Asian Americans are the fastest growing group of seniors in the US, but they often face language and cultural barriers when seeking care for dementia-related symptoms.
As part of a broader mission to address these challenges, a Rutgers Health study involving internationally renowned clinicians and scientists from the National Institute on Aging-funded Rutgers-NYU Resource Center for Alzheimer’s Disease and Research Center in Asian and Pacific Americans and Stanford Disease Center for Old Research and Stanford Taiwan.
The study, published in Alzheimer & Dementia: The Journal of the Alzheimer’s Associationdesigned a new suite of neuropsychological tests suitable for Mandarin-speaking older adults. The researchers developed and validated these tests, taking into account the non-alphabetic nature of Chinese languages, the frequency of using Chinese characters and words in daily life, and cultural exposure before moving to the US.
The recent Chinese Older Adults Study (COAST) involved 208 older adults aged 60 to 90 from across New Jersey, New York, and the San Francisco Bay Area with varying degrees of bilingualism. The researchers looked at the reproducibility of the cognitive tests over six months, the equivalence with the corresponding tests of English, and the correspondence to known dimensions of memory and thinking.
“Direct translation of English tests of memory and thinking into other languages often fails to capture key linguistic and cultural nuances, leading to underdiagnosis, false passion, and distrust in the doctor-patient relationship — especially when both doctors and patients know the instruments are poor,” said William Hu, professor of neurology and head of cognitive and cognitive epistemology. Rutgers Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital, and director of the Center for Research on Healthy Aging at the Rutgers Institute for Health, Health Policy and Aging Research. “This is the first set of tests to be validated in elderly people from China, Taiwan and other overseas Chinese diasporas.”
These new cognitive tests – which include innovative word fluency and memory tasks – demonstrate high stability when used over time (up to six months), correlate strongly with performance on English-based tests, and show strong links to new blood-based Alzheimer’s disease biomarkers.
The researchers said next steps include adding the tests to tablets or other electronic environments, such as virtual reality, to instruct patients and record responses without the need for a clinician fluent in Mandarin, thereby supporting more accurate cognitive assessment in Mandarin-speaking patients — particularly those underserved by existing English-based tools and those affected by cultural or language differences. The researchers are also set to validate these tools in Cantonese and other Chinese dialects.
This research opens the door to greater participation in clinical trials by older Chinese Americans who may not meet the level of English proficiency necessary for standard North American neuropsychological testing. Our work provides a scientifically validated pathway to include and accurately characterize this community in contemporary clinical care and cutting-edge research.”
William Hu, member, RWJBarnabas Health Medical Group
The study was a collaboration between Rutgers researchers led by William Hu, including Michelle Chen and Karthik Kota, and Stanford researchers led by Vankee Lin.
