Table 4.
Cross-cultural considerations and recommendations for instruments proposed in HL 1–2-3
| Domains | Tools | Considerations and recommendations |
|---|---|---|
| Cognitive screeners (HL 1–2) | MOCA-5/T-MoCA | + More culturally appropriate telephonic cognitive screening measure. − Recommended over BTACT. |
| BTACT | + Relies partially on instruments with cross-cultural validity testing (e.g., RAVLT; Digit backwards). − Number-Series task compromised validity for some LMIC populations (social and formal educational differences). − Must adjust the BTACT cut-off score when some tasks are not suitable for inclusion (e.g., Number-Series task). |
|
| Functional Screeners (HL 1–2) | Activities of Daily Living (ADL) Scales | + ADLs are culturally bound and vary significantly between and within settings. + Local/national tools are more suitable than global measures, if available (Pashmdarfard & Azad, 2020). + Lawton Instrumental Activities of Daily Living Scale (IADL) has several cultural adaptations (Dubbelman et al., 2020; Ng, Niti, Chiam, & Kua, 2006; Siriwardhana, Walters, Rait, BazoAlvarez, & Weerasinghe, 2018; Stone et al., 2018). − If not available, develop and validate tools using Siestke et al. methods. |
| Standard neuropsychological tests (HL 2–3) | BVMT-R (visuospatial learning and memory) | − Some subjectivity associated with scoring with an inter-rater agreement of ~60% (Caneda, Cuervo, Marinho, & Vecino, 2018). − Must adhere strictly to standard scoring guidelines to reduce bias. |
| HVLT-R (verbal learning and memory) | − A culturally and linguistically appropriate version of the HVLT-R must be used − In the absence of an appropriate version of the HVLT-R, a culturally suitable substitute e.g., Rey Auditory Verbal Learning Test (RAVLT), California Verbal Learning Test (CVLT) or Free and Cued Selective Reminding Test (FCSRT) (Lim et al., 2009) can be used. |
|
| Category fluency | + More normative data exist for the Animal category than the Fruits and Vegetables category. The former is therefore recommended. | |
| Premorbid ability | − LMIC lack normative data to reliably estimate premorbid intelligence. − Within countries, disparities in terms of socio-economic status must be taken in account (Shuttleworth-Edwards, 2016) in the validation processes of these measures. − Premorbid IQ should only be assessed if appropriate normative data are available accounting for age, education and SES status. |
|
| Performance Validity | − See Supplemental file 5. − Collection of data in appropriate control group will be needed in many locations as cross-cultural versions of such tests are lacking |