Accurate early detection of subtle cognitive difficulties is critical for optimizing treatment of neurodegenerative disease. Those who speak English as a second language (ESL) in the US may be at a disadvantage on Englishwritten neuropsychological tests, increasing the potential for error, particularly when cognitive difficulties are mild and/or when informants are not available/unreliable. This study examined the utility of a standardized, performance-based test of everyday function for the assessment of cognition in ESL older adults.

Five ESL participants (Mage=83 years; range 65-84 years old) were recruited along with 43 cognitively healthy, native English speakers (controls) as part of a larger study of functional assessment in community-dwelling older adults. Participants were required to identify a study partner to answer questions about their cognitive abilities and everyday functioning. ESL participants reported diverse native languages: Cantonese, Mandarin, Gujarati/Hindi, Farsi, and Azeri. One of the 5 ESL participants reported a diagnosis of MCI. Participants completed the Mini-Mental Status Exam, Trail Making Tests, Digit Span, Boston Naming Test, Hopkins Verbal Learning Test, and Brief Visual Memory Test, resulting in 15 test scores. Participants also completed the Naturalistic Action Test (NAT), a performance-based tests that requires preparation of a breakfast and lunch using standardized objects presented on a table. Recordings of NAT performance were scored by two coders for time to completion, accomplishment of task steps, and errors (overt, micro-error, motor), resulting in 10 scores for the Breakfast and the Lunch tasks. Any discrepancies amongst the two coders were resolved by our lab. Informant-report questionnaires included the Functional Assessment Questionnaire (FAQ), Everyday Cognition Questionnaire (ECog) and IADL-C. Total scores from the cognitive tests, NAT, and informant reports for each ESL participant were compared against the scores of Controls by computing T-scores using the Control M and SD. Low/impaired test scores were defined as <1.5 SD.

Informants reported intact everyday function (FAQ, IADL-C) for all ESL participants. Informant-reported ECog scores varied as expected; with mild decline reported for the participant with MCI. On traditional cognitive tests, ESL participants showed variable performance, such that low scores were obtained on up to 9 of the 15 scores. The ESL participant with MCI obtained low scores on 11/15 scores. On the NAT, all of the ESL participants without MCI showed scores on the Breakfast (accomplishment, errors) that were comparable to Controls. Completion time for both Breakfast and Lunch and Lunch scores (accomplishment, errors) were variable, with low across observed in ESL participants with healthy cognition.

Older participants with ESL and healthy cognition showed highly variable scores on traditional, neuropsychological tests. However, on one item from a performance-based assessment of everyday function (NAT Breakfast), ESL participants with healthy cognition consistently performed well compared to healthy Controls. Performance was less consistent for completion time across both NAT tasks and on all measures from the Lunch task, for which the steps and objects may have been less familiar to ESL participants. Thus, performance-based testing holds promise for informing neuropsychological assessment of ESL older adults, but care should be taken in selecting test items that are highly familiar and outcome measures that are most meaningful across a range of cultures.