Challenges in the neuropsychological assessment of illiterate older adults

ABSTRACT

Illiterate individuals are over-represented among the elderly in many countries. Discrepancies in neuropsychological test performance between literate and illiterate groups raise questions regarding their appropriateness for the latter due to the potential for over-diagnosis. Additionally, performance of illiterate individuals often resembles that of literate individuals with dementia. Indeed, studies of illiteracy have demonstrated structural and functional brain changes through literacy attainment. Factors leading to suboptimal performance among illiterate individuals include lack of metalinguistic training, visuosymbolic representation, and familiarity with testing procedures (automatisation), and limited early life opportunities. Methods of improving diagnostic assessment of elderly illiterate individuals include adaptation or development of tests with construct validity and normative data for this group, circumventing the effect of illiteracy through the use of functional and/or structural brain indices of degeneration, and pre-assessment training of illiterate individuals. Future research may further elucidate the optimal methods for improving diagnostic assessment of illiterate elderly individuals.

KEYWORDS:

• Illiteracy
• dementia
• test adaptation
• elderly
• cross-cultural neuropsychology

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1 The studies reviewed in the present paper have generally relied on samples with no formal education due to a lack of opportunity (e.g. socioeconomic reasons), rather than early pathology.