Cultural Effects on the Performance of Older Haitian Immigrants on Timed Cognitive Tests.

Background: Ignoring the cultural factors that can affect performance on cognitive tests may result in use of tests that have not been validated for that group. One example is testing of Haitian Creole speaking adults who are increasingly affected by Alzheimer's disease and related dementias, for whom few tests have been validated. Aims: Our purpose is to describe differences in timed test performance between Haitian Creole and English-speaking participants and explore factors that may account for any differences in results found. Methods: Data was obtained from an ongoing longitudinal driving and cognition study "In Vehicle Sensors to Detect Cognitive Change in Older Drivers." Two groups consisting of 12 Creole speaking and 12 English speaking older adults were matched by age and gender. Test scores were selected from the battery of tests administered in the parent study. The measures were translated by two bilingual Creole-English researchers. Group performance on five timed cognitive tests commonly used in research was compared. Results: The English-speaking group's mean scores were significantly higher than the Creole speaking group on the MoCA and the timed Animal category fluency, letter P fluency, Stroop Color Test, and Trail Making Test A and B. The most significant effects were noted in Letter P fluency, Trail Making Test A and B and Animal category fluency where the differences had large effect sizes. However, the Creole speaking group had higher mean scores than the English-Speaking group on the Stroop Color Word Test, although the difference was not statistically significant. It was not feasible to match education levels due to the differences in years of education across the groups. These results highlight the significant role of culture and linguistic context in cognitive task performance. Conclusions: The results suggest performance in cognitive testing among non-English speaking groups may be impacted by cultural factors related to time perception and the testing approach employed, leading to misinterpretation and misdiagnosis. Future studies should explore the fairness of various cognitive testing approaches with Haitian older adults and other societies with cultures and educational approaches different from those of Western cultures.