The prevalence of dementia is higher among minoritized Hispanic/Latino populations in the U.S. Development of linguistically relevant and validated cognitive assessments are urgently needed to adequately address the care needs of this at-risk group. List learning tasks are widely used to evaluate verbal episodic memory and are consistently shown to be sensitive to memory deficits across various

neurologic etiologies. The aim of this study was to validate a Spanish list learning task developed as a linguistically appropriate measure of memory in a diverse sample of Spanish speaking Bay Area older adults who identify as Hispanic/Latino.

Cognitive scores were assessed in 72 Spanish-speaking older adults living in the Bay Area, California, originally from different countries across South and Central America [(n=29 with CDR scores of 0; n=31 with CDRs of 0.5; and n=12 with CDR of 1), aged 54-96, 30% male)], who completed the Spanish list learning task and a brief neuropsychological battery. The list learning task contains 9 words, 3 words from 3 different semantic categories. Category exemplars were excluded. Administration includes three immediate recall trials, a 30-second delay free recall, 10-minute delay free and cued recall, and yes/no recognition. In this initial validation study, we selected the 10-minute delay recall trial as our primary variable and looked at several indices of construct validity. We hypothesized delayed free recall would: 1) correlate highly with other episodic memory tasks, and minimally with non-memory tests (controlling for CDR sum of boxes), and 2) show step-wise declines as total CDR increased from 0 to 1 (controlling for age, sex, and education).

Delayed recall scores of 30-seconds and 10-minutes showed step-wise declines as CDR scores increased (CDR 0 vs. 1, p<0.001 and CDR 0.5 vs. 1, p=0.001). There were no differences in delayed recall between CDR 0 vs. CDR 0.5 (p>0.05). 10-minute delay showed medium-to-large correlations with UDS Craft Story Delayed Recall (partial r =0.45, p<0.001) and Benson Complex Figure Recall (partial r=0.63, p<0.001). Nonsignificant, weaker associations were observed with measures of executive (F Word Verbal Fluency partial r=0.10, Digit Span Forward partial r=0.12), and language (Animal Fluency partial r=0.18) function.

Although there is heterogeneity within Hispanic/Latino populations in the U.S., findings begin to support ecological and construct validity of the Spanish list learning task as a measure of verbal memory in older Spanish-speaking adults in the Bay Area. Supporting ecological validity, delayed recall scores significantly differentiated functionally impaired (CDR=1) from functionally mild or unimpaired older adults (CDR=0 or 0.5), though evidenced less sensitivity differentiating unimpaired from mild stages of illness. The Spanish list learning task evidenced strong construct validity as a measure of episodic memory, including strong correlations with other validated memory tasks, and non-significant correlations with non-memory tasks. Larger studies should account for diversity of Spanish speakers in the U.S to see how region of origin, education, and differences between first- and second-generation Spanish speakers influences performance on the task. Future work incorporating imaging markers of brain structure may help further validate the Spanish list learning task as an appropriate measure of memory.