Culture-­‐related differences in visual cogni<ve processing in Western and East Asian subjects –  Differences in ac<va<on in frontal, parietal and occipital areas of brain during visual cogni<ve task –  Greater collec<vism in East Asians was associated with less suppression of default-­‐network brain regions compared with Western subjects Culture and language
•  Culture and language are closely wedded;
but not all individuals who speak the same
language come from the same culture
•  Early experience of language affects some
of the ways the brain processes
information
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Neurocognitive networks that
mediate the use of languages
•  Chinese language
processing
–  Involves more bilateral
brain areas
•  English language
processing
–  Lateralized to the left
hemisphere
(Chan et.al. 2003)
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•  Bilinguals vs
monolinguals
(Kovelman et.al.
2008)
–  Differential activation in leftinferior frontal cortex in
bilinguals compared with
monolinguals (“neural
signature”)
Differences between mono-­‐ and bilinguals in brain ac8va8on areas T
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Source: Montreal Neurological Ins<tute, McGill University •  Findings in brain science – some
assessment tools based on neurocognitive
models for western cultures may not be
suitable for people of other cultures (Chan
et.al., 2003)
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Findings on cross-cultural testing for cognitive
function
•  Patterns of decline may differ across cultures
•  Individuals of other cultures underperform on
certain standard neuropsychological tests
•  Bilingualism – associated with certain advantages/
disadvantages on some tests
•  Education, ethnicity, spoken language,
acculturation, and age impact test performance
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Findings on cross-cultural cognitive testing
•  Weissberger et.al. (2013) found significant differences in
sensitivity of tests to predict future cognitive decline between
cultural groups
–  used longitudinal data (Hispanics and non-Hispanics) to
determine which cognitive tests are affected by culture or
bilingualism
–  Some tests were sensitive to eventual progression to AD
among Hispanics but not among non-Hispanics
•  Hispanic decliners (subsequent AD) had significantly higher
semantic fluency scores than non-Hispanic decliners
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Limitations of cognitive tests adapted from
Western societies
•  Need to determine whether assessment measures are
equivalent (culturally and linguistically) and appropriate
•  Just because the content of the items is preserved does not
ensure that the item taps the same ability within the cultural
context of the individual being tested (Construct bias)
•  Measures that have been translated or adapted from other
cultures have to be revalidated in the new culture where they
will be used
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Cultural diversity in Southeast Asia
Country Es8mated number of languages/dialects spoken Indonesia 700 Philippines 175 Malaysia 137 Thailand 10 Cambodia 6 Vietnam 5 Singapore 4 T
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Challenges in cogni<ve assessment for Southeast Asia •  Transla8on and test development for specific ethnic groups require a thorough understanding of the group’s culture & language •  Need to tailor each test to the needs and values of the culture in which it is to be used •  Need for ethnic-­‐specific norma8ve data that take into account issues such as culture and bi-­‐ or tri-­‐
lingualism •  Need to understand the effects of biculturalism and bilingualism on test performance in various ethnic groups Challenges in cogni<ve assessment for Southeast Asia •  Need to create tests that can op8mally detect cogni8ve impairment across mul8ple cultural groups •  Need to develop indigenous tools for tapping cogni8ve func8ons that may be unique to a par8cular culture or linguis8c community THANK YOU T
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References cited
•
•
•
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Chan AS et.al. Recent development of
cognitive and neuropsychological
assessment in Asian countries.
Psychological Assessment.
2003.15:257-67.
Goh JOS et.al. Culture-related
differences in default network activity
during visuo-spatial judgments. SCAN.
2013;8:134-42.
Ketay S et.al. Culture and attention:
evidence from brain and behavior. Prog
Brain Res. 2009; 178:79-92.
Mushquash CJ & Bova DL. Cross-cultural
assessment and measurement issues.
Journal on Developmental Disabilities.
2007; 13:53-62.
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Weissberger et.al. Which
neuropsychological tests predict
progression to Alzheimer’s disease in
Hispanics? Neuropsychology. 2013;
27:343-55.
•
Zaroff et.al. Understanding differences
in cognition across the lifespan:
comparing Eastern and Western cultures.
In: Neuropsychology of Asians and Asian
Americans, Issues of diversity in clinical
neuro psychology. JM Davis & RC
D’Amato (eds). 2014. New York:
Springer Science+Business Media.