Improving Accuracy Of Cross-Cultural Europsychological Testing

Study shows that measuring reading could improve the cognitive assessment of elders from diverse educational backgrounds

New York, N.Y., March 18, 2002— To evaluate the elderly for memory loss and dementia, neuropsychologists use a variety of memory, image recognition, and abstract reasoning tests. The tests require participants to name objects from drawings, match similar shapes, and remember lists of items. Neuropsychologists assess people who take the test based on their age and years of schooling, among other factors. But African Americans do not perform as well as whites on these tests even if test-takers from both ethnic groups have attained the same number of years of schooling. Because of the lower scores, healthy African Americans may be more likely to be misdiagnosed with Alzheimer’s disease or other cognitive defects. In an effort to make neuropsychological tests more accurate, Columbia Health Sciences researchers decided to study whether quality of education, rather than quantity, could explain the lower test scores among African Americans. In their study, the investigators measured quality of schooling by administering a reading test to 192 elderly African Americans and 192 elderly non-Hispanic whites from Northern Manhattan. The participants, who were all 65 years and older, did not have dementia and were functioning normally in their daily lives. The researchers found that they could eliminate most of the racial differences found in the neuropsychological test assessments by factoring in the scores from the reading tests. Both blacks and whites with a poor reading test result achieved similar neuropsychological test scores. “The findings suggest that including an assessment of reading skills will help neuropsychologists know what scores to expect from elders with diverse educational backgrounds,” says Dr. Jennifer Manly, lead author of the study and assistant professor of neuropsychology in the Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain. “Incorporating reading tests into our testing battery could help reduce misdiagnosis of cognitive impairment among people with low reading levels regardless of race.” The findings were published in the March issue of the Journal of the International Neuropsychological Society.The study participants were drawn from the Washington Heights-Inwood Columbia Aging Project, a 10-year-old epidemiological study of cognitive aging and dementia that currently includes about 2,800 people and is led by Dr. Richard Mayeux, professor of neurology and psychiatry and director of the Gertrude H. Sergievsky Center. Each individual received a battery of neuropsychological tests and a reading test that asked participants to pronounce words of increasing difficulty from a list. Participants who had a better quality of education were better able to pronounce the more uncommon words. On average, African Americans in the study population scored worse than whites on the reading tests because the reading test reflects the poor educational experience of many African American elders. Dr. Manly suggests that segregated schooling, shorter school years, and limited funding devoted to African American schools in the 1920s and 1930s explain the poorer quality of education for the African Americans in the study. Many elderly African Americans, now living in New York, were educated in the rural South where state school boards mandated shorter school years. But Dr. Manly’s findings extend beyond African Americans. Testing reading as part of neuropsychological assessment could help clinicians improve their accuracy of diagnosis of dementia or cognitive deficits among whites or other ethnic groups who had a poor education. Columbia researchers now include reading tests in their neuropsychological evaluations of individuals in their ongoing aging and dementia project. They are performing follow-up studies to validate whether the reading test is a better estimate of educational experience than years of education, the current standard. Even without the validation, Dr. Manly’s findings are pushing the field of neuropsychology. “Dr. Manly has shown that by accounting for just one indicator of educational quality, racial differences on cognitive test performance in older people are significantly reduced,” says Dr. Molly Wagster, program director for neuropsychology of aging research at the National Institute on Aging, the major supporter of the research. “This very important work will help guide the development of tests that are more culturally relevant and more accurate.” Dr. Manly hopes the paper and related ones will help people with dementia and those at risk of developing it. “Maybe measuring educational and cultural experiences will reduce the tendency in some cognitive research to put such an emphasis on race,” Dr. Manly says.

· The Alzheimer’s Association and the New York City Speakers Fund for Biomedical Research also provided funding for the study.

· Other Columbia researchers who participated in the study were Diane Jacobs, adjunct associate research scientist in the Sergievsky Center; Pegah Touradji, research assistant in the Sergievsky Center; Scott Small, Irving Assistant Professor of Neurology; and Yaakov Stern, professor of clinical neuropsychology in neurology, psychiatry, the Sergievsky Center, and the Taub Center.

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African Americans, Categories, New York, Sergievsky Center