T. Rune Nielsen, PhD

Transcription

1 Development and validation of the European Cross-Cultural Neuropsychological Test Battery (CNTB), PhD Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen NNF, Oslo September 2016

2 Background Among European dementia experts, 64% find it more challenging to make cognitive assessments in patients with immigrant background 1. Language proficiency (88%) 2. Presentation of symptoms (84%) 3. Educational level(84%) 4. Lacking clinical tools (68%) 5. Lacking cultural knowledge (44-56%) Nielsen et al., International Psychogeriatrics, 2011

3 What is the problem with our clinical tools? The available clinical tools are usually developed and validated in Western educated populations and are biased by cultural, lingusitic and educational factors (ie. the MMSE). Mini Mental State Examination (MMSE) and Rowland Universal Dementia Assessment Scale (RUDAS) in healthy Turkish immigrants Variable n RUDAS MMSE Total score ± ±4.3 Education 0-4 years ± ± years ± 2.2 p= ± 2.4 p<0.001 Nielsen et al., Scandinavian Journal of Psychology, 2012

4 What is the problem with our clinical tools? Percentage of diagnostic mistakes of Minor- and Major Neurocognitive Disorder (DSM-IV) when using original standardized US norms on available neuropsychological tests Groups matched by: age gender educational level monthly income All fluent in Spanish at an academic level Daugherty et al., Applied Neuropsyhology: Adult, 2016

5 European research alliance on development of a cross-cultural neuropsychological test battery Brussels Thessaloniki Copenhagen Oslo Malmö Berlin Manila / Colombo? Rio de Janeiro og São Paulo Beirut

6 The CNTB study The first European study on cross-cultural cognitive assessment

7 Healthy control sample (preliminary data) Majority Minority Belgian, Danish, Norwegian, Swedish Polish Former Yugoslavian Pakistani Turkish Moroccan Total sample p N Age (years) 68.4 (11.1) 67.7 (8.7) 63.3 (6.0) 58.7 (6.8) 61.6 (7.3) 57.7 (8.1) 64.7 (9.9) <.001 Education (years) 12.0 (3.3) 14.4 (2.5) 11.0 (3.1) 9.9 (4.8) 3.9 (3.9) 2.9 (2.6) 9.7 (5.2) <.001 Data on Pakistani immigrants generously made available by Peter Bekkhus-Wetterberg, MD

8 Culture reduced instruments in the CNTB Requirements for included tests: Sensitive to cognitive dysfunction in dementia. Short and easy to administer. Can be applied with an interpreter. Does not include elements that need written translation. Can be performed by individuals with limited or no schooling.

9 Tests in the CNTB The CNTB consists of 12 tests that can be administered in approximately 60 minutes Global cognitive function Rowland Universal Dementia Assessment Scale (RUDAS) Memory Recall of Pictures Test (RPT) Enhanced Cued Recall (ECR) Recall of simplified Rey figure Executive functions Color Trails Test (CTT) Five Digit Test (FDT) Serial threes Visuospatial functions Copying of simple figures Copying of simplified Rey figure Clock Drawing Test (CDT) Clock Reading Test (CRT) Language Picture naming (RPT) Animal fluency Supermarket fluency

10 Global cognitive function - Rowland Universal Dementia Assessment Scale (RUDAS) What explains the variation? Age Education Country of origin 3% 15% <1% Storey et al., International Psychogeriatrics, 2004

11 Learning and memory - Enhanced Cued Recall (ECR) Based on Solomon et al., Archives of Neurology, 1998

12 Learning and memory - Recall of Pictures Test (RPT) Nielsen et al., International psychogeriatrics, 2012

13 Learning and memory - Preliminary data P=.28 What explains the variation? Age Education Country of origin ECR 1% <1% 6% p=.63 RPT immediate recall 5% - 8% RPT delayed recall 7% <1% 3% RPT recognition <1% 1% 1% Rey recall 9% 15% 3%

14 Executive functions - Color Trails Test (CTT) CTT 1 CTT2 Only participants with >4 years of education d Elia et al., Color Trails Test: Professional Manual, 1996

15 Executive functions - Five Digit Test (FDT) Sedó, FDT Manual, 2007

16 Executive functions - Preliminary data What explains the variation? Age Education Country of origin CTT 1 5% 22% 7% CTT 2 4% 31% 10% FDT 1 4% 31% 3% * Scale multiplied with 10 to with other scales FDT 2 4% 31% 5% FDT 3 9% 22% 3% 20-3 <1% 13% 13%

17 Language - RPT picture naming

18 Language - Animal and supermarket fluency Strauss et al., A Compendium of Neuropsychological Tests, 2006

19 Language - Preliminary data What explains the variation? Age Education Country of origin RPT picture naming <1% 12% 5% Animal fluency 2% 22% 7% Supermarket fluency 11% 17% 5%

20 Visuospatial functions - Copying tests Simple copying tests Simplyfied Rey figure (22 points)...

21 Visuospatial functions - Clock Drawing Test (CDT) Shulman et al., International Journal of Geriatric Psychiatry, 2000

22 Visuospatial functions - Clock Reading Test (CRT) Schmidtke and Olbrich, International Psychogeriatrics, 2007

23 Visuospatial functions - Preliminary data What explains the variation? Age Education Country of origin Cross <1% 27% 6% Star 2% 40% <1% CDT 8% 12% 1% CRT 5% 10% 6% Rey 2% 40% <1%

24 Internal structure of the CNTB Structure Matrix Component Executive FDT 2 -,871 Memory FDT 1 -,863 CTT 1 -,847 Visuospatial CTT 2 -,808 FDT 3 Language -,761 CDT,730 Copyng,695,606 RPT naming,587,406 Subtraction 20-3,569 RPT recall,828 RPT immediate recall,814 RPT recognition,484 ECR,367 Rey copy,896 Rey recall,440,764 CRT,533,594 Supermarket fluency,421,423 -,716 Animal fluency,530 -,650 Extraction Method: Principal Component Analysis. Rotation Method: Oblimin with Kaiser Normalization. Only factors with loading <.4 are shown

25 But is the CNTB sensitive to cognitive dysfunction? Controls, n = 339 Patients with dementia, n = 61 Area Under the Curve Test Result Variable(s) Area RPT recall,993 RPT learning,988 ECR,928 Rey recall,928 RUDAS,920 Fluence, supermarket,918 Fluence, animals,894 FDT3 (time),869 Color2 (time),834 Color1 (time),814 FDT2 (time),809 CDT (Shulman,2000),803 CRT,792 FDT1 (time),767 RPT recognition,753 RPT naming,672 Subtraction 20-3,667 Rey copy,643 Copying,580

26 The CNTB - summary The preliminary data from the CNTB control sample suggests that the included measures are suitable for the targeted cultural groups (on average, country of origin explains 5% of the variation). Although the measures seem to be relatively independant of cultural differences, education should be taken into consideration in the interpretation of test results (on average, age explains 4% of the variation, while education explains 16%). The majority of the test on the CNTB have satisfactory sensitivity to cognitive dysfunction in a multicultural sample. The final validation of the CNTB is expected during 2016.

27 Acknowledgements Collaborators Norway: Peter Bekkhus-Wetterberg, MD; Oslo University Hospital Ullevål, Oslo. Sweden: Lennart Minthon, MD, professor; Skåne University Hospital Malmö, Malmö. Germany: Ulrike Beinhoof, PhD; Charité - Universitätsmedizin Berlin, Berlin. Belgium: Kurt Segers, MD; Brugmann University Hospital, Brussels. Greece: Magda Tsolaki, MD, professor; Aristotle University of Thessaloniki, Thessaloniki. Funding The study is supported by the EU-funded program Interreg IV A. The Danish Dementia Research Center is supported by the Danish Health Insurance Foundation and the Danish Ministry of Health.