Asian Americans are the fastest-growing group of older adults in the U.S., but they often face language and cultural barriers when seeking care for dementia-related symptoms.
As part of a broader mission to tackle these challenges, a Rutgers Health-led study involving internationally renowned clinicians and scientists from the National Institute on Aging-funded Rutgers-NYU Resource Center for Alzheimer's Disease and Research Center in Asian and Pacific Americans and Stanford Alzheimer's Disease Research Center has proposed a solution for older Americans from China and Taiwan.
The study, published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, designed a new suite of neuropsychological tests suitable for Mandarin-speaking older adults. Researchers developed and validated these tests, accounting for the non-alphabetical nature of Chinese languages, frequency of Chinese character and word usage in daily living, and cultural exposure before moving to the U.S.
The recent Chinese Older Adult STudy (COAST) involved 208 older adults ages 60 to 90 from throughout New Jersey, New York City and the San Francisco Bay Area with varying degrees of bilingualism. Researchers tested the reproducibility of the cognitive tests over six months, equivalency to corresponding English tests and correspondence to known dimensions of memory and thinking.
"Direct translation of English tests for memory and thinking into other languages often fails to capture essential linguistic and cultural nuances, leading to underdiagnosis, faux pas and mistrust in the physician-patient relationship – especially when both physicians and patients know the instruments are poor," said William Hu , a professor of neurology and chief of Cognitive Neurology and Alzheimer's Disease Clinic at Rutgers Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital, as well as director of the Center for Healthy Aging Research at Rutgers Institute for Health, Health Care Policy and Aging Research . "This is the first set of tests validated in older adults from China, Taiwan, and other overseas Chinese diaspora."
These new cognitive tests – which include innovative tasks for word fluency and memory – demonstrate high stability when used over time (up to six months), correlate strongly with performance on English-based tests and show strong links to novel Alzheimer's disease blood-based biomarkers.
Researchers said next steps include adding the tests on tablets or other electronic environments, such as virtual reality, to provide instructions to patients and record responses without the need for a clinician fluent in Mandarin, thereby supporting more accurate cognitive assessment in Mandarin-speaking patients – particularly those underserved by existing English-based tools and those affected by cultural or linguistic differences. Researchers also are ready to validate these tools in Cantonese and other Chinese dialects.
"This research opens the door for greater involvement in clinical trials by older Chinese Americans who may not meet the English proficiency level necessary for standard North American neuropsychological testing," said Hu, who is also a member of the RWJBarnabas Health Medical Group. "Our work provides a scientifically validated pathway to accurately include and characterize this community in modern clinical care and cutting-edge research."
The study was a collaboration between Rutgers researchers led by William Hu, including Michelle Chen and Karthik Kota, and Stanford researchers led by Vankee Lin.
