A Cultural Neuropsychological Approach to Harmonization of Cognitive Data Across Culturally and Linguistically Diverse Older Adult Populations

Objective: To describe a cultural neuropsychological approach to prestatistical harmonization of cognitive data across the United States (U.S.) and Mexico with the Harmonized Cognitive Assessment Protocol (HCAP). Method: We performed a comprehensive review of the administration, scoring, and coding procedures for each cognitive test item administered across the English and Spanish versions of the HCAP in the Health and Retirement Study (HRS) in the U.S. and the Ancillary Study on Cognitive Aging in Mexico (Mex-Cog). For items that were potentially equivalent across studies, we compared each cognitive test item for linguistic and cultural equivalence and classified items as confident or tentative linking items, based on the degree of confidence in their comparability across cohorts and language groups. We evaluated these classifications using differential item functioning techniques. Results: We evaluated 132 test items among 21 cognitive instruments in the HCAP across the HRS and Mex-Cog. We identified 72 confident linking items, 46 tentative linking items, and 14 items that were not comparable across cohorts. Measurement invariance analysis revealed that 64% of the confident linking items and 83% of the tentative linking items showed statistical evidence of measurement differences across cohorts. Conclusions: Prestatistical harmonization of cognitive data, performed by a multidisciplinary and multilingual team including cultural neuropsychologists, can identify differences in cognitive construct measurement across languages and cultures that may not be identified by statistical procedures alone. Key Points Question: To combine information collected about cognitive health of older adults across different countries, it is important to consider whether cognition is measured equivalently across culturally and linguistically diverse cohorts. We described a cultural neuropsychological approach to harmonization of cognitive data across culturally and linguistically diverse cohorts in the United States and Mexico. Findings: We identified a set of cognitive test items that showed equivalent measurement across studies, and several cognitive test items that showed measurement differences. Importance: Comprehensive and careful comparison of cognitive data through the lens of a cultural neuropsychologist is needed for appropriate combination of cognitive data across countries. Next Steps: Future studies may adapt and expand this approach given specific cultural and li