Neuropsychological Language Tests in Dementia Diagnosis in English-Speaking Hispanic and Non-Hispanic White Outpatients

Abstract

Neuropsychological language tests have limitations (e.g., unrepresentative norms) when applied to “Hispanics” of which clinicians are likely aware that may lead to inaccurate dementia diagnoses. Therefore, it was hypothesized that language tests would be weaker diagnostic predictors in Hispanics versus “non-Hispanic Whites.” Participants included 436 English-speaking Hispanic and 436 non-Hispanic White (randomly selected from 10,937) outpatients classified as dementia or normal cognition at initial evaluation. When covarying for age, sex, education, and functional abilities, vegetable fluency significantly predicted diagnosis among non-Hispanic Whites, odds ratio = 0.80, 95% confidence interval [0.69, 0.94], p < .01. Animal fluency and an abbreviated (30-item) Boston Naming Test (BNT) comparably predicted diagnosis across groups. Results remained similar when covarying for primary language among Hispanics. Findings suggest that vegetable but not animal fluency was relatively unimportant in diagnosis for the English-speaking Hispanics in this study possibly because of cultural influences on the familiarity, salience, and relevance of this category’s items. Additionally, clinicians may have informally adjusted Hispanics’ 30-item BNT and animal fluency scores and discounted vegetable fluency to account for their limitations. Animal fluency and BNT may be preferable language tests when assessing dementia in English across groups, as they comparably predicted diagnosis in both groups.

Validity of Cognitive Assessment Tools for Older Adult Hispanics: A Systematic Review

“…One study investigated the Boston Naming Test and did not find significant differences in performance by H/Ls compared with non‐H/L groups (Supplementary File 2, Table S2).…”

“…One study investigated the verbal fluency test using the sample of the ADRC and found no significant difference in performance (animals and vegetables) between H/Ls and non‐H/Ls . The study with random population sampling in New Mexico, however, found significant differences in test performance (same‐sex first names) for H/L ethnicity (Supplementary File 2, Table S2).…”