Table 1.

Cultural issues related to diagnosis

ISSUE	EXPLANATION	ACTION
Language barriers and low education can lead to diagnostic errors	Low education among ethnic elderly can result in inappropriate responses from these patients due to educational misinterpretation as opposed to cognitive dysfunction2	Health professionals should identify the first language, including the dialect, used by the patient and caregiver
	When untrained translators are used, there is a possibility of translator bias, poor understanding of terminology, and inaccurate paraphrasing3	Access appropriately trained translators
	Studies have shown diagnosis is difficult among ethnic groups, even after accounting for age and education; health care professionals should be aware that measures of cognitive testing, such as the Mini-Mental State Examination, can often overestimate cognitive impairment in many cultural and linguistic groups4	The Mini-Mental State Examination is available in different languages, thus the appropriate language should be used, with the help of language interpreters, when assessing ethnic patients
Cultural beliefs about dementia are a barrier to its acceptance and diagnosis	Dementia or memory changes are considered among various cultures to be a normal part of aging5	In-depth discussion about dementia is required in order for it to be recognized and accepted; to achieve this goal, it is important to identify the primary caregiver and decision maker in the family
	Some ethnic families often avoid sharing members’ cognitive disturbances and behavioural problems with outsiders, including health care professionals; these families view dementia as taboo and fear it will bring shame to their families6