Why is the diagnosis of dementia in elderly immigrants so important and so challenging?

In the coming decades, the immigrant population will grow older. The cognitive impairment and dementia in this group will increase accordingly. The diagnosis is difficult for several reasons. Most of the elderly immigrants from ethnic minorities have limited knowledge of the host country’s language and many are low educated or illiterate. This makes cognitive testing impossible. Other cultural factors may also influence how these minorities perceive cognitive symptoms that accompany dementia, or their likelihood of visiting a memory clinic, or the communication between them and their doctors.

What is the Cross-Cultural Dementia screening?

The Cross-Cultural Dementia screening is a new neuropsychological dementia screening test. There are three tests that measure memory, mental speed and executive function.

• Memory is assessed by the Objects test which is a memory test that uses colored pictures of everyday objects. The individual has to recognize thirty target items amongst an increasing number of distracters. The test has two parts. Part A is a learning trial with immediate recognition. Part B consists of a delayed recognition trial.

• Mental speed and inhibition are assessed by the Sun-Moon test. It contains a series of suns and moons that the participant has to name as fast as possible in the mother tongue. This test has also a second part, in which the individual has to say “sun” when a moon is shown and “moon” when a sun is shown.

• Mental speed and divided attention are assessed by the Dots test. In part A of the test, the dominoes that have one to nine dots have to be connected in the right order as fast as possible by drawing a line in pencil. In part B of the test, the participant needs to connect black and white dominoes to one another, in both an alternating and an ascending order from one to nine, as fast as possible.

The test does not require general factual knowledge or reading and writing skills. There are several examples to make sure the individual understands the test. The researcher does not have to speak the same language as the participant to use this test.

Is the Cross-Cultural Dementia screening a culturally fair and valid test?

The results show that the Cross-Cultural Dementia test is a culture-fair test. The three subtests all showed good sensitivity and specificity for dementia. The test proved to be suitable for elderly immigrants from different ethnic backgrounds.