Week 5 - Culture in Neuropsychological Assessment Flashcards
(35 cards)
WHAT IS NEUROPSYCHOLOGY?
Study of the relationship between behavior, emotion and cognition on one hand, and brain function on the other
PHYSICAL DIFFERENCES:
BRAIN
- Specialized skill acquisition
- Enrichment (education, social-life, etc.)
- Deprivation (lack of stimulation)
- Education (different levels)
- Health, stress
- Correlates of differing cognitive mechanisms
- … experience more generally
PHYSICAL DIFFERENCES:
GENETICS
(Core of nature/nurture interactions!)
- Heredity: passing on characteristics from parents to children based on genetic material (99% =fixed, 1% differs across individuals) Genes can have effects that depend on external variables.
- Epigenetics: environmental factors cause genes to switch on or off without modification of the DNA sequence. Chemical tags can control genes in specific cells, they can result from lifestyle choices or specific experiences, but some are hereditary!
MEASURING BRAIN FUNCTION:
NP ASSESSMENT
- Intelligence
- Memory
- Verbal abilities
- Executive functions
- Visuo-spatial functions
- Attention
- Syndrome-related combinations
- General batteries
- Compare scores to normative data
–> Sometimes with corrections for age or education level
CULTURE AND NP ASSESSMENT
Normative data based on very limited subsample:
WEIRD patients!
* Partial
* Biased
WHY WOULD CULTURE AFFECT NP ASSESSMENT?
- Values and meanings
- Modes of knowing (Individual task vs collective endeavor)
- Conventions of communication (Interaction: one-way questions, authority; Type of questions)
PATTERNS OF ABILITIES: what, when, who
- tests: appropriate how?
Culture prescribes what should be learned, at what age, and by which gender
Tests need to be appropriate for subject’s learning opportunities and contextual experiences
CULTURAL VALUES: what is or is not situationally relevant and significant, or even appropriate
- One-to one testing relationship with a stranger
- Background authority: why follow orders?
- Best performance: why try to get a high score?
- Isolated environment: unusual social situation
- Special type of communication: unusual language
- Speed: why trade off speed for accuracy?
- Private, embarrassing or subjective issues
- Specific testing materials and strategies
FAMILIARITY
- Testing situation
- Attitudes that facilitate good performance
- Elements used in testing
- Strategies needed to solve task
LANGUAGE
- Linguistic relativity
- Language use and meaning differs with cultural & subcultural background
- Correlates strongly with education
level, testing language often formal –> Important to make test instructions
understandable and appropriate!
EDUCATION
Accounts for up to 50% of variance in IQ tests, 0.6-38% in NP tests!
Double role:
* Increases knowledge of test content
* Increases familiarity with testing setting and strategies
LITERACY / ILLETERACY
Illiteracy: Not being able to read or write
Functional illiteracy: reading and writing is inadequate “to manage
daily living and employment tasks that require reading skills beyond
a basic level”
- Higher in men then women, 2/3 illiterates = women
LITERACY
- Higher in men then women, 2/3 illiterates = women
- In Europe, North-America and Australia, literacy is closely tied to poverty: functional illiteracy can be high in specific groups!
- All countries have significant numbers of people with low skills: between 1/3 and 2/3 do not attain minimum level demanded by increasingly complex knowledge economy
- Especially the US and Italy show a large range in skills
- Lower document literacy and numeracy also associated
with poorer health
ILLITERACY & COGNITION
Learning to read reinforces certain cognitive abilities, such as…
- verbal memory
- phonological awareness
- visuospatial discrimination
- More difficulty copying nonsense figures or words (to abstratc)
ILLETERATES & LOWER SCORES
- Naming tasks
- Verbal fluency
- Verbal memory
- Visuo-perceptual abilities
- Conceptual functions
- Numerical abilities
MINORITIES WITHIN A CULTURE: + six potential distinguish variables….
- Different ethnic groups in one country
- After migration (especially first-generation)
- Groups with no country
- Nationality and legality
- Relative culture distance to majority culture
- Relative language distance to majority language
- Normality: how ‘strange’ is the minority culture perceived by the majority?
- Reference group: how big is the minority group?
- Social image: positive or negative attitudes of the majority group towards a minority group
NECESSITY FOR SPECIFIC TESTS AND NORMS
Indication of functional level depends on relative scores
> language
> culture region
> education level
> SES level
> age group
AGING: cognitive function decline/stable
decline: memory & executive function
stable (“better”): vocabulary & world knowledge
AGING: increased risk
mild cognitive impairment (MCI) and
dementia increases with age
MCI
Mild cognitive impairment:
- Cognitive changes that are serious enough to be noticed
- Not severe enough to interfere with daily life or independent function
- Most common subtype of MCI first presents as memory impairment
- Progression to dementia in 10 to 15% of afflicted persons per year
DEMENTIA
Umbrella term for symptoms caused by neural disorders, especially cognitive symptoms
Most common causes of dementia
* Alzheimer’s disease: 50-80%
* Vascular dementia: 20%
* Dementia with Lewy bodies 15%
* Frontotemporal dementia 5%
Each have own most prominent symptoms, all interfere with everyday activities
SCREENING FOR DEMENTIA
MMSE: Mini-Mental Screening Exam (Folstein)
- Orientation to time and place
- Naming
- Registration (responding to prompts)
- Attention and calculation
- Recall
- Repetition
- Complex command (figure)
Maximum score=30, dementia is indicated for scores below 24
➢ screening, not diagnosis!
MAJOR NEUROCOGNITIVE DISORDER (DEMENTIA)
A, B, C, D
A)
- learning & memory
- language
- executive function
- complex attention
- perceptual-motor
- social cognition
B)
- interfere with independence in everyday activity and require assistance.
C)
- the deficits do not occur exclusively in the context of a delirium.
D)
- deficits are not better explained by another mental disorder.
PREVALENCE: MCI
- MCI prevalence = 3.0 - 19.0%, with a risk of developing dementia of 11-33% within 2 years.
- Dementia prevalence = 5.4 - 6.4% (≥60 years)
- Not the same everywhere! (Related to wealth)
- Higher prevalence MCI and dementia described for immigrant populations
in USA and UK
