The development, pilot and validation of a multicultural cognitive assessment scale
Australia is a multicultural society with an ageing population. Diseases such as dementia, which affect older age groups, are therefore becoming increasingly important health issues. Brief cognitive assessment instruments are used to screen older patients for dementia. Many of these instruments have been developed for use in English speaking populations and are not culture-fair or easily translated for use with non-English speakers. To ensure that people from all cultural backgrounds receive optimal health care, primary health care workers need a quick, reliable, and non-threatening dementia screening tool that is valid across cultures and easy to administer in a wide range of settings. This thesis explores the philosophical, scientific, and social antecedents of current approaches to measuring cognition. It argues that these have led to the treatment of culture as an intrinsic human attribute rather than one which describes variations in human experience. The consequences for approaches to the assessment of cognition in people from diverse cultural backgrounds are discussed and a model is presented to provide theoretical support for the development of a multicultural cognitive screening test for dementia. Following a literature review of brief cognitive screening instruments, clock drawing tests, and cross-cultural cognitive tests, two studies are presented. The first study tests the hypothesis that clock drawing is a useful multicultural screening instrument. There were no significant differences between six clock scoring methods for predicting dementia in a sample of 93 patients from non-English speaking backgrounds. While the Wolf-Klein clock scoring method produced the best trade-off between sensitivity (78%) and specificity (58%), this was insufficient to recommend clock drawing as a useful screening test for dementia in a multicultural population. The second study provides support for the hypothesis that a cognitive screening test with good predictive accuracy can be developed and used to screen for dementia in a multicultural population. This study reports the development, pilot, and validation stages of a multicultural cognitive test with excellent diagnostic accuracy (Area under the ROC curve = 0.95) and 89% sensitivity and 98% specificity for detecting dementia. This research has important implications for current clinical practice and the potential to improve public health for many Australians.
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