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70 The Effect of Executive Functioning on Predicting Health Literacy in a Memory Disorders Clinic
- Kyle J Jennette, Aya Haneda, Jason R Soble, Zachary J Resch
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 273-274
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Objective:
Health literacy is the degree to which an individual is able to attain, process, and understand information, skills, and services required to make informed decisions. Limited health literacy is a risk factor for problems understanding health information and adhering to medical instructions, underuse of preventive services, increased hospitalizations and associated medical costs, and higher mortality rates. Recognizing individuals with reduced health literacy can be difficult given demographic information such as age or years of education do not reliably reflect an individual’s health literacy level. Cross-sectional studies have identified limited health literacy as associated with lower scores on cognitive tests measuring memory, executive function (EF), and processing speed, independent from the influence of demographic variables (e.g., age, race, education). This study assessed the association of objective measures of executive functioning and health literacy when controlling for premorbid estimated intellectual functioning and relevant demographic variables.
Participants and Methods:A sample of 44 adult patients (20 Male; 24 Female) referred for neuropsychological evaluation for memory complaints who were administered the Test of Premorbid Functioning (TOPF), and multiple measures of EF including the Trail Making Test - Part B (TMT-B), Stroop Color and Word Test (SCWT), and Letter (FAS) and Semantic (Animals) Fluency as part of part of a larger standardized battery. Patients were also administered the Short Assessment of Health Literacy-English (SAHL-E). All included patients had <2 performance validity test failures. The sample was 50% non-Hispanic Black, 31.8% non-Hispanic White, 15.9% Hispanic, 2.3% Asian/Pacific Islander, and 54.5% female. Diagnostically, 50.9% of the sample were cognitively normal, 36.4% had mild cognitive impairment, and 15.9% had dementia. Two multiple regressions were conducted to evaluate (1) the predictive power of EF on the SAHL-E, and (2) the moderating impact of estimated premorbid IQ and demographics via the TOPF on the relationship between EF and SAHL-E.
Results:The first regression was not significant (p=.168) with FAS as the only independent predictor of SAHL-E performance (ß=.387, p<.05). The overall model was significant with the addition of the TOPF (p<.001). FAS accounted for 29% (ß=.336, p<.05) of the variance in SAHL-E when controlling for TOPF and other measures of EF.
Conclusions:These results indicate that novel generativity is a significant predictor of health literacy beyond the influence of estimated premorbid intelligence and demographic factors. Importantly, these findings suggest that broadly speaking EF abilities have minimal impact on health literacy, although reduced verbal generativity to letter cues is associated with reduced health literacy. Identification of at-risk populations such as individuals with limited health literacy is clinically important and can make way for early intervention. Health information targeted at this at-risk population should go beyond vocabulary and more specifically reduce the burden on verbal fluency.
6 A review of neuropsychological measures of executive functioning in the Japanese and Japanese-American population
- Aya Haneda, Erin T Kaseda, Hirofumi Kuroda
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 421-422
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Objective:
There are approximately 1.5 million Japanese and Japanese Americans in the United States, with the Japanese population increasing steadily over the past two decades. Given the growing number of the Japanese population, it is likely that a clinical neuropsychologist may encounter a Japanese patient, particularly for neurocognitive disorder evaluations given the aging population. Literature has reported that cross-cultural bias in neuropsychological testing and cultural factors affect individuals’ test performance. In order to conduct and interpret neuropsychological assessments for this population, it is important to use normative data and consider the impact of various factors such as acculturation, language, and generation in the U.S. Availability of normative cognitive test data for Japanese-Americans is limited. Tests with most extensive use, adaptation, validation, and norming were identified. Many clinically used measures of executive functioning (EF) have been translated into Japanese and studied in multiple clinical populations. We present information on tests in this domain given their appropriateness for use in cross-linguistic and cross-cultural evaluations.
Participants and Methods:Available studies of neuropsychological tests measuring EF that have been translated and normed in the Japanese and/or Japanese-American patient population are reported. Review of the literature was conducted by authors of Japanese descent familiar with neuropsychological assessment and Japanese and Japanese-American culture. We prioritized studies published in both English and Japanese and those that included commonly utilized tests in the U.S, allowing for maximum accessibility and utility for Western-based neuropsychologists. Additionally, inclusion priority was given to studies published in English which report the clinical diagnoses, age range, and gender characteristics of the sample population. The Wisconsin card sorting test (WCST) and Trail Making Test (TMT) were reviewed.
Results:The WCST and the TMT, with its variant, was the most normed EF cognitive test currently available. The Keio version Japanese-Trail Making Test (J-TMT) and a simplified version of the Trail Making Test (S-TMT) has been utilized in Japan, however norms are still lacking. Of the available studies, the S-TMT and J-TMT were found to be moderately correlated with the TMT. The Keio version WCST (KWCST) (Kao et al., 2012) was correlated to education level (Abe et al., 2004), appropriately differentiating severity of social anxiety disorder (Fujii et al., 2013), patients with schizophrenia (Banno et al., 2012), and cognitive impairment in Parkinson’s disease (Yoshii et al., 2019).
Conclusions:Information regarding translated and normed tests are presented to assist clinical neuropsychologists provide competent services to Japanese-Americans. The J-TMT and the S-TMT may be clinically useful as an evaluation of attention for the Japanese population. The KWCST has also been found to be an appropriate tool for this population. However, publicly available norms for these assessments are still sparse, and there is very limited information about administration of these tests by English-speaking neuropsychologists with the use of interpreters. Further work is needed to increase access to and awareness of linguistically and culturally appropriate versions of clinical measures to better serve the Japanese and Japanese-American population.
13 Considerations for the Neuropsychological Assessment of Verbal Abilities in Japanese Speakers
- Erin T. Kaseda, Aya Haneda, Hirofumi Kuroda, Sayaka Machizawa, Torricia Yamada
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 428-429
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Objective:
Although the majority of Japanese speakers live in Japan, there are also large populations of Japanese speakers in the United States of America and Brazil, with more than a million Japanese speakers across the two countries. Only 53% of foreign-born Japanese individuals in the United States report proficiency in English. Although there has been increasing attention to the neuropsychological assessment of linguistically diverse patients broadly in recent years, there are specific considerations unique to Japanese that clinicians and researchers should be aware of when working with Japanese speakers outside of Japan. The aim of the present study is to present considerations and appropriately normed assessments of verbal abilities for Japanese patients.
Participants and Methods:A systematic review of cognitive screeners and assessments of verbal fluency, verbal memory, and verbal academic skills that have been translated and normed for use with Japanese speaking populations was conducted. Studies published in both English and Japanese were reviewed. Test content modifications, administration modifications, and relevant cultural and linguistic considerations were synthesized and summarized.
Results:One consideration in translation is the use of words that are linguistically and culturally comparable across the two languages. Multiple cognitive screeners and verbal learning/memory tasks have been translated with cultural equivalency considerations (e.g., for the Montreal Cognitive Assessment, velvet, church, and daisy were changed to silk, shrine, and lily). In Japanese, there is a one-to-one correspondence between sound (syllable) and graphemes (kana script), compared to one-to-many associations in alphabet-based languages like English. This impacts normative expectations on letter fluency tasks. The hiragana letters, A, Ka, and Shi (fc, fr, L) are recommended because there are relatively large number of words that start with these letters and the number of words generated with these letters showed close to normal distributions in previous research. Unlike letter fluency, semantic fluency is believed to be relatively culture-free and independent of language systems. The Japanese writing system utilizes both phonographic systems where written symbols map onto sounds, and logographic systems, where written symbols map onto concepts. This is in contrast to English, which has a solely phonographic written system. These two separate writing systems complicate the assessment of reading among Japanese-speaking individuals, as there may be a dissociation between abilities in reading in the phonographic versus logographic systems. Acculturation has been shown to impact performance on certain verbal task performances, along with demographic variables such as immigration generation status and bilingualism.
Conclusions:Neuropsychologists should be familiar with linguistic differences between English and Japanese such as the one-to-one correspondence between sound and grapheme in Japanese and the use of both phonographic and logographic systems in written Japanese. Neuropsychologists should also be careful to use tests that are translated for cultural equivalence rather than direct translations, and that have been normed for use with Japanese speakers. Finally, general cross-cultural considerations in assessment such as the evaluation of bilingualism, familiarity with the testing environment, and other factors remain essential.
11 Sociodemographic, Cultural, and Linguistic Considerations for Clinical Neuropsychological Assessment with Japanese and Japanese American Patients in the United States
- Daryl Fujii, Erin T. Kaseda, Aya Haneda, Hirofumi Kuroda, Sayaka Machizawa, Yoko Okamura, Kim Ono, Torricia Yamada, Nicholas S. Thaler
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 426-427
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- Article
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Objective:
Japanese-Americans are the sixth largest Asian ethnicity in the United States. They represent a highly heterogeneous population due to their history of immigration dating back to the late 19th century. In comparison to the total Japanese-American population, there are very few neuropsychologists of Japanese descent who are familiar with the culture. The Asian Neuropsychological Association lists 16 licensed members of Japanese descent, and only 7 practice outside of Hawaii or California. These numbers suggest that unless non-Japanese neuropsychologists are knowledgeable of the culture, test translations, and appropriate norms, it would be challenging for many Japanese-Americans to receive culturally and linguistically competent neuropsychological services. The aim of the present study is to provide guidance for conducting neuropsychological assessments with Japanese-Americans with the goal of facilitating competent culturally-informed services to this population.
Participants and Methods:Pertinent facets of Japanese culture as identified in the ECLECTIC framework and demographics of the U.S. Japanese-American population, and the available literature on neuropsychological tests that are translated into Japanese and normed with Japanese samples, was reviewed by authors with knowledge of Japanese language and culture. Literature published in both English and Japanese were included for review.
Results:Psychological testing is a Western technology fraught with the behavioral expectations and values of the culture in which it was developed. Thus, these tests may be biased against persons coming from cultures that differ from the West. Recommendations for providing neuropsychological services to Japanese-Americans are presented with an aim of maximizing test fairness by addressing the following issues: comfort with the testing situation, test biases, accessibility, and validity. Given the emphasis on education, Japanese-Americans should be familiar and comfortable with cognitive testing, although they may experience undue pressure to perform well to avoid shame. Japanese-Americans may experience discomfort disclosing personal information during the interview, particularly if the evaluation is perceived to be psychiatric in nature, as there is a strong stigma associated with mental illness that could bring shame to the family. Japanese communication styles are indirect in nature, where the message is implied and what is “not said” is just as important as what is directly conveyed. Accessibility issues will primarily impact first generation Japanese-Americans who are native Japanese speakers. Another characteristic that may impact responding is hesitancy for guessing when unsure. Recommendations for providing culturally competent neuropsychological assessment given these considerations will be presented and expanded upon in detail. Finally, an online database of translated and normed neuropsychological tests by cognitive domain has been created and will be presented.
Conclusions:Providing neuropsychological services to Japanese-Americans can be challenging as Japanese culture is significantly different from western culture. In addition, Japanese-Americans are heterogenous with salient issues of English proficiency and acculturation. Information to individualize a conceptual understanding of Japanese-Americans, translated and normed tests, and recommendations to maximize fairness in testing are presented to assist clinical neuropsychologists provide competent services to Japanese-Americans.