Cognitive screening tools

The lack of suitable dementia assessment instruments is noted in a number of studies (Alzheimer’s Association, 2009; CSIE, 2011; Trinh & Ahmed, 2009). However, assessment tools are merely one part of a comprehensive assessment, and diagnosis is more likely to be made based on the history of presenting problems and clinical examination.

Some instruments may be culturally biased and overestimate the severity of dementia in people with lower levels of education or among people who are not proficient in English. For CALD people with dementia who have learned English as a second or additional language, their ability to speak English may be lost as their dementia progresses.

The M.I.N.I is an appropriate translated tool for non-English speaking background older people. It is designed as a brief structured interview for the major Axis 1 Psychiatric Disorders in DSM-IV and ICD-10. The M.I.N.I. International Neuropsychiatric Interview Tool, translated into more than 30 languages, is available free through the Medical Outcome Systems, Inc website.
There is an expanding literature discussing the cross-cultural validity of tests and interviews used in medical assessments (Basic et al., 2009; Nasreddine, 2006; Paniagua, 2000). However, little attention has been paid to cultural bias in the use of social care assessments and reviews of CALD people with dementia and their carers. Good cross-cultural communication and using interpreters when needed, is essential. It is also important to remember that:

• Conducting an assessment or review in a culturally sensitive way is critical to making an accurate assessment.
• Where interpreters are being used, they should ideally be briefed beforehand.
• Reassuring CALD clients and families about interpreter confidentiality is important.