Validation of a European Cross‐Cultural Neuropsychological Test Battery (CNTB) for evaluation of dementia

Abstract

Background The aims of this study were to establish the diagnostic accuracy of the European Cross‐Cultural Neuropsychological Test Battery (CNTB) for dementia in different ethnic populations in Western Europe, to examine its ability to differentiate cognitive impairment profiles for dementia subtypes, and to assess the impact of demographic variables on diagnostic properties. Methods The study was a Western European cross‐sectional multi‐center study. A total of 66 patients with dementia and 118 cognitively intact participants were included across six memory clinics; 93 had ethnic minority background and 91 had ethnic majority background. Tests in the CNTB cover global cognitive function, memory, language, executive functions, and visuospatial functions. Results Significant differences with moderate to large effect sizes were present between patients with dementia and control participants on all CNTB measures. Area under the curves (AUC) ranged from .62 to .99 with a mean AUC across all measures of .83. Comparison of ethnic minority and majority groups generally revealed higher sensitivity in the minority group but no significant difference in the mean AUC's across all measures (.84 vs78, P = .42). Comparison of impairment profiles for patients with Alzheimer's disease (AD) and non‐AD dementia revealed that AD patients were significantly more impaired on the memory domain, whereas patients with non‐AD dementia were more impaired on the executive functions domain. Conclusions The CNTB was found to have promising cross‐cultural diagnostic properties for evaluation of dementia in the targeted minority and majority populations and could represent a valid cross‐cultural alternative to other well‐established neuropsychological test batteries when assessing patients from these populations.

Validation of a brief Multicultural Cognitive Examination (MCE) for evaluation of dementia

“…10,11 Newly referred patients with a clinical diagnosis of dementia with Revision (DSM-IV-TR) diagnostic criteria for dementia 16 and diagnostic research criteria for dementia subtypes. 10,11 Newly referred patients with a clinical diagnosis of dementia with Revision (DSM-IV-TR) diagnostic criteria for dementia 16 and diagnostic research criteria for dementia subtypes.…”

“…7 However, as the RUDAS is a very brief screening instrument, it may have certain limitations when it comes to detection of the early cognitive deficits in dementia disorders and to differentiating between dementia subtypes. Although more comprehensive neuropsychological batteries, such as the European Cross-Cultural Neuropsychological Test Battery (CNTB), 10,11 do not seem to suffer from these limitations, it requires specialized test materials and trained personnel to administer and is usually beyond the scope of routine cognitive evaluations.…”

“…[10][11][12] The Multicultural Cognitive Examination (MCE) evaluates key aspects of cognition with minimal need for specialized test materials. [10][11][12] The Multicultural Cognitive Examination (MCE) evaluates key aspects of cognition with minimal need for specialized test materials.…”

“…On the basis of these limitations, we designed a new brief screening instrument for the detection and classification of dementia in multicultural populations based on our research with the CNTB. [10][11][12] The Multicultural Cognitive Examination (MCE) evaluates key aspects of cognition with minimal need for specialized test materials. It is a brief instrument that incorporates the RUDAS and expands assessment of memory, verbal fluency, and visuospatial function.…”

“…groups to ensure them proper treatment for their specific dementia disorders and reduce ethnic inequalities in dementia care. Learning and recall of pictures has previously been shown to be unaffected by education, including illiteracy, across a variety of cultural groups while remaining sensitive to memory impairment in AD and other dementia disorders 11,12,[27][28][29]. By expanding the evaluation of cognitive functions covered by the RUDAS, the MCE improves the diagnostic accuracy in cross-cultural evaluations of early or mild dementia and may particularly be a resource in settings where neuropsychological support is not readily available.…”