Testing the Test: A Move toward Culturally Inclusive Cognitive Screening

Neuropsychological assessments, used to examine cognitive function, may not accurately measure the same abilities across cultural groups. In a study that received a Silver 2021 Innovative Research on Aging Award from Mather Institute, researchers investigated how a computer-based test compares to a traditional paper-based test among older Black adults.

Eighty-seven adults, age 55 to 86, identifying as Black, participated in the study. All participants completed computer-based neuropsychological assessments and traditional paper-based tests, both of which assessed similar aspects of cognitive functioning. The computer-based tests took about 30 minutes to complete and were delivered in a game-like format on an iPad and desktop computer. The traditional, paper-and-pencil tests lasted about 90 minutes. Participants also reported sociodemographic characteristics and completed measures of testing anxiety, everyday discrimination, stigma consciousness, health conditions, and computer use.

Compared to the traditional assessments, Black older adults found the computerized tests more satisfying, easier to use, less time-consuming, and simpler to complete alone. Overall, performance on the computer-based tests was related to performance on the traditional tests, meaning those who scored higher in the computer version also scored higher on the paper version. Higher perceived discrimination was associated with higher testing anxiety. Participants reported more testing anxiety from the paper than the computer version; more testing anxiety was associated with poorer performance on the traditional paper version, but unrelated to performance on the computer version. Further, comfort level with using a computer was not related to performance on any of the assessments, suggesting that computer-based testing is a valid instrument regardless of tech-savviness.

While no control group was used in this study, the similarity in performance across assessment types showed that computer-based testing is a viable alternative to paper tests. Shorter time commitment and overall better satisfaction make computer-based testing more appealing, as well as offering potential for self-administration. The lower anxiety levels around computer-based tests may also help to counter effects of perceived discrimination. This study was one of the first to examine this topic specifically among older Black adults. As computer-based tests continue to evolve, more research will be needed to minimize cultural biases.


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Gamaldo AA, Tan SC, Sardina AL, et al. Older Black adults’ satisfaction and anxiety levels after completing alternative versus traditional cognitive batteries. Journals of Gerontology: Psychological Sciences 2021;75(7) :1462-1474.



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