Culture Bias in Testing Expressive Ability In Dementia

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DESCRIPTION (provided by applicant): The dramatically increasing numbers of African American and Hispanic American older adults raises concerns about their adequate representation in research and the appropriateness of current assessments and interventions. This is especially important for those who develop dementia with concomitant difficult expressing their thoughts and feelings. The purpose of this study is to: 1) examine existing and newly created measures of expressive language and mood for culture bias in use with older African Americans and Hispanic Americans, and 2) refine and modify those instruments that do not demonstrate adequate reliability and validity until satisfactory levels are achieved. Six hundred subjects, 100 African American, 100 Hispanic American and 100 European American older adults with dementia and equal number of normal controls, will be recruited from community and institutional sites. Data on subjects' age, gender, socioeconomic status, education, ethnic group, acculturation and mental status will be obtained. Primary raters will be matched on ethnic group; reliability of raters of same and different ethnic group will be examined using videotapes of the testing sessions. Two new instruments, the Miami Naming Test and Alzheimer's Mood Scale will be evaluated as will the well known Boston Naming Test, Animal Fluency, Lawton Observed Affect Scale, Cornell Scale for Depression in Dementia and Dementia Mood Assessment Scale. Internal consistency of each measure will be evaluated. Using generalizability theory as a framework for analysis, all measures will be evaluated for interrater reliability and stability over time. Cultural match/mismatch between subject and rater will also be evaluated on the mood scales. Ability of Miami Naming Test to discriminate cognitively impaired and unimpaired will be compared with the Boston Naming Test as will the Animal Fluency with other categories (fruit, vegetable, clothing). Likewise, ability of the new Alzheimer's Mood Scale to discriminate psychiatrically distressed from nondistressed subjects will be compared with the other mood scales. Differential item functioning analysis will guide the revisions and modifications. As outreach efforts to bring minority individuals in for assessment of memory disorders expands and research on the efficacy of treatment is conducted, the demand for culturally appropriate tests is an urgent one. Both clinicians and researchers need to know which tests are appropriate, the extent to which the ethnicity of the examiner affects the results and how to interpret the scores obtained on both the newly developed and widely used tests.