Developing an assessment protocol to detect cognitive impairment and dementia in Cree Aboriginal seniors and to investigate cultural differences in cognitive aging
Recent publications have urged researchers to address neuropsychological assessment issues among culturally and linguistically diverse individuals for whom current assessment measures are not typically appropriate. This dissertation examined cultural considerations in clinical neuropsychological practice with Cree-speaking Canadians residing in Saskatchewan. Four inter-related studies focused on understanding cultural perceptions of normal aging and dementia within a Canadian Aboriginal population, modifying existing screening and neuropsychological assessment instruments for use in both normal aging research and clinical practice, and investigating the role of culture in cognitive aging with Cree-speaking. Study 1 involved the qualitative analyses of a series of key informant interviews with an Aboriginal Grandmothers Group. Three related themes were identified that highlighted Aboriginal experiences of aging, caregiving, and dementia within the healthcare system. The third theme, the importance of culturally grounded healthcare, directly informed test development for Studies 2 and 3. In Study 2, two screening measures that were adapted for use with seniors from diverse cultural groups were further modified and examined for use with Canadian Aboriginal seniors. Overall, performance was consistent across the two screening measures, and the measures informed clinical diagnosis and were well-received by both the Aboriginal patients and their family members. Study 3 describes the development of the Grasshoppers and Geese Test battery (G&G), created by modifying and integrating existing instruments and paradigms for language and memory assessment for use with culturally diverse seniors. All G&G subtests demonstrated adequate preliminary psychometric properties and generated excellent sensitivity and good specificity in differentiating healthy older adults from adults with Alzheimer’s disease. Finally, Study 4 examined performance on the G&G and on other neuropsychological measures in groups of young-middle aged and older adults from majority culture and Cree background. Cree participants’ mean scores were lower on measures of confrontational naming, semantic memory, verbal fluency, prospective memory, and processing speed, and were presumed to be in keeping with the significantly fewer years of education, lower estimated reading ability, and possible health disparities in the participants of Cree background. Findings of the four studies are discussed in the context of implications for current clinical practice and with regard to future research.
culturally appropriate assessment, dementia, neuropsychological assessment, Aboriginal
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