Assessment and diagnosis of dementia in Hispanic and non-Hispanic white outpatients.
OBJECTIVE
We examined whether (a) neuropsychological test performance (NP) or (b) informant reports of patients' functional abilities or (c) behavioral and psychological symptoms (BPS) predicted dementia diagnoses to different degrees among Hispanic and non-Hispanic Whites (NHWs).


METHODS
Our sample included 444 Hispanic and 444 (randomly selected from 11,081) NHW outpatients diagnosed with normal cognition or dementia at their initial evaluations. We tested for significant ethnic-group differences in dementia diagnosis predictors using NP and the 2 informant reports, covarying for age, sex, and education.


RESULTS
When using ethnic group-specific norms, NP and functional abilities predicted diagnosis in both groups with no significant differences but BPS was only significant in Hispanics. When using combined ethnic group norms, the only major difference was that BPS approached but did not meet statistical significance in Hispanics.


CONCLUSIONS
Clinicians may be aware of the limitations of NP and may thus be informally adjusting their overall impressions of patients' NP among Hispanics and weighing certain tests differentially across ethnic groups when assessing dementia. Though these approaches may be aimed at reducing misdiagnosis, their effectiveness is questionable and they may be driving systematic differences in diagnosis within and across ethnicities. In addition, informant-reported functional abilities may be less sensitive to ethnicity-related influences and represent an important, ethnically neutral area in dementia assessment. The predictive value of informant-reported BPS in the diagnostic process across ethnic groups warrants further attention.
Address correspondence to Philip Sayegh, Departments of Psychology and Preventive Medicine, University of Southern California, 3620 S. McClintock Avenue-SGM 501, M/C 1061, Los Angeles, CA 90089-1061. E-mail: psayegh@usc.edu.
Philip
P
Sayegh
Bob G
BG
Knight
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000208:ethnology; D054521:Cultural Competency; D003704:Dementia / Q000175:diagnosis* / Q000208:ethnology; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards*; D010045:Outpatients; D044465:White People
Ethnicity; Functional Assessment Questionnaire; Latino/a; Neuropsychi atric Inventory Questionnaire; Neuropsychology