We assessed the interobserver agreement on the clinical diagnosis of dementia syndrome and dementia subtypes as part of a cross-national project on the prevalence of dementia. Fourteen clinicians from the participating countries (Canada, Chile, Malta, Nigeria, Spain, and the United States) independently assessed the diagnosis of 51 patients whose clinical information was in standard records written in English. We used the DSM-III-R and ICD-10 criteria for dementia syndrome, the NINCDS-ADRDA criteria for Alzheimer's disease (AD), and the ICD-10 criteria for other dementing diseases, and measured interobserver agreement. We found comparable levels of agreement on the diagnosis of dementia using the DSM-III-R (kappa = 0.67) as well as the ICD-10 criteria (kappa = 0.69). Cognitive impairment without dementia was a major source of disagreement (kappa = 0.10). The kappa values were 0.58 for probable AD, 0.12 for possible AD, and rose to 0.72 when the two categories were merged. The interrater reproducibility of the diagnosis of vascular dementia was 0.66 in terms of kappa index; the diagnoses of other dementing disorders as a whole reached a kappa value of 0.40. This study suggests that clinicians from different cultures and medical traditions can use the DSM-III-R and the ICD-10 criteria for dementia effectively and thus reliably identify dementia cases in cross-national research. The interrater agreement on the diagnosis of dementia might be improved if clear-cut guidelines in the definition of cognitive impairment are provided. To improve the reliability of AD diagnosis in epidemiologic studies, we suggest that the NINCDS-ADRDA "probable" and "possible" categories be merged.

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The manifestations of externalizing and internalizing behaviors among minority adolescents might best be understood by examining their relation to culturally specific factors, such as cultural identity, as well as to factors that seem to be relevant across cultures, such as age and gender. In this study, we examined the roles of age and gender in moderating the relation between self-reported cultural identity and externalizing and internalizing problems and the interaction between Indigenous and Mainstream cultural identity in relation to problematic behaviors. The participants included 61 students (32 female) with a mean age of 14.5 years (SD = 1.69) from a Naskapi reserve in Quebec, Canada. Age moderated the relation between identification with Indigenous culture and internalizing symptomatology. Indigenous and Mainstream cultural identity did not interact in predicting internalizing or externalizing problems. Consistent with the available evidence regarding the centrality of identity in adolescent development, the magnitude of the inverse relation between identification with Indigenous culture and number of clinical internalizing symptoms appears to increase in significance later in adolescence. The lack of an interaction between Indigenous and Mainstream cultural identity in relation to internalizing and externalizing problems suggests that it is the need to consider both cultures individually without the assumption that one negates the other.