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Cross-cultural Psychology of Health & Illness (Leiden University 22-23) > Week 5 - Culture in Neuropsychological Assessment > Flashcards

Week 5 - Culture in Neuropsychological Assessment Flashcards

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1
Q

WHAT IS NEUROPSYCHOLOGY?

A

Study of the relationship between behavior, emotion and cognition on one hand, and brain function on the other

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2
Q

PHYSICAL DIFFERENCES:
BRAIN

A
  • Specialized skill acquisition
  • Enrichment (education, social-life, etc.)
  • Deprivation (lack of stimulation)
  • Education (different levels)
  • Health, stress
  • Correlates of differing cognitive mechanisms
  • … experience more generally
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3
Q

PHYSICAL DIFFERENCES:
GENETICS
(Core of nature/nurture interactions!)

A
  • Heredity: passing on characteristics from parents to children based on genetic material (99% =fixed, 1% differs across individuals) Genes can have effects that depend on external variables.
  • Epigenetics: environmental factors cause genes to switch on or off without modification of the DNA sequence. Chemical tags can control genes in specific cells, they can result from lifestyle choices or specific experiences, but some are hereditary!
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4
Q

MEASURING BRAIN FUNCTION:
NP ASSESSMENT

A
  • Intelligence
  • Memory
  • Verbal abilities
  • Executive functions
  • Visuo-spatial functions
  • Attention
  • Syndrome-related combinations
  • General batteries
  • Compare scores to normative data
    –> Sometimes with corrections for age or education level
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5
Q

CULTURE AND NP ASSESSMENT

A

Normative data based on very limited subsample:
WEIRD patients!
* Partial
* Biased

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6
Q

WHY WOULD CULTURE AFFECT NP ASSESSMENT?

A
  • Values and meanings
  • Modes of knowing (Individual task vs collective endeavor)
  • Conventions of communication (Interaction: one-way questions, authority; Type of questions)
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7
Q

PATTERNS OF ABILITIES: what, when, who

  • tests: appropriate how?
A

Culture prescribes what should be learned, at what age, and by which gender

Tests need to be appropriate for subject’s learning opportunities and contextual experiences

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8
Q

CULTURAL VALUES: what is or is not situationally relevant and significant, or even appropriate

A
  • One-to one testing relationship with a stranger
  • Background authority: why follow orders?
  • Best performance: why try to get a high score?
  • Isolated environment: unusual social situation
  • Special type of communication: unusual language
  • Speed: why trade off speed for accuracy?
  • Private, embarrassing or subjective issues
  • Specific testing materials and strategies
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9
Q

FAMILIARITY

A
  • Testing situation
  • Attitudes that facilitate good performance
  • Elements used in testing
  • Strategies needed to solve task
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10
Q

LANGUAGE

A
  • Linguistic relativity
  • Language use and meaning differs with cultural & subcultural background
  • Correlates strongly with education
    level, testing language often formal –> Important to make test instructions
    understandable and appropriate!
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11
Q

EDUCATION

A

Accounts for up to 50% of variance in IQ tests, 0.6-38% in NP tests!
Double role:
* Increases knowledge of test content
* Increases familiarity with testing setting and strategies

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12
Q

LITERACY / ILLETERACY

A

Illiteracy: Not being able to read or write

Functional illiteracy: reading and writing is inadequate “to manage
daily living and employment tasks that require reading skills beyond
a basic level”
- Higher in men then women, 2/3 illiterates = women

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13
Q

LITERACY

A
  • Higher in men then women, 2/3 illiterates = women
  • In Europe, North-America and Australia, literacy is closely tied to poverty: functional illiteracy can be high in specific groups!
  • All countries have significant numbers of people with low skills: between 1/3 and 2/3 do not attain minimum level demanded by increasingly complex knowledge economy
  • Especially the US and Italy show a large range in skills
  • Lower document literacy and numeracy also associated
    with poorer health
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14
Q

ILLITERACY & COGNITION

A

Learning to read reinforces certain cognitive abilities, such as…
- verbal memory
- phonological awareness
- visuospatial discrimination

  • More difficulty copying nonsense figures or words (to abstratc)
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15
Q

ILLETERATES & LOWER SCORES

A
  • Naming tasks
  • Verbal fluency
  • Verbal memory
  • Visuo-perceptual abilities
  • Conceptual functions
  • Numerical abilities
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16
Q

MINORITIES WITHIN A CULTURE: + six potential distinguish variables….

A
  • Different ethnic groups in one country
  • After migration (especially first-generation)
  • Groups with no country
  1. Nationality and legality
  2. Relative culture distance to majority culture
  3. Relative language distance to majority language
  4. Normality: how ‘strange’ is the minority culture perceived by the majority?
  5. Reference group: how big is the minority group?
  6. Social image: positive or negative attitudes of the majority group towards a minority group
17
Q

NECESSITY FOR SPECIFIC TESTS AND NORMS

A

Indication of functional level depends on relative scores
> language
> culture region
> education level
> SES level
> age group

18
Q

AGING: cognitive function decline/stable

A

decline: memory & executive function
stable (“better”): vocabulary & world knowledge

19
Q

AGING: increased risk

A

mild cognitive impairment (MCI) and
dementia increases with age

20
Q

MCI
Mild cognitive impairment:

A
  • Cognitive changes that are serious enough to be noticed
  • Not severe enough to interfere with daily life or independent function
  • Most common subtype of MCI first presents as memory impairment
  • Progression to dementia in 10 to 15% of afflicted persons per year
21
Q

DEMENTIA
Umbrella term for symptoms caused by neural disorders, especially cognitive symptoms

A

Most common causes of dementia
* Alzheimer’s disease: 50-80%
* Vascular dementia: 20%
* Dementia with Lewy bodies 15%
* Frontotemporal dementia 5%

Each have own most prominent symptoms, all interfere with everyday activities

22
Q

SCREENING FOR DEMENTIA
MMSE: Mini-Mental Screening Exam (Folstein)

A
  • Orientation to time and place
  • Naming
  • Registration (responding to prompts)
  • Attention and calculation
  • Recall
  • Repetition
  • Complex command (figure)

Maximum score=30, dementia is indicated for scores below 24
➢ screening, not diagnosis!

23
Q

MAJOR NEUROCOGNITIVE DISORDER (DEMENTIA)
A, B, C, D

A

A)
- learning & memory
- language
- executive function
- complex attention
- perceptual-motor
- social cognition

B)
- interfere with independence in everyday activity and require assistance.

C)
- the deficits do not occur exclusively in the context of a delirium.

D)
- deficits are not better explained by another mental disorder.

24
Q

PREVALENCE: MCI

A
  • MCI prevalence = 3.0 - 19.0%, with a risk of developing dementia of 11-33% within 2 years.
  • Dementia prevalence = 5.4 - 6.4% (≥60 years)
  • Not the same everywhere! (Related to wealth)
  • Higher prevalence MCI and dementia described for immigrant populations
    in USA and UK
25
Q

MIGRANT GROUPS IN THE NETHERLANDS

A
  • 24.9% of the population in 2010 consisted of migrants (14.2% from outside the EU)
  • Turkish, Moroccan and Surinamese people make up 65% of all non-western immigrants in NL
  • First-generation non-western immigrants are aging: 9% of older population in 1990, to 15% in 2019, 26% expected in 2050
  • Older immigrants in the US show higher prevalence of risk factors for dementia
26
Q

CARE EXPERTS: Among European dementia experts, 64% find it more
challenging to assess dementia in patients from ethnic
minorities…

A

Reported problems include:
* Language proficiency (88%)
* Presentation of symptoms (84%)
* Educational level (84%)
* Lacking assessment tools (68%)
* Lacking cultural knowledge (44-56%)

27
Q

OVER- & UNDERDIAGNOSIS
Accurate diagnosis: ?

Over-diagnosed?
Under-diagnosed?

A

High sensitivity (good true detection) and high specificity (low false detection)

Over-diagnosed = Younger age group
Under-diagnosed = Older age group

28
Q

OVER- & UNDERDIAGNOSIS: in immigrants

A
  • Differences in help-seeking behavior (Stigma, more inclined to solve problems within the family, Insufficient knowledge)
  • Difficulty with the health care system (Language barrier, Literacy skills)
  • Assessment and diagnosis (Language & literacy, Test-wiseness, etc.)
29
Q

CULTURE-FAIR DIAGNOSIS

A

need to account for cultural values,
familiarity, language, different education levels, interpretation of norms, etc

Examples:
Daily practice in memory clinic:
* In which province are we? (MMSE)
* Who is our prime minister? (CST)
* Read and follow this instruction (MMSE)
* What is this?

30
Q

CROSS-CULTURAL DEMENTIA
SCREENING (CCD)
(Developed in Amsterdam)

A
  • Instructions in own language
  • Culture-free/fair items
  • Nonverbal as much as possible

Domains:
* Memory, mental speed, executive function

31
Q

CCD TASKS

A

Memory
* Objects test: remember objects among distractors

Mental speed and divided attention
* Dots test: connect objects in order of increasing numbers

Mental speed and inhibition
* Sun-moon test: cross-name pictures in own language
* Adjusted Stroop task

32
Q

INTERPRETERS: issues

A
  • Interpreters that are not family are preferred
  • Native testers are ideal!
33
Q

CCD EVALUATION

A

Total battery:
Sensitivity (true detection of dementia): 85%
Specificity (true detection of no dementia): 89%

34
Q

DEMENTIA RESEARCH IN MIGRANT GROUPS

A

Netherlands: SYMBOL study
SYstematic Memory testing Beholding OLder Migrants

35
Q

SYMBOL STUDY: aim & hypothesis

A

Aim: to assess prevalence of MCI and dementia in community-dwelling migrants ≥ 55yrs, and to map their and
their caregivers’ health care use and care needs.

Hypothesis: prevalence MCI and dementia for older immigrants =2x prevalence in native Dutch.

Large sample of older community-dwelling immigrants was screened with ‘Cross-Cultural Dementia screening
instrument’ (CCD) to overcome barriers of culture

Cross-cultural Psychology of Health & Illness (Leiden University 22-23) (5 decks)

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