Kiselica Andrew M, Johnson Ellen, Lewis Kaleea R, Trout Kate
Department of Health Psychology, University of Missouri, Columbia, MO, USA.
Department of Psychology, Ohio University, Athens, OH, USA.
Appl Neuropsychol Adult. 2023 Nov-Dec;30(6):749-756. doi: 10.1080/23279095.2021.1976778. Epub 2021 Sep 23.
Black individuals are less likely to receive an accurate diagnosis of mild cognitive impairment (MCI) than their White counterparts, possibly because diagnoses are typically made by a physician, often without reference to objective neuropsychological test data. We examined racial differences in actuarial MCI diagnoses among individuals diagnosed with MCI via semi-structured clinical interview (the Clinical Dementia Rating) to examine for possible biases in the diagnostic process. Participants were drawn from the National Alzheimer's Coordinating Center Uniform Data Set and included 491 individuals self-identifying as Black and 2,818 individuals self-identifying as White. Chi-square tests were used to examine racial differences in rates of low scores for each cognitive test (domains assessed included attention, processing speed/executive functioning, memory, language, and visual skills). Next, we tested for racial differences in probability of meeting actuarial criteria for MCI by race. Compared to Black participants diagnosed with MCI via clinical interview, White individuals diagnosed with MCI via clinical interview demonstrated significantly higher rates of low demographically-adjusted -scores on tests of memory, attention, processing speed, and verbal fluency. Furthermore, White individuals were significantly more likely to meet actuarial criteria for MCI (71.60%) than Black individuals (57.90%). Results suggest there may be bias in MCI classification based on semi-structured interview, leading to over diagnosis among Black individuals and/or under diagnosis among White individuals. Examination of neuropsychological test data and use of actuarial approaches may reduce racial disparities in the diagnosis of MCI. Nonetheless, issues related to race-based norming and differential symptom presentations complicate interpretation of results.
与白人相比，黑人被准确诊断为轻度认知障碍（MCI）的可能性较小，这可能是因为诊断通常由医生做出，且往往未参考客观的神经心理学测试数据。我们通过半结构化临床访谈（临床痴呆评定量表）诊断为MCI的个体中，研究了精算MCI诊断中的种族差异，以检查诊断过程中可能存在的偏差。参与者来自国家阿尔茨海默病协调中心统一数据集，包括491名自我认定为黑人的个体和2818名自我认定为白人的个体。卡方检验用于检查每项认知测试低分率的种族差异（评估的领域包括注意力、处理速度/执行功能、记忆、语言和视觉技能）。接下来，我们测试了按种族划分的符合MCI精算标准概率的种族差异。与通过临床访谈诊断为MCI的黑人参与者相比，通过临床访谈诊断为MCI的白人个体在记忆、注意力、处理速度和语言流畅性测试中，经人口统计学调整后的低分率显著更高。此外，白人个体比黑人个体更有可能符合MCI的精算标准（71.60%对57.90%）。结果表明，基于半结构化访谈的MCI分类可能存在偏差，导致黑人个体被过度诊断和/或白人个体被漏诊。检查神经心理学测试数据和使用精算方法可能会减少MCI诊断中的种族差异。尽管如此，与基于种族的常模和不同症状表现相关的问题使结果的解释变得复杂。
