The Utility of Word List and Story Recall for Identifying Older U.S. Chinese Immigrants With Cognitive Impairment

• Published in: Neuropsychology 2023-11, Vol.37 (8), p.966-974
• Main Authors: Li, Clara, Hong, Yue, Wang, Kun, Neugroschl, Judith, Zhu, Carolyn W., Zeng, Xiaoyi, Yang, Xiao, Aloysi, Amy, Grossman, Hillel, Cai, Dongming, Spat-Lemus, Jessica, Martin, Jane, Sewell, Margaret, Sano, Mary
• Format: Article
• Language: English
• Subjects: Aged; Alzheimer Disease - psychology; Cognitive Assessment; Cognitive Dysfunction - diagnosis; Cognitive Dysfunction - psychology; Dementia; Diagnosis; East Asian People; Emigrants and Immigrants; Female; Human; Humans; Immigration; Language; Male; Memory; Memory, Short-Term; Middle Aged; Mild Cognitive Impairment; Neuropsychological Tests; Recall (Learning); United States; Verbal Memory
• ISSN: 0894-4105; 1931-1559; 1931-1559
• DOI: 10.1037/neu0000906

Objective: This study examined the utility of the Chinese-language translations of the word list memory test (Philadelphia Verbal Learning Test) and story memory test (Logical Memory subtest of the Wechsler Memory Scale) for differentiating cognitive diagnosis in older U.S. Chinese immigrants. Method: Participants were ≥60 years old, with Chinese language proficiency to complete a diagnostic workup at the Mount Sinai's Alzheimer's Disease Research Center. The workup included an evaluation by a geriatric psychiatrist and cognitive testing with a psychometrician. Diagnosis of normal, mild cognitive impairment (MCI), and dementia was made independent of the cognitive tests at consensus led by a dementia expert physician. Multivariable logistic regression models were used to assess the sensitivity of story and word list memory tests for distinguishing between groups. Receiver operating characteristic (ROC area/area under the curve [AUC]) was used to compare the predictive accuracy of the two tests. Results: The sample included 71 participants with normal cognition, 42 with MCI, and 24 with dementia. The MCI group was older and less educated than normal controls but younger and more educated than the dementia group. Delayed recall of both memory tests, but not immediate recall of either test, predicted diagnosis. While composite memory score of word list (AUC = 0.90) predicted diagnosis slightly better than that of stories (AUC = 0.85), the difference was not significant in this small sample (p = .14). Conclusions: Chinese-language translations of verbal memory tests, in particular delayed recall scores, were equally sensitive for classifying cognitive diagnosis in older U.S. Chinese immigrants. Key Points Question: The purpose of the present study was to examine the sensitivity of the Chinese translation of word list learning test and story recall test for differentiating cognitive diagnosis of normal aging, mild cognitive impairment, and dementia. Findings: Chinese translation of verbal memory tests during the delayed recall trials provides the greatest sensitivity to detect cognitive diagnosis. Importance: Chinese translation of verbal memory tests can be used as a diagnostic tool for identifying cognitive impairment. Next Steps: Examination of test equivalence between Chinese and English versions of verbal memory tests will be needed to identify potential bias across the two language versions.