Department of Psychology, Florida Atlantic University, Charles E. Schmidt College of Science 3200 College Av, Davie, FL, 33314, USA.
1Florida Alzheimer's Disease Research Center, Miami Beach, FL, USA.
Neurotherapeutics. 2022 Jan;19(1):26-54. doi: 10.1007/s13311-022-01193-z. Epub 2022 Mar 28.
Alzheimer's disease (AD) is the most frequent cause of dementia, where the abnormal accumulation of beta-amyloid (Aβ) and tau lead to neurodegeneration as well as loss of cognitive, behavioral, and functional abilities. The present review analyzes AD from a cross-cultural neuropsychological perspective, looking at differences in culture-associated variables, neuropsychological test performance and biomarkers across ethnic and racial groups. Studies have found significant effects of culture, preferred language, country of origin, race, and ethnicity on cognitive test performance, although the definition of those grouping terms varies across studies. Together, with the substantial underrepresentation of minority groups in research, the inconsistent classification might conduce to an inaccuratte diagnosis that often results from biases in testing procedures that favor the group to which test developers belong. These biases persist even after adjusting for variables related to disadvantageous societal conditions, such as low level of education, unfavorable socioeconomic status, health care access, or psychological stressors. All too frequently, educational level is confounded with culture. Minorities often have lower educational attainment and lower quality of education, causing differences in test results that are then attributed to culture. Higher levels of education are also associated with increased cognitive reserve, a protective factor against cognitive decline in the presence of neurodegeneration. Biomarker research suggests there might be significant differences in specific biomarker profiles for each ethnicity/race in need of accurate cultural definitions to adequately predict risk and disease progression across ethnic/racial groups. Overall, this review highlights the need for diversity in all domains of AD research that lack inclusion and the collection of relevant information from these groups.
阿尔茨海默病（AD）是痴呆症最常见的病因，其特征是β-淀粉样蛋白（Aβ）和 tau 的异常积累导致神经退行性变以及认知、行为和功能能力的丧失。本综述从跨文化神经心理学的角度分析 AD，探讨了不同文化相关变量、不同种族和民族群体的神经心理学测试表现和生物标志物的差异。研究发现，文化、首选语言、原籍国、种族和民族对认知测试表现有显著影响，尽管这些分组术语的定义在不同的研究中有所不同。此外，少数民族群体在研究中的代表性严重不足，以及这些分组术语的不一致分类可能导致不准确的诊断，而这种不准确的诊断往往源于测试程序中的偏见，这些偏见倾向于测试开发者所属的群体。即使在调整与不利社会条件相关的变量（如教育程度低、不利的社会经济地位、医疗保健获取或心理压力源）后，这些偏见仍然存在。教育程度与文化常常混淆在一起。少数民族的受教育程度往往较低，教育质量也较差，这导致了测试结果的差异，而这些差异随后被归因于文化。较高的教育程度也与认知储备的增加有关，认知储备是神经退行性变存在时对认知能力下降的一种保护因素。生物标志物研究表明，每种种族/民族的特定生物标志物特征可能存在显著差异，需要准确的文化定义来充分预测跨种族/民族群体的风险和疾病进展。总的来说，本综述强调了在缺乏包容性的 AD 研究的所有领域中纳入多样性的必要性，以及从这些群体中收集相关信息的必要性。
