montreal cognitive assessment moca cultural bias

Barriers to dementia diagnosis that are particularly relevant to LA include inadequate physician training ( Olavarría et al., 2016 Mansfield et al., 2019), especially among primary care providers ( Saxena et al., 2007 Parra et al., 2018) lack of knowledge about different types of dementia, such as frontotemporal dementia (FTD) ( Gleichgerrcht et al., 2011 Custodio et al., 2018a) language barriers the stigma associated with age-related health problems insufficient access to healthcare a lack of diagnostic protocols and scarcity of neuropsychological services ( Custodio et al., 2017c Parra et al., 2018).

Indeed, some studies have suggested that only 3% of dementia patients are diagnosed by their primary care providers in these countries ( Chong et al., 2016), and it is estimated that 77% of dementia cases in Brazil go undiagnosed ( Nakamura et al., 2015). However, dementia is significantly underdiagnosed, especially in LMICs.

Timely diagnosis is one of the most promising strategies for addressing dementia and reducing patient and caregiver morbidity ( Watson et al., 2018). By 2020, it is estimated that 89.28 million people will be living with dementia in low- and middle-income countries (LMICs), compared with 42.18 million in high-income nations ( Bongaarts, 2009). The number of people with dementia in LA is expected to rise fourfold by 2050 ( Parra et al., 2018). Given the heterogeneity that exists in the levels of education in LA, more studies involving illiterate and indigenous populations are required.ĭementia has become a public health priority in Latin America (LA) owing to the increasing life expectancy of the population, which has led to escalating rates of neurological disorders ( Custodio et al., 2017c). Moreover, the diagnostic validity of the INECO frontal screening (IFS) test should be evaluated in populations with a low level of education. Although the Montreal cognitive assessment (MoCA) is the most widely-used BCS tool in LA, it is significantly influenced by education level.Ĭonclusions: Although evidence is still limited, the findings from studies on LA populations suggest that MoCA requires cultural adaptations and different cutoff points according to education level. No publication to date has included an illiterate population. Most studies reported samples with an average of 10 years of education and only one reported a sample with an average of <5 years of education. All the studies originated from five of the 20 countries of LA and all used standardized diagnostic criteria for the diagnosis of dementia and MCI however, the diagnostic protocols applied differed. The studies primarily involved memory clinic-based samples, with the exception of two studies from an adult day-care center, one from a primary care clinic, and one from a community-based sample. Results: Thirteen of 211 articles met the inclusion criteria. The data related to the study sample, methodology, and procedures applied, as well as the performance obtained with the corresponding BCS, were collected and systematized. Standard procedures were applied for reviewing the literature. Inclusion criteria were papers written in English or Spanish involving samples from Spanish-speaking Latin American individuals published until 2018. Methods: A systematic search of titles and abstracts in Medline, Biomed Central, Embase, Scopus, Scirus, PsycINFO, LILACS, and SciELO was conducted. Objectives: The aim of this study was to evaluate the validity of brief cognitive screening (BCS) tools designed to diagnose mild cognitive impairment (MCI) or dementia in Spanish-speaking individuals over the age of 50 years from Latin America (LA). 9Neurology Unit, Department of Medicine, Alemana Clinic, Universidad del Desarrollo, Santiago, Chile.8Memory and Neuropsychiatric Clinic (CMYN), Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile.7Geroscience Center for Brain Health and Metabolism (GERO), University of Chile School of Medicine, Santiago, Chile.6Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, ICBM, Neurosciences and East Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile.5Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru.4Neuromedicenter Adult Day Care Center, Quito, Ecuador.3Neurology Department, Instituto Peruano de Neurociencias, Lima, Peru.2Cognitive Decline and Dementia Diagnostic and Prevention Services Unit, Instituto Peruano de Neurociencias, Lima, Peru.1Research Unit, Instituto Peruano de Neurociencias, Lima, Peru.Nilton Custodio 1,2,3 * Lissette Duque 4 Rosa Montesinos 1,2 Carlos Alva-Diaz 5 Martin Mellado 6 Andrea Slachevsky 6,7,8,9 *

Montreal cognitive assessment moca cultural bias