Asian Americans are the fastest growing group of older adults in the United States, yet many face barriers when seeking care for dementia symptoms, especially due to language and cultural differences.
A new study led by Rutgers Health has developed and validated a suite of neuropsychological tests tailored specifically for Mandarin-speaking older adults. Published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, the research focuses on older Americans from China and Taiwan, where direct translations of English-language cognitive tests often fail to capture key linguistic and cultural nuances.
The study is part of an initiative supported by the National Institute on Aging through the Rutgers-NYU Resource Center for Alzheimer’s Disease and the Research Center in Asian and Pacific Americans (RCASIA), in collaboration with the Stanford Alzheimer’s Disease Research Center. The team designed tests that account for the non-alphabetical structure of Chinese languages, the frequency of character and word usage in daily life, and cultural experiences prior to immigration to the United States.
The Chinese Older Adult STudy (COAST) recruited 208 participants between ages 60 and 90 from New Jersey, New York City, and the San Francisco Bay Area. Participants had varying levels of bilingual ability. Researchers evaluated the new tests for six-month reproducibility, equivalence with corresponding English versions, and consistency with established measures of memory and cognition.
William Hu, professor of neurology and chief of the Cognitive Neurology and Alzheimer’s Disease Clinic at Rutgers Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital, emphasised the need for culturally appropriate tools. Hu also directs the Centre for Healthy Ageing Research at the Rutgers Institute for Health, Health Care Policy and Aging Research.
“Direct translation of English tests for memory and thinking into other languages often fails to capture essential linguistic and cultural nuances, leading to underdiagnosis, faux pas and mistrust in the physician-patient relationship especially when both physicians and patients know the instruments are poor,” said Hu. “This is the first set of tests validated in older adults from China, Taiwan, and other overseas Chinese diaspora.”
The new battery includes innovative tasks assessing word fluency and memory. Results demonstrated high stability over six months, strong correlations with English-based assessments, and robust associations with emerging blood-based biomarkers for Alzheimer’s disease.
Researchers plan to adapt the tests for tablet and electronic platforms, including virtual reality, enabling standardised instruction and response recording without requiring a Mandarin-fluent clinician. The team also intends to validate the tools in Cantonese and other Chinese dialects to broaden accessibility.
“This research opens the door for greater involvement in clinical trials by older Chinese Americans who may not meet the English proficiency level necessary for standard North American neuropsychological testing,” Hu said. “Our work provides a scientifically validated pathway to accurately include and characterise this community in modern clinical care and cutting-edge research.”
The collaboration included Rutgers researchers Michelle Chen and Karthik Kota, alongside Stanford researchers led by Vankee Lin.
As the Asian American population continues to age, culturally tailored diagnostic tools may help reduce disparities in dementia detection and expand participation in clinical care and research.