Hostname: page-component-77c89778f8-fv566 Total loading time: 0 Render date: 2024-07-20T11:26:04.577Z Has data issue: false hasContentIssue false

Assessment of dementia in ethnic minority patients in Europe: a European Alzheimer's Disease Consortium survey

Published online by Cambridge University Press:  06 July 2010

T. Rune Nielsen*
Memory Disorders Research Group, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
Asmus Vogel
Memory Disorders Research Group, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Matthias W. Riepe
Division of Mental Health and Old Age Psychiatry, Psychiatry II, Ulm University, Ulm, Germany
Alexandre de Mendonça
Department of Neurology and Laboratory of Neurosciences, Institute of Molecular Medicine and Faculty of Medicine, University of Lisbon, Portugal
Guido Rodriguez
Clinical Neurophysiology Unit, Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Genoa, Italy
Flavio Nobili
Clinical Neurophysiology Unit, Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Genoa, Italy
Anders Gade
Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
Gunhild Waldemar
Memory Disorders Research Group, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Correspondence should be addressed to: T. Rune Nielsen, Memory Disorders Research Group, section 7661, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. Phone: +45 35 45 87 59; Fax: +45 35 45 53 23. Email:


Background: In most European countries the ethnic minority migrant populations are currently reaching an age where dementia becomes an increasingly important issue. There is no European consensus on good clinical practice with these patient groups, who often have special needs and expectations with regard to dementia services.

Methods: A survey was conducted in clinical dementia centers in 15 European countries. Questionnaires focusing on different points in the clinical assessment of dementia in ethnic minority patients were mailed to leading dementia experts of the European Alzheimer's Disease Consortium.

Results: Thirty-six centers from 15 countries responded to the survey. Ethnic minority patients were seen on a regular basis in 69% of these centers. The diagnostic evaluation was in accordance with evidence-based clinical guidelines in 84–100% of the centers, but most centers performed cognitive assessment with instruments that are only validated in Western cultures and frequently relied on family members for interpretation. Diagnostic evaluation of the patients was considered to be challenging in 64% of the centers, mainly because of communication problems and lack of adequate assessment tools. In general, there were few indicators of culturally sensitive dementia services in the centers.

Conclusions: Ethnic minority patients are seen on a regular basis in European dementia clinics. Assessment of such patients is difficult for a number of reasons. Results from this study show that the most challenging issues are communication problems and assessment of cognitive function where there is a need to develop specific tests for ethnic minority patients.

Research Article
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Aranguri, C., Davidson, B. and Ramirez, R. (2006). Patterns of communication through interpreters: a detailed sociolinguistic analysis. Journal of General Internal Medicine, 21, 623629.CrossRefGoogle ScholarPubMed
Ardila, A. (2005). Cultural values underlying psychometric cognitive testing. Neuropsychology Review, 15, 185195.CrossRefGoogle ScholarPubMed
Bhatnagar, K. and Frank, J. (1997). Psychiatric disorders in elderly from the Indian sub-continent living in Bradford. International Journal of Geriatric Psychiatry, 12, 907912.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
Chandra, V. et al. (2001). Incidence of Alzheimer's disease in a rural community in India: the Indo-US study. Neurology, 57, 985989.CrossRefGoogle Scholar
Crum, R. M., Anthony, J. C., Bassett, S. S. and Folstein, M. F. (1993). Population-based norms for the Mini-mental State Examination by age and educational level. JAMA, 269, 23862391.CrossRefGoogle ScholarPubMed
Daker-White, G., Beattie, A. M., Gilliard, J. and Means, R. (2002). Minority ethnic groups in dementia care: a review of service needs, service provision and models of good practice. Aging and Mental Health, 6, 101108.CrossRefGoogle Scholar
Demirovic, J. et al. (2003). Prevalence of dementia in three ethnic groups: the South Florida program on aging and health. Annals of Epidemiology, 13, 472478.CrossRefGoogle ScholarPubMed
Dilworth-Anderson, P. and Gibson, B. E. (2002). The cultural influence of values, norms, meanings, and perceptions in understanding dementia in ethnic minorities. Alzheimer's Disease and Associated Disorders, 16, 5663.CrossRefGoogle ScholarPubMed
Fitzpatrick, A. L. et al. (2004). Incidence and prevalence of dementia in the Cardiovascular Health Study. Journal of the American Geriatrics Society, 52, 195204.CrossRefGoogle ScholarPubMed
Flores, G. (2005). The impact of medical interpreter services on the quality of health care: a systematic review. Medical Care Research and Review, 62, 255299.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Greenhalgh, T., Voisey, C. and Robb, N. (2007). Interpreted consultations as ‘business as usual’? An analysis of organisational routines in general practices. Sociology of Health and Illness, 29, 931954.CrossRefGoogle ScholarPubMed
Hinton, L., Franz, C. and Friend, J. (2004). Pathways to dementia diagnosis: evidence for cross-ethnic differences. Alzheimer's Disease and Associated Disorders, 18, 134144.CrossRefGoogle ScholarPubMed
Janevic, M. R. and Connell, C. M. (2001). Racial, ethnic, and cultural differences in the dementia caregiving experience: recent findings. The Gerontologist, 41, 334347.CrossRefGoogle ScholarPubMed
Lawrence, V., Murray, J., Samsi, K. and Banerjee, S. (2008). Attitudes and support needs of Black Caribbean, south Asian and White British carers of people with dementia in the UK. The British Journal of Psychiatry, 193, 240246.CrossRefGoogle ScholarPubMed
Lindert, J., Schouler-Ocak, M., Heinz, A. and Priebe, S. (2008). Mental health, health care utilisation of migrants in Europe. European Psychiatry, 23, 1420.CrossRefGoogle ScholarPubMed
Lindesay, J. (1998). Diagnosis of mental illness in elderly people from ethnic minorities. Advances in Psychiatric Treatment, 4, 219229.CrossRefGoogle Scholar
Lindesay, J., Jagger, C., Hibbett, M. J., Peet, S. M. and Moledina, F. (1997a). Knowledge, uptake and availability of health and social services among Asian Gujarati and white elderly persons. Ethnicity and Health, 2, 5969.CrossRefGoogle ScholarPubMed
Lindesay, J., Jagger, C., Mlynik-Szmid, A., Sinorwala, A., Peet, S. and Moledina, F. (1997b). The Mini-mental State Examination (MMSE) in an elderly immigrant Gujarati population in the United Kingdom. International Journal of Geriatric Psychiatry, 12, 11551167.3.0.CO;2-E>CrossRefGoogle Scholar
Liu, D., Hinton, L., Tran, C., Hinton, D. and Barker, J. C. (2008). Reexamining the relationships among dementia, stigma, and aging in immigrant Chinese and Vietnamese family caregivers. Journal of Cross-Cultural Gerontology, 23, 283299.CrossRefGoogle ScholarPubMed
Livingston, G., Leavey, G., Kitchen, G., Manela, M., Sembhi, S. and Katona, C. (2001). Mental health of migrant elders-the Islington study. British Journal of Psychiatry, 179, 361366.CrossRefGoogle ScholarPubMed
Mayberry, R. M., Mili, F. and Ofili, E. (2000). Racial and ethnic differences in access to medical care. Medical Care Research and Review, 57, 108145.CrossRefGoogle ScholarPubMed
McCracken, C. F. et al. (1997). Prevalence of dementia and depression among elderly people in black and ethnic minorities. British Journal of Psychiatry, 171, 269273.CrossRefGoogle ScholarPubMed
Meeuwesen, L., Twilt, S., Ten Thije, J. D. and Harmsen, H. (2009). “Ne diyor?” (What does she say?): Informal interpreting in general practice. Patient Education and Counseling. Epublished ahead of print.Google Scholar
Michaelsen, J., Krasnik, A., Nielsen, A., Norredam, M. and Torres, A. M. (2004). Health professionals’ knowledge, attitudes, and experiences in relation to immigrant patients: a questionnaire study at a Danish hospital. Scandinavian Journal of Public Health, 32, 287295.CrossRefGoogle Scholar
Parker, C. and Philp, I. (2004). Screening for cognitive impairment among older people in black and minority ethnic groups. Age and Ageing, 33, 447452.CrossRefGoogle ScholarPubMed
Purandare, N., Luthra, V., Swarbrick, C. and Burns, A. (2007). Knowledge of dementia among South Asian (Indian) older people in Manchester, U.K. International Journal of Geriatric Psychiatry, 22, 777781.CrossRefGoogle Scholar
Shah, A., Lindesay, J. and Jagger, C. (1998). Is the diagnosis of dementia stable over time among elderly immigrant Gujaratis in the United Kingdom (Leicester)? International Journal of Geriatric Psychiatry, 13, 440444.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Storey, J. E., Rowland, J. T., Basic, D., Conforti, D. A. and Dickson, H. G. (2004). The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. International Psychogeriatrics, 16, 1331.CrossRefGoogle Scholar
Stronks, K., Ravelli, A. C. and Reijneveld, S. A. (2001). Immigrants in the Netherlands: equal access for equal needs? Journal of Epidemiology and Community Health, 55, 701707.CrossRefGoogle ScholarPubMed
Waldemar, G. et al. (2007). Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline. European Journal of Neurology, 14, 126.CrossRefGoogle ScholarPubMed
World Health Organization (1993). The ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research. Geneva: World Health Organization.Google Scholar