Culturally and Linguistically Informed Neuropsychological Evaluation Protocol for Primarily Spanish-Speaking Adults.

OBJECTIVE: The Latina(o)/Hispanic (L/H) population represents the largest and fastest-growing ethnic group in the United States. Migration patterns have evolved and greater diversity (i.e., country of origin) is evident, highlighting the ever-changing heterogeneity of this community and the need for the field of neuropsychology to ensure equitable care for linguistically and culturally diverse communities. This paper aims to provide a flexible protocol of neuropsychological instruments appropriate for primarily Spanish-speaking adults residing in the United States. METHOD: Spanish measures were selected based on availability, translations/cultural modifications, accompanying normative data sets, and clinician experience/acumen. Bilingual/bicultural providers of neuropsychological services to Spanish speakers across the training spectrum working at U.S.-based medical centers implemented a multimodal approach (i.e., literature search, clinical practice parameters, and focus groups) in the development of a multi-domain primary protocol that includes core and supplemental measures that are appropriate for individuals with varying linguistic proficiency and sociocultural demographic characteristics. RESULTS: A multi-domain, evidence-based, flexible neuropsychological protocol is presented. Recommendations for test selection based on sociocultural demographic factors and examples of clinical assessment practices are provided via a case illustration. Most instruments included may be applied across cultural and regional backgrounds. CONCLUSION: Provision of neuropsychological services to primarily Spanish-speaking adults presents unique challenges. Existing Spanish measures and accompanying data rarely capture the heterogeneity of L/H individuals. Although Spanish has the largest number of neurocognitive instruments, relative to other languages, robust and representative norms continue to be scarce. Future studies should prioritize collecting normative data from educationally and geographically diverse samples.

Factor Structure of the Wechsler Intelligence Scale for Children-Fourth Edition Spanish in a Clinical Sample.

OBJECTIVE: The Wechsler Intelligence Scale for Children-Fourth Edition Spanish (WISC-IV Spanish) is a translation and adaptation of the WISC-IV that is often used in neuropsychological evaluation of children and adolescents with acquired or developmental brain disorders. However, there is limited information on the factor structure of the WISC-IV Spanish when used with clinical populations. To address the potential effects of language and culture on the validity of the WISC-IV Spanish factor structure, this study examined the construct validity of the WISV-IV Spanish scores using confirmatory factor analysis in a clinical sample of Hispanic children with Attention-Deficit/Hyperactivity Disorder (ADHD). METHOD: Participants included 148 children whose primary language was Spanish, who had a primary diagnosis of ADHD, and who had been administered the WISC-IV Spanish as part of a clinical evaluation (mean age = 10.6 years; SD = 2.7). Confirmatory factor analyses were performed to evaluate if the WISC-IV Spanish was best explained by a 1-, 2-, 3-, 4-, or 5-factor model based on the Cattell-Horn-Carroll theory. RESULTS: A 4-factor model composed of verbal comprehension, perceptual reasoning, working memory, and processing speed factors provided the best fit for the data (comparative fit index = .95; root mean square error of approximation = .06). CONCLUSIONS: Findings for children with ADHD and LD support interpretation of WISC-IV Spanish Index scores based on the 4-factor model identified in Spanish- and English-speaking normative samples. Additional research with understudied clinical populations is warranted to address gaps in cross-cultural research.

The relationship between neuropsychological tests of visuospatial function and lobar cortical thickness.

INTRODUCTION: Tests of visuospatial function are often administered in comprehensive neuropsychological evaluations. These tests are generally considered assays of parietal lobe function; however, the neural correlates of these tests, using modern imaging techniques, are not well understood. In the current study we investigated the relationship between three commonly used tests of visuospatial function and lobar cortical thickness in each hemisphere. METHOD: Data from 374 patients who underwent a neuropsychological evaluation and MRI scans in an outpatient dementia clinic were included in the analysis. We examined the relationships between cortical thickness, as assessed with Freesurfer, and performance on three tests: Judgment of Line Orientation (JoLO), Block Design (BD) from the Fourth edition of the Wechsler Adult Intelligence Scale, and Brief Visuospatial Memory Test-Revised Copy Trial (BVMT-R-C) in patients who showed overall average performance on these tasks. Using a series of multiple regression models, we assessed which lobe's overall cortical thickness best predicted test performance. RESULTS: Among the individual lobes, JoLO performance was best predicted by cortical thickness in the right temporal lobe. BD performance was best predicted by cortical thickness in the right parietal lobe, and BVMT-R-C performance was best predicted by cortical thickness in the left parietal lobe. CONCLUSIONS: Performance on constructional tests of visuospatial function appears to correspond best with underlying cortical thickness of the parietal lobes, while performance on visuospatial judgment tests appears to correspond best to temporal lobe thickness. Future research using voxel-wise and connectivity techniques and including more diverse samples will help further understanding of the regions and networks involved in visuospatial tests.