Neuropsychological Assessment and Intervention with Native Americans

Challenges to the recognition and assessment of Alzheimer's disease in American Indians of the southwestern United States

“…Historical factors and the corresponding issues of mental health have been shown to be important in understanding present-day health issues in AIs [15][16][17][18]. For this reason, the physicians and psychologists who wrote the Supplement to the 2001 Surgeon General's report on mental health structured each chapter in a way that takes into account the unique character and circumstances that influenced the course of mental health issues particular to the ethnic minority population that was being described.…”

“…AIs are unique among ethnic minority populations in the United States because they have a distinctive history with regard to the federal government, beginning with the "destruction of entire Indian nations" [5], colonization, treaties, forced relocation, and attempts at assimilation through the removal of their children and the impact of missionaries. Forced education in boarding schools caused considerable trauma to the mental health of AIs [19][20][21], in addition to resulting in the long-term undermining of tribal ways of childrearing and language use [22]; ultimately, the boarding school experience resulted in "natural resistance to the forced assimilation of European American culture" [17]. AIs are also unique in that they are the only ethnic group in the United States affected by policies that have been characterized as a unique "'government-to-government' relationship among the federal government, the states, and the Indian tribes" [22].…”

“…The very existence of the Indian Health Service (IHS) came from treaty obligations to serve the needs of the Native populations of the United States as a dependent population. Whether perceived as representatives of the federal government or as researchers who have come to exploit the Native community, clinicians need to take into account that "initial feelings for an AI elder may be quite different than those of an Anglo person when entering an institutional setting" [17]. These sociopolitical/ interpersonal factors can have a considerable effect on the nature of the interaction.…”

“…These sociopolitical/ interpersonal factors can have a considerable effect on the nature of the interaction. Because "individuals react differently when there is an unequal power base" [17], benefit in rapport might be gained by holding the assessments in a familiar setting, such as a tribal senior center on the reservation.…”

“…Less easily documented differences that have been demonstrated between European American people and Native people might also influence the assessment process and outcome. These include differences in cognitive processing styles, sociopolitical/interpersonal orientation, and personality/sociality [17]. These differences between AIs and the majority population are also seen among individuals within tribes, between tribes, and reflected in the interaction between the individual and the medical assessor.…”