Educational Bias in Cognitive Screening of Adults with Sickle Cell Disease: A Bilingual Multisite Observational Study

Stéphanie Forté ^1,2,3, Maryline Couette ^4,5, Damien Oudin Doglioni ⁶

¹Division of Medical Oncology and Hematology, Department of Medicine, CHUM, Montréal, Canada.
²Department of Medicine, University of Montréal, Montréal, Canada.
³Innovation Hub, CRCHUM, Montréal, Canada.
⁴Medicine Intensive Réanimation, CHU Henri Mondor, Créteil, France.
⁵Sickle Cell Referral Center, Internal Medicine Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Creteil, France.
⁶Laboratoire Interuniversitaire de Psychologie/Personnalité, Cognition, Changement Social (LIP/PC2S), Grenoble Alpes University, Grenoble, France.
⁷Division of Geriatrics, Department of Medicine, CHUM, Montréal, Canada.
⁸INSERM-U955, Equipe 2, Laboratoire D'Excellence, GRex, Institut Mondor, Créteil, France.
⁹Henri Mondor Hospital - APHP, Creteil, France.
¹⁰Division of Medical Oncology and Hematology, Department of Medicine, UHN, Toronto, Canada.
¹¹Department of Medicine, University of Toronto, Toronto, Canada.

⁰Division of Medical Oncology and Hematology, Department of Medicine, CHUM, Montréal, Canada.

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April 11, 2025

View abstract on PubMed

Summary

Cognitive impairment screening in sickle cell disease (SCD) can be biased by education. The Rowland Universal Dementia Assessment Scale (RUDAS), adjusted for years of schooling, shows promise for more equitable neurocognitive assessment in SCD patients.

Area Of Science

Neurology
Hematology
Psychometrics

Background

Cognitive impairment significantly impacts sickle cell disease (SCD) patients' lives.
Current cognitive screening tools may exhibit educational and language biases.
The Rowland Universal Dementia Assessment Scale (RUDAS) is designed for multicultural cognitive screening.

Purpose Of The Study

To compare the influence of educational attainment on RUDAS and Montreal Cognitive Assessment (MoCA) in adults with SCD.
To investigate if adjusting RUDAS scores for highest level of education (HLE) mitigates educational bias.

Main Methods

Cross-sectional study of adults with SCD undergoing cognitive screening with RUDAS and MoCA.
Cognitive scores were analyzed against HLE (years of schooling).
RUDAS scores were adjusted by adding a point for HLE < 12 years.

Main Results

High rates of abnormal cognitive scores were observed for both RUDAS (75.3%) and MoCA (71.2%).
Both RUDAS and MoCA scores significantly increased with HLE (p < 0.001).
Adjusting RUDAS scores for HLE significantly reduced the effect of education (p=0.26), unlike MoCA (p=0.003).

Conclusions

Educational bias exists in current neurocognitive screening for adults with SCD.
Adjusted RUDAS demonstrates a reduced educational bias, suggesting it as a potentially more equitable screening tool.
This adjusted RUDAS may offer a novel strategy for systematic identification of SCD patients needing further neurocognitive evaluation.

Keywords:

MoCA RUDAS Sickle cell disease cognitive impairment cognitive screening

Related Concept Videos

Language and Cognition

Language serves as a bridge between ideas and communication, influencing how individuals perceive and interact with the world. Psychologists have long debated whether language shapes thought or vice versa. This discussion gained grip with Edward Sapir and Benjamin Lee Whorf in the 1940s, who proposed that language determines thought, a concept known as linguistic determinism. They suggested that the vocabulary and structure of a language influence how its speakers think and perceive reality.