Neuropsychological application of the International Test Commission Guidelines for Translation and Adapting of Tests.

OBJECTIVE: The number of test translations and adaptations has risen exponentially over the last two decades, and these processes are now becoming a common practice. The International Test Commission (ITC) Guidelines for Translating and Adapting Tests (Second Edition, 2017) offer principles and practices to ensure the quality of translated and adapted tests. However, they are not specific to the cognitive processes examined with clinical neuropsychological measures. The aim of this publication is to provide a specialized set of recommendations for guiding neuropsychological test translation and adaptation procedures. METHODS: The International Neuropsychological Society's Cultural Neuropsychology Special Interest Group established a working group tasked with extending the ITC guidelines to offer specialized recommendations for translating/adapting neuropsychological tests. The neuropsychological application of the ITC guidelines was formulated by authors representing over ten nations, drawing upon literature concerning neuropsychological test translation, adaptation, and development, as well as their own expertise and consulting colleagues experienced in this field. RESULTS: A summary of neuropsychological-specific commentary regarding the ITC test translation and adaptation guidelines is presented. Additionally, examples of applying these recommendations across a broad range of criteria are provided to aid test developers in attaining valid and reliable outcomes. CONCLUSIONS: Establishing specific neuropsychological test translation and adaptation guidelines is critical to ensure that such processes produce reliable and valid psychometric measures. Given the rapid global growth experienced in neuropsychology over the last two decades, the recommendations may assist researchers and practitioners in carrying out such endeavors.

Identifying culturally insensitive tests, stimuli, and assessment practices in neuropsychology: A survey of professionals and trainees.

OBJECTIVE: Identify culturally insensitive tests and assessment practices based on a survey of neuropsychologists and neuropsychology trainees. METHOD: A survey was distributed to neuropsychology and psychology listservs asking for respondents to report tests, stimuli, and/or assessment practices perceived as being culturally insensitive and for which populations. A total of 100 participants provided responses, which were coded by three raters to identify commonly reported themes. Frequencies of themes (i.e. different issues related to culturally insensitive tests and practices) and how often specific tests were reported as culturally insensitive were determined. RESULTS: Lack of exposure due to items being biased toward U.S./Westernized culture or being unfamiliar based on age cohort, regional differences, and language background was the most commonly reported theme (20.1%), followed by tests and stimuli that were considered to be triggering or culturally offensive (17.4%). Among responses that mentioned specific tests, the Boston Naming Test was most frequently reported (43.2%), followed by the Wechsler Adult Intelligence Scale - Verbal subtests (20.3%), and Story B from the Wechsler Memory Scale-IV Logical Memory subtest (10.1%). CONCLUSIONS: Beyond the Boston Naming Test noose item, which was recently replaced, survey respondents identified several other culturally insensitive tests and assessment practices that may negatively impact an examinee's performance and their assessment experience. These results emphasize the need for more research to inform test revisions, updated normative data, and increased consideration for cultural differences to provide more equitable neuropsychological assessment services.

Conversion between the Rowland Universal Dementia Assessment Scale and Mini-Mental State Examination test scores in majority and minority populations.

INTRODUCTION: Despite the Rowland Universal Dementia Assessment Scale (RUDAS) having significant advantages as a cognitive screening tool, particularly for minority populations, the Mini-Mental State Examination (MMSE) test is the most widely used test for cognitive screening in Alzheimer's disease (AD). This study aimed to develop a conversion table to predict MMSE scores from observed RUDAS scores, allowing an easy-to-use method to compare both screening tests. METHODS: The equipercentile equating method was used to develop the conversion table using a training sample consisting of cognitively intact participants and individuals with early-stage AD. The resulting conversion table was validated in two samples, comprising participants from majority and minority populations assessed in Spanish. RESULTS: The conversion table demonstrated excellent reliability with intraclass correlation coefficients of.92 in both validation samples. CONCLUSION: This study provides a conversion table between RUDAS and MMSE scores, improving the comparability of these cognitive screening tools for use in clinical and research purposes.

An interplay between cross-cultural and psychometric factors in the Montreal Cognitive Assessment: Experience from the language of a small nation.

The present study aimed to test the hypothesis that the total word length on the Memory subtest of the Czech version of the MoCA, which is 12 syllables compared to the English version of 7 syllables, would have a significant effect on Delayed Recall scores compared to the newly created well-balanced version of the test (further MoCA-WLE). In the original Czech version of MoCA, we replaced the 12-syllable word list in the Memory subtest with a 7-syllable list (MoCA-WLE) to make it equivalent to the standard English version in this respect. We analyzed data from 83 participants in the original MoCA group (70.63 ± 7.01 years old, 14.61 ± 3.17 years of education, 30.12% males) and 83 participants in the MoCA-WLE group (70.72 ± 6.95 years old, 14.93 ± 3.48 years of education, 30.12% males). We did not find evidence for a significant word-length effect in the original MoCA versus MoCA-WLE Delayed Recall in either the Mann-Whitney U test (W = 3418.0, p = .932) or multilevel binomial regression (b = 0.10, 95% posterior probability interval [-0.46, 0.68]). The present study shows cross-cultural limits in the adaptation of the test material. The results underline the caveats of such an approach to test adaptation. Fortunately, 12-syllables in the MoCA Memory Czech version versus the original 7-syllable list did not show a detectable word-length effect. We did not find evidence for differential item functioning or cultural item bias. The original MoCA Czech version is psychometrically comparable to the original English version.

Demographically adjusted Rey-Osterrieth Complex Figure Test norms in a Swedish and Norwegian cohort aged 49-77 years and comparison with North American norms.

INTRODUCTION: The Rey-Osterrieth Complex Figure Test (RCFT) is one of the most commonly used neuropsychological tests in Sweden and Norway. However, no publications provide normative data for this population. The objective of this study was to present demographically adjusted norms for a Swedish and Norwegian population and to evaluate these in an independent comparison group. METHODS: The RCFT was administrated to 344 healthy controls recruited from the Swedish Gothenburg MCI study, the Norwegian Dementia Disease Initiation study, and the Swedish Cardiopulmonary Bioimage Study. Age ranged from 49 to 77 years (mean = 62.4 years, SD = 5.0 years), and education ranged from 6 to 24 years (mean = 13.3 years, SD = 3.0 years). Using a regression-based procedure, we investigated the effects of age, sex, and years of education on test performance. We compared and evaluated our Swedish and Norwegian norms with North American norms in an independent comparison group of 145 individuals. RESULTS: In healthy controls, age and education were associated with performance on the RCFT. When comparing normative RCFT performance in an independent comparison group, North American norms generally overestimated immediate and delayed recall performance. In contrast, our Swedish and Norwegian norms appear to better take into account factors of age and education. CONCLUSIONS: We presented demographically adjusted norms for the RCFT in a Swedish and Norwegian sample. This is the first normative study of the RCFT that presents normative data for this population. In addition, we showed that North American norms might produce inaccurate normative estimations in an independent comparison group.

Sex significantly predicts medial temporal volume when controlling for the influence of ApoE4 biomarker and demographic variables: A cross-ethnic comparison.

OBJECTIVE: To explore the relationship between age, education, sex, and ApoE4 (+) status to brain volume among a cohort with amnestic mild cognitive impairment (aMCI). METHOD: One hundred and twenty-three participants were stratified into Hispanic (n = 75) and White non-Hispanic (WNH, N = 48). Multiple linear regression analyses were conducted with age, education, sex, and ApoE4 status as predictor variables and left and right combined MRI volumes of the hippocampus, parahippocampus, and entorhinal cortex as dependent variables. Variations in head sizes were corrected by normalization with a total intracranial volume measurement. RESULTS: Bonferroni-corrected results indicated that when controlling for ApoE4 status, education, and age, sex was a significant predictor of hippocampal volume among the Hispanic group (ß = .000464, R2 = .196, p < .01) and the WNH group (ß = .000455, R2 = .195, p < .05). Education (ß = .000028, R2 = .168, p < .01) and sex (ß = .000261, R2 = .168, p < .01) were significant predictors of parahippocampal volume among the Hispanic MCI group when controlling for the effects of ApoE4 status and age. One-way ANCOVAs comparing hippocampal and parahippocampal volume between males and females within groups revealed that females had significantly larger hippocampal volumes (p < .05). Hispanic females had significantly larger hippocampal (p < .001) and parahippocampal (p < .05) volume compared to males. No sex differences in parahippocampal volume were noted among WNHs. CONCLUSIONS: Biological sex, rather than ApoE4 status, was a greater predictor of hippocampal volume among Hispanic and WNH females. These findings add to the mixed literature on sex differences in dementia research and highlight continued emphasis on ethnic populations to elucidate on neurodegenerative disparities.

Regression-based normative data for the D-KEFS Color-Word Interference Test in Norwegian adults ages 20-85.

Objective: The Delis-Kaplan Executive Function System (D-KEFS) Color-Word-Interference Test (CWIT; AKA Stroop test) is a widely used measure of processing speed and executive function. While test materials and instructions have been translated to Norwegian, only American age-adjusted norms from D-KEFS are available in Norway. We here develop norms in a sample of 1011 Norwegians between 20 and 85 years. We provide indexes for stability over time and assess demographic adjustments applying the D-KEFS norms. Method: Participants were healthy Norwegian adults from Center for Lifespan Changes in Brain and Cognition (LCBC) (n = 899), the Dementia Disease Initiation (n = 77), and Oslo MCI (n = 35). Using regression-based norming, we estimated linear and non-linear effects of age, education, and sex on the CWIT 1-4 subtests. Stability over time was assessed with intraclass correlation coefficients (ICC). The normative adjustment of the D-KEFS norms was assessed with linear regression models. Results: Increasing age was associated with slower completion on all CWIT subtests in a non-linear fashion (accelerated lowering of performance with older age). Women performed better on CWIT-1&3. Higher education predicted faster completion time on CWIT-3&4. The original age-adjusted norms from D-KEFS did not adjust for sex or education. Furthermore, we observed significant, albeit small effects of age on all CWIT subtests. ICC analyses indicated moderate to good stability over time. Conclusion: We present demographically adjusted regression-based norms and stability indexes for the D-KEFS CWIT subtests. US D-KEFS norms may be inaccurate for Norwegians with high or low educational attainment, especially women.

Cross-cultural evaluation of learning and memory using a consonant-vowel-consonant trigram list.

OBJECTIVE: Word list-learning tasks are commonly used to evaluate auditory-verbal learning and memory. However, different frequencies of word usage, subtle meaning nuances, unique word phonology, and different preexisting associations among words make translation across languages difficult. We administered lists of consonant-vowel-consonant (CVC) nonword trigrams to independent American and Italian young adult samples. We evaluated whether an auditory list-learning task using CVC nonword trigrams instead of words could be applied cross-culturally to evaluate similar learning and associative memory processes. PARTICIPANTS AND METHODS: Seventy-five native English-speaking (USA) and 104 native Italian-speaking (Italy) university students were administered 15-item lists of CVC trigrams using the Rey Auditory Verbal Learning Test paradigm with five study-test trials, an interference trial, and short- and long-term delayed recall. Bayesian t tests and mixed-design ANOVAs contrasted the primary learning indexes across the two samples and biological sex. RESULTS: Performance was comparable between nationalities on all primary memory indices except the interference trial (List B), where the Italian group recalled approximately one item more than the American sample. For both nationalities, recall increased across the five learning trials and declined significantly on the postinterference trial, demonstrating susceptibility to retroactive interference. No effects of sex, age, vocabulary, or depressive symptoms were observed. CONCLUSIONS: Using lists of unfamiliar nonword CVC trigrams, Italian and American younger adults showed a similar performance pattern across immediate and delayed recall trials. Whereas word list-learning performance is typically affected by cultural, demographic, mood, and cognitive factors, this trigram list-learning task does not show such effects, demonstrating its utility for cross-cultural memory assessment.

Do normative data specific to Greek Australian older adults improve validity of neuropsychological assessment results?

OBJECTIVE: This study aimed to compare Greek Australian and English language normative data with regard to impairment rates yielded within a healthy Greek Australian older adult sample. We also examined whether optimal cut scores could be identified and capable of sensitively and specifically distinguishing between healthy Greek Australians from those with a diagnosis of Alzheimer's disease (AD). METHOD: Ninety healthy Greek Australian older adults and 20 demographically matched individuals with a diagnosis of AD completed a range of neuropsychological measures, including the Wechsler Adult Intelligence Scale-Fourth Edition, Greek Adaptation (WAIS-IV GR), verbal and visual memory, language and naming, and executive functions. Impairment rates derived from the use of either Greek Australian or English language normative data were calculated and compared, using a 1.5 standard deviation criterion to denote impairment. Receiver operating characteristics curve analysis was used to investigate the sensitivity and specificity of alternate cut scores. RESULTS: Impairment rates derived from the Greek Australian normative data showed that rates of impairment generally fell within the expected 7% range. In contrast, impairment rates for all tests derived using English language normative data were significantly higher and ranged from 11%-66%. Comparisons between healthy and AD participants with moderate dementia showed significant differences across all measures. Area under the curve results ranged from .721 to .999 across all measures, with most tests displaying excellent sensitivity and specificity. CONCLUSIONS: English language normative data were found to be inappropriate for use with Greek Australian elders, potentially leading to erroneous diagnostic outcomes. The use of minority group specific normative data and associated cut points appear to partially ameliorate this issue. Clinical implications are discussed alongside future research directions.

Performing pediatric neuropsychological evaluation with Chinese patients: A narrative review of the literature and recommendations for practice.

Objective: This paper offers a narrative overview of performance-based cognitive tests and behavior rating inventories that can be considered when working with Chinese youth in assessment settings. Methods: A total of 46 articles that focused on assessment tools and normative data in Chinese-speaking patients were reviewed. Based on the gaps in research and patterns of strengths/weaknesses across reviewed articles, we provide recommendations for selection of tests and norms while utilizing the ECLECTIC framework. Results: Our review of literature suggests extant research on neuropsychological tools for Chinese pediatric patients have largely been focused on translated or adapted measures. Findings highlight the need for the development of indigenous measures across multiple cognitive and behavioral domains to optimally integrate cultural considerations in the assessment process. Conclusions: Specifically, cultural factors that may impact test and norm selection, patients' test performance, and diagnostic considerations are discussed. Finally, gaps in literature are highlighted for future research directions.

Validation of the European Cross-Cultural Neuropsychological Test Battery (CNTB) for the assessment of mild cognitive impairment due to Alzheimer's disease and Parkinson's disease.

Background: The Cross-Cultural Neuropsychological Test Battery (CNTB) is a novel test battery specifically designed to reduce the impact of multiculturality in cognitive assessment. Objective: We aimed to validate the CNTB in Spaniards in patients with Alzheimer's disease (AD), including patients at mild cognitive impairment (MCI) and mild dementia stages, and Parkinson's disease with MCI (PD-MCI). Methods: Thirty patients with AD-MCI, 30 with AD-dementia (AD-D), and 30 with PD-MCI were recruited. Each clinical group was compared against a healthy control group (HC) with no differences in sex, age, or years of education. Intergroup comparisons, ROC analysis, and cut-off scores were calculated. Results: AD-MCI scored lower than HC in those subtests associated with episodic memory and verbal fluency. AD-D also showed lower scores in executive functions and visuospatial tests. Effect sizes for all the subtests were large. PD-MCI showed lower performance than HC in memory and executive functions, particularly on error scores, with large effect sizes. Comparing AD-MCI and PD-MCI, AD-MCI had lower memory scores, while PD-MCI showed the worst performance in executive functions. CNTB showed appropriate convergent validity with standardized neuropsychological tests measuring the same cognitive domains. We obtained similar cut-off scores to previous studies performed in other populations. Conclusions: The CNTB showed appropriate diagnostic properties in AD and PD, including those stages with mild cognitive impairment. This supports the utility of the CNTB for the early detection of cognitive impairment in AD and PD.

Examining the Vietnamese Montreal cognitive assessment in healthy and moderate-to-severe traumatic brain injury populations.

Objective: There have been attempts to modify the Montreal Cognitive Assessment (MoCA), a brief cognitive screening tool, for use across several Asian countries, but evidence to support the utility of these translations has been limited, particularly for the Vietnamese translation of the MoCA (MoCA-V). This two-part study aimed to evaluate the MoCA-V in a Vietnamese sample. Methods: In the first stage, we examined the relationships between the MoCA-V subscales and common neuropsychological tests among healthy Vietnamese adults (n = 129) and individuals with moderate-to-severe traumatic brain injury (n = 80). In the second stage, we explored the relationship of TBI status (TBI vs non-TBI) and demographic variables to MoCA-V performance and investigated the optimal cut-off score of the MoCA-V using the two samples combined. Results: The MoCA-V Attention, Language, and Executive Function subscales were correlated with the Digit Span Test, Verbal Fluency Test, and Trail Making Test, respectively, across healthy participants and participants with TBI. Global performance on the MoCA-V was predicted by TBI status, education, and age. Our ROC analysis revealed that a cut-off score of 22 offered the best sensitivity (76.3%) and specificity (71.3%) trade-off for identifying cognitive impairment as measured by the MoCA-V. Conclusions: In addition to identifying a cut-off score for cognitive screening, the findings provide support for the validity of the examined MoCA-V subscales and for the MoCA-V's ability to distinguish TBI survivors vs controls. These results may pave the way for larger-scale investigations of the MoCA-V and for the development of more neuropsychological batteries in Vietnamese.

Cross-cultural considerations for teleneuropsychology with Asian patients.

OBJECTIVE: Recent teleneuropsychology (TeleNP) models provide some degree of guidance in the application of telecommunication technologies toward the practice of neuropsychology. However, there remains a paucity of peer-reviewed data on TeleNP practices with culturally diverse patients, including Asian patients. This manuscript describes the challenges related to TeleNP practices with Asian patients and offers practical recommendations to complement existing TeleNP guidelines. METHOD: Based on extant literature on multicultural applications of neuropsychology, weprovide recommendations for TeleNP services with Asian patients that pertain to specific components of a TeleNP evaluation, such as a) pre-evaluation preparation, b) determining the appropriateness of the referral, c) determining language proficiency, d) working with interpreters, e) informed consent and confidentiality issues, f) conducting a culturally sensitive clinical interview, g) behavioral observations and communication, h) test selection, and i) interpreting data and writing reports. CONCLUSIONS: Our recommendations for TeleNP services with Asian patients highlight the need for flexibility to accommodate cultural differences and commitment to the complex nature of working with patients requiring interpretation services, while also recognizing the importance of preserving the validity of neuropsychological methods. Moving forward, it is imperative that the field of neuropsychology increases the training and accessibility of neuropsychologists who are knowledgeable in providing TeleNP services to Asian patients, and promotes research on the validation of TeleNP for Asian and other ethnic minority groups.

Validity of Visuoconstructional Assessment Methods within Healthy Elderly Greek Australians: Quantitative and Error Analysis.

AIMS: Visuospatial skills are frequently assessed with drawing tests. Research has suggested that the use of drawing tasks in low educated groups may lack the ability to discriminate healthy individuals from clinical populations. The aims of this study were to investigate the validity of visuoconstructional tests in a sample of older Greek Australian immigrants and compare their performances to a matched sample of patients with Alzheimer's disease (ad). METHOD: We assessed visuoconstructional performances in a sample of 90 healthy older Greek Australians, with a primary school level of education, and compared performances to a demographically matched sample of 20 Greek Australians with a diagnosis of ad on four visuoconstructional drawing tests: Greek cross, four-pointed star, intersecting pentagons, and the Necker Cube. RESULTS: While healthy participants tended to outperform the ad group on most copy tasks, high fail rates within the healthy sample were observed for the intersecting pentagons and Necker cube (78% and 73% fail rates, respectively) when using established clinical cut-off scores. High rates of curved angle, omission, distorted relation between elements, spatial disorganization and three-dimensional design errors were found across the four-pointed star, intersecting pentagons, and the Necker cube in both healthy participants and those with ad. Exploratory receiver operating characteristic curve analysis revealed that, with perhaps the exception of the Greek cross, meaningful sensitivity and specificity could not be reached for the four-pointed star, intersecting pentagons, and Necker cube. CONCLUSION: Cognitively healthy immigrants with low education appear to be at a disadvantage when completing visuoconstructional drawing tests, as their performance may be misinterpreted as indicating cognitive impairment. Future research is needed to identify alternative approaches to assess visuoconstructional ability in culturally and linguistically diverse older cohorts with limited education.

Incorporating Intersectionality in Neuropsychology: Moving the Discipline Forward.

OBJECTIVE: Intersectionality is the interface between a person's identities in relation to social systems and institutional discrimination. The concept has generated much interest in psychology for understanding societal inequities and providing culturally informed services to minoritized patients but has yet to be incorporated in clinical neuropsychology. This omission is unfortunate as it is argued that appreciating the impact of institutional discrimination on minoritized groups can enhance our understanding of brain organization and functioning and bolster access to competent neuropsychological services to minoritized patients. The purpose of this article is to illustrate how intersectionality is germane to the discipline of clinical neuropsychology and to make recommendations for infusing it into the practice. METHOD: Theories and findings in cultural neuroscience are summarized to provide a theoretical background for understanding how the environment can impact brain development and organization. The literature on disparities in education, economics, and health disparities between Whites and minoritized groups was reviewed for institutional biases that place minoritized groups at a disadvantage. These topics were selected due to their known impact on brain organization and cognition. This was followed by a similar review for access to competent neuropsychological assessments for minoritized patients. RESULTS: There is a confluence of institutional discriminatory processes that contribute to disparities in education attainment, economic status, health disparities, and accessibility to culturally informed neuropsychological services. Perceived discrimination has significant health and cognitive ramifications. CONCLUSIONS: Intersectionality is germane to appreciating brain functioning and providing competent services to minoritized patients. Recommendations were made to incorporate intersectionality in clinical neuropsychology.

Language and Acculturation: Neuropsychological Sequalae of COVID-19 in Indian Americans.

Coronavirus 2019 (SARS-CoV-2; COVID-19) has significant mental health and neuropsychological consequences, but data are insufficient on these specific implications of COVID-19, especially for Indian American patients. Few studies have critically explored risk factors and neuropsychological assessment considerations from a cultural and linguistic perspective, including how they impact the evaluation process for Indian Americans. The present paper focuses on cultural and linguistic considerations for case conceptualization, ethical challenges for best practices, and a specific example with a middle-aged Indian American woman. The need for a greater contextual understanding is emphasized as a step forward in establishing methodological and procedural guidelines for working with patients of Indian descent in the United States.

Associations Between Country where Education is Obtained and Cognitive Functioning Among South American and Caribbean Older Adults Living in the U.S.

The increasing prevalence of AD among Hispanics calls for a need for examining factors that affect cognitive functioning and risk of AD among Hispanic older adults. The current study examined cognitive functioning among older Hispanic adults living in the U.S. from two Hispanic regions, South America and the Caribbean, in relation to the country where education was obtained. Participants (n = 139) were stratified into groups based on Hispanic education region and diagnostic categories: cognitively normal and amnestic MCI (aMCI). Results of Pearson correlations showed that among Hispanic Americans in general, there were significant positive correlations between the country of education to performance on measures of episodic, verbal, and word list tests. When examined separately by region and diagnosis, only cognitively normal (CN) South Americans showed significant relationships between country of education and cognitive functioning in these areas. Results of general linear models controlling for education identified differences in neuropsychological performance between groups with the CN groups demonstrating better performance than the aMCI groups within each region. Overall, it was evident that relationships between years of education obtained outside of the U.S. and cognitive functioning were not similar among individuals from these two disparate Spanish speaking regions. This is the first study to examine the country where education was obtained among individuals from countries located in different regions with different cultures that may influence their education and cognitive development throughout life. Findings contribute to the cross-cultural neuropsychological literature in understanding factors that are unique to Hispanic older adults at risk for developing AD.

Neuropsychological evaluation in American Sign Language: A case study of a deaf patient with epilepsy.

In high-stake cases (e.g., evaluating surgical candidacy for epilepsy) where neuropsychological evaluation is essential to care, it is important to have culturally and linguistically appropriate and accessible neuropsychological instruments and procedures for use with deaf individuals who use American Sign Language (ASL). Faced with these ethical and professional issues, clinicians may be unable to provide equitable services without consulting with other psychologists and collaborating with the patient and interpreter. This is a case report describing a 43-year-old male with bilateral sensorineural deafness and a lifelong history of drug-resistant temporal lobe epilepsy who presented as a candidate for a comprehensive neurological workup to determine surgical candidacy. He was bilingual (ASL and written English). We describe all aspects of the evaluation, including functional magnetic resonance imaging (fMRI) and Wada testing, using an ASL interpreter. Results from the neuropsychological evaluation were not clearly lateralizing, but suggested greater compromise to the non-dominant right hemisphere. fMRI and Wada test results revealed language and verbal memory functions were lateralized to the left hemisphere. The patient was deemed to be an adequate candidate for surgical resection of portions of the right hemisphere. Comprehensive assessment of neuropsychological functioning in deaf persons who use ASL is feasible. This case report illustrates the important considerations relevant to neuropsychologists providing culturally and linguistically informed assessments to deaf ASL users with epilepsy. Additional research in this area will support future efforts to develop effective and efficient models that could be implemented across different settings. Moreover, clinical guidance is warranted to guide professionals interested in promoting access to high quality neuropsychological services.

Neurocognitive Profiles Associated With Limited English Proficiency in Cognitively Intact Adults.

OBJECTIVE: The objective of the present study was to examine the neurocognitive profiles associated with limited English proficiency (LEP). METHOD: A brief neuropsychological battery including measures with high (HVM) and low verbal mediation (LVM) was administered to 80 university students: 40 native speakers of English (NSEs) and 40 with LEP. RESULTS: Consistent with previous research, individuals with LEP performed more poorly on HVM measures and equivalent to NSEs on LVM measures-with some notable exceptions. CONCLUSIONS: Low scores on HVM tests should not be interpreted as evidence of acquired cognitive impairment in individuals with LEP, because these measures may systematically underestimate cognitive ability in this population. These findings have important clinical and educational implications.

Examining the cross-cultural validity of the test of memory malingering and the Rey 15-item test.

OBJECTIVE: This study was designed to investigate the cross-cultural validity of two freestanding performance validity tests (PVTs), the Test of Memory Malingering - Trial 1 (TOMM-1) and the Rey Fifteen Item Test (Rey-15) in Romanian-speaking patients. METHODS: The TOMM-1 and Rey-15 free recall (FR) and the combination score incorporating the recognition trial (COMB) were administered to a mixed clinical sample of 61 adults referred for cognitive evaluation, 24 of whom had external incentives to appear impaired. Average scores on PVTs were compared between the two groups. Classification accuracies were computed using one PVT against another. RESULTS: Patients with identifiable external incentives to appear impaired produced significantly lower scores and more errors on validity indicators. The largest effect sizes emerged on TOMM-1 (Cohen's d = 1.00-1.19). TOMM-1 was a significant predictor of the Rey-15 COMB ≤20 (AUC = .80; .38 sensitivity; .89 specificity at a cutoff of ≤39). Similarly, both Rey-15 indicators were significant predictors of TOMM-1 at ≤39 as the criterion (AUCs = .73-.76; .33 sensitivity; .89-.90 specificity). CONCLUSION: Results offer a proof of concept for the cross-cultural validity of the TOMM-1 and Rey-15 in a Romanian clinical sample.