Language Dominance and Education Considerations in the Neuropsychological Assessment of Southwestern American Indians...

To address disparities in dementia diagnosis and care in American Indian and Alaska Native communities, it is crucial to understand how sociocultural factors, such as language dominance and education, impact performances on standardized neuropsychological assessments. We discuss sociocultural considerations that are important to consider when evaluating cognition in American Indians. We conducted t tests/Kruskal-Wallis tests and correlation analyses to evaluate the impact of language and education factors on performances on the National Alzheimer Coordinating Center's Uniform Data Set Version 3 Neuropsychological assessments in a community of Southwestern American Indians. There were no significant differences in cognitive performances between the Zuni (Shiwi)-dominant and English-dominant individuals. Number of years of education had a greater effect on cognitive performances relative to language dominance, particularly for the common cognitive screening measure, the Montreal Cognitive Assessment. Our results highlight that education factors have a greater effect on cognitive performances relative to language dominance in this unique cohort. The associations with the Montreal Cognitive Assessment raise concerns for the use of this tool in this population, highlighting a need to develop culturally appropriate cognitive testing tools as well as ensuring comprehensive, culturally competent neuropsychological assessments are accessible.