Development and validation of novel cognitive tests in Mandarin-speaking older Americans

Mandarin Chinese has the largest number of native speakers globally, yet few Mandarin cognitive tests have undergone rigorous validation in multicultural settings for Alzheimer's disease (AD) detection.

We adapted or developed Mandarin cognitive tests to assess memory, executive, and language functions (including new Chinese character, phoneme, and homophone fluency tasks) and then prospectively recruited 208 older adults at two US centers to determine the tests' reliability as well as convergent, construct, and concurrent validity.

All Mandarin cognitive measures had high test-retest reliability (intraclass correlation coefficients of 0.680to 0.849), and English letter-guided fluency best correlated with Chinese phoneme and homophone fluency. Factor analysis revealed six factors that underlie 16 cognitive measures, with at least one abnormal executive function or a story memory test associated with mild cognitive impairment and elevated plasma p-Tau₂₁₇.

Validated cognitive measures provide culturally and linguistically appropriate tools to detect early AD among older Chinese Americans.