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A Systematic Review of Neuropsychological Tests for the Assessment of Dementia in Non-Western, Low-Educated or Illiterate Populations

  • Sanne Franzen (a1), Esther van den Berg (a1), Miriam Goudsmit (a2), Caroline K. Jurgens (a3), Lotte van de Wiel (a4), Yuled Kalkisim (a1), Özgül Uysal-Bozkir (a5), Yavuz Ayhan (a6), T. Rune Nielsen (a7) and Janne M. Papma (a1)...



Neuropsychological tests are important instruments to determine a cognitive profile, giving insight into the etiology of dementia; however, these tests cannot readily be used in culturally diverse, low-educated populations, due to their dependence upon (Western) culture, education, and literacy. In this review we aim to give an overview of studies investigating domain-specific cognitive tests used to assess dementia in non-Western, low-educated populations. The second aim was to examine the quality of these studies and of the adaptations for culturally, linguistically, and educationally diverse populations.


A systematic review was performed using six databases, without restrictions on the year or language of publication.


Forty-four studies were included, stemming mainly from Brazil, Hong Kong, Korea, and considering Hispanics/Latinos residing in the USA. Most studies focused on Alzheimer’s disease (n = 17) or unspecified dementia (n = 16). Memory (n = 18) was studied most often, using 14 different tests. The traditional Western tests in the domains of attention (n = 8) and construction (n = 15), were unsuitable for low-educated patients. There was little variety in instruments measuring executive functioning (two tests, n = 13), and language (n = 12, of which 10 were naming tests). Many studies did not report a thorough adaptation procedure (n = 39) or blinding procedures (n = 29).


Various formats of memory tests seem suitable for low-educated, non-Western populations. Promising tasks in other cognitive domains are the Stick Design Test, Five Digit Test, and verbal fluency test. Further research is needed regarding cross-cultural instruments measuring executive functioning and language in low-educated people.

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Corresponding author

*Correspondence and reprint requests to: Janne M. Papma, Ph.D., Department of Neurology, Erasmus Medical Center, Room Ee-2291, Wytemaweg 80, 3015 CN Rotterdam, the Netherlands. E-mail:


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