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Screening for Cognitive Impairment in Bilinguals: What Is the Influence of the Language of Assessment?

Published online by Cambridge University Press:  03 May 2024

Rania Kassir Open the ORCID record for Rania Kassir [Opens in a new window] ,
Martine Roussel ,
Halim Abboud  and
Olivier Godefroy
Rania Kassir*
Affiliation:
Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France Research Laboratory in Neurosciences (LAREN), Saint-Joseph University, Beirut, Lebanon
Martine Roussel
Affiliation:
Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France Department of Neurology, Amiens University Hospital, Amiens, France
Halim Abboud
Affiliation:
Department of Neurology, Saint-Joseph University, Beirut, Lebanon
Olivier Godefroy
Affiliation:
Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France Department of Neurology, Amiens University Hospital, Amiens, France
*
Corresponding author: R. kassir; Email: [email protected]
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Abstract

Background:

Bilingualism’s impact on cognitive assessment remains underexplored. This study analyzes the efficacy of the Mini-Mental State Examination (MMSE) as a screening tool for bilinguals, specifically examining the influence of language choice on balanced and unbalanced Lebanese bilinguals (Arabic-French) and its implications for diagnosing cognitive impairment.

Methods:

Ninety-three bilingual healthy controls (mean age = 67.99 ± 9.3) and 29 Alzheimer’s disease patients (mean age = 77.2 ± 5.9), including 26 with mild and 3 with moderate dementia, underwent MMSE assessments in both Arabic and French. The study aimed to assess language impact on cognitive screening outcomes in different bilingual subtypes.

Results:

Sensitivity in screening for cognitive impairment using the MMSE varied based on language and bilingualism subtype. For unbalanced bilinguals, using the prominent language increased sensitivity. Conversely, in balanced bilinguals, employing the societal majority language enhanced sensitivity. This suggests that the conventional use of the non-prominent language in cognitive screening for foreigners/immigrants may result in a subtle loss of MMSE sensitivity.

Conclusion:

This study emphasizes the critical role of language choice in cognitive assessment for bilinguals. The MMSE’s sensitivity is influenced by language selection, with clinical implications for screening procedures. Recommendations include using the prominent language for cognitive screening in dominant bilinguals and the societal majority language for balanced bilinguals. This nuanced approach aims to improve the accuracy and cultural sensitivity of cognitive screening in bilingual populations, addressing the gap in current assessment practices.

Résumé

RÉSUMÉ

Dépistage des troubles cognitifs chez les individus bilingues : quelle est l’influence de la langue d’évaluation ?

Contexte :

L’impact du bilinguisme de patients sur leur évaluation cognitive demeure sous-exploré. Cette étude entend donc analyser l’efficacité du test de Folstein (TF ou Mini-Mental State Examination) en tant qu’outil de dépistage chez des individus bilingues en examinant plus particulièrement l’influence du choix de la langue chez des individus d’origine libanaise dont le bilinguisme (arabe et français) est équilibré et non équilibré de même que les implications sous-jacentes en vue d’un diagnostic de troubles cognitifs.

Méthodes :

Au total, 93 témoins en santé et bilingues (âge moyen = 67,99 ± 9,3), ainsi que 29 patients atteints de la maladie d’Alzheimer (âge moyen = 77,2 ± 5,9), dont 26 souffraient de démence légère et 3 de démence modérée, ont subi un TF en arabe et en français. Notre étude visait donc à évaluer l’impact de la langue sur les résultats du dépistage cognitif dans différents sous-types d’individus bilingues.

Résultats :

La sensibilité du dépistage de troubles cognitifs à l’aide du TF a varié en fonction de la langue et du sous-type d’individus bilingues. Chez les individus bilingues « déséquilibrés », l’utilisation de la langue dominante a augmenté le niveau de sensibilité du test. Inversement, chez les bilingues « équilibrés », l’utilisation de la langue majoritaire de la société a augmenté la sensibilité. Cela suggère en somme que l’utilisation conventionnelle de la langue non dominante dans le dépistage cognitif des étrangers ou des immigrants peut entraîner une perte subtile de sensibilité du TF.

Conclusion :

Cette étude souligne en définitive le rôle essentiel du choix de la langue dans l’évaluation cognitive des individus bilingues. La sensibilité du TF est en effet influencée par le choix de la langue, ce qui a des implications cliniques pour les procédures de dépistage. Voilà pourquoi il est recommandé d’utiliser la langue dominante pour le dépistage cognitif effectué chez des individus bilingues « déséquilibrés » et la langue majoritaire de la société chez des individus bilingues « équilibrés ». En comblant les lacunes des pratiques actuelles d’évaluation, cette approche nuancée entend améliorer la précision et la sensibilité culturelle du dépistage cognitif au sein de populations bilingues.

Keywords

Alzheimer’s diseasebilingualismlanguageMMSEtesting
Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 52 , Issue 2 , March 2025 , pp. 263 - 268
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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