Guiding Appropriate Neuropsychological Assessment for Older Australians from Culturally and Linguistically Diverse Backgrounds: A Multi-Method Investigation

The provision of culturally and linguistically appropriate and equitable neuropsychological services presents an immense challenge amid rapidly increasing demand, given the rising prevalence of dementia. Despite this urgent public health issue, older adults from culturally and linguistically diverse (CALD) backgrounds often face difficulty in obtaining a timely dementia diagnosis due to a lack of suitable, validated neuropsychological assessments. The overarching aim of this thesis was to generate knowledge to guide the appropriate selection and interpretation of neuropsychological assessments for older Australians from CALD backgrounds. Three complementary lines of enquiry in samples of older Australians from CALD backgrounds were undertaken to address this aim. First, a scoping review identified five methods to reduce test bias of neuropsychological measures; while minor statistical approaches (e.g., ethnicity as a covariate) were commonest, the role of these approaches in reducing bias was often not explicitly addressed. Second, a new tool, the Characterising Language Experience and Acculturation Questionnaire (CLEAr- Q), was constructed to measure aspects of language and acculturation potentially related to cognitive performance. Exploratory factor analysis provided evidence for the interrelationship between language and acculturation variables. Recruitment, data collection, and dissemination of study results were enriched through community consultation using an adapted community-based participatory research framework. Third, suitability of a pencil-and-paper neuropsychological assessment (PnP) and two commercially-available computerised neuropsychological assessments (CNAs) were investigated. Comparisons of cognitive performance between participants from English-speaking and CALD backgrounds, along with examination of variance in cognitive performance explained by linguistic and acculturation composites, both suggested that in a sample of older Australians from CALD backgrounds with higher levels of English proficiency, CNAs comprised of nonverbal tests may be more appropriate than PnP; but caution is needed in concluding that these tools are free of bias due to limited statistical power. Collectively, these findings offer guidance on the selection, administration, and interpretation of neuropsychological assessments for older adults from CALD backgrounds, contributing to more culturally and linguistically appropriate research and clinical practices.