Developing a Scientific Agenda for Cultural Neuropsychology

Jennifer Manly

HNS ConferenceNovember 2015

Overview

• Examples of gaps in knowledge with impact on practice• Bilingualism as protective factor• Neuropathology among African Americans with AD

• Interdisciplinary approaches• Lifecourse Model• Deconstructing culture to understand mechanisms• Summary

Bilingualism and cognitive aging

• Bialystok suggests that the continuous task of managing competing representations of two languages imparts cognitive reserve• However, the results of these studies are mixed (Zahodne, Schofield,

Farrell, Stern, & Manly, 2013)

Prior studies on bilingualism and cognitive aging/dementia

Protective No effectCross-sectional

Retrospective

Alladi et al., 2013Bialystok et al., 2007Bialystok et al., 2012Craik et al., 2010Gollan et al., 2011 Schweizer et al., 2013Kavé et al., 2008

Longitudinal

Trajectory

Incidence

Zahodne et al., 2014Crane et al., 2009Sanders et al., 2012Yeung et al., 2014Lawton et al., 2015

Zahodne et al., (2014)

Survival curves by (a) age, (b) education, (c) gender, and (d) degree of bilingualism

Barnes et al. Neurology 2015

Racial differences in mixed pathology in black and white decedents with Alzheimer disease (AD) dementia

Source: Carl Hill, PhD

Lifecourse Model of Disparities in Cognitive Aging

Race/ Ethnicity

Geographic Exposures/ Immigration

Socioeconomic Position

Discrimination

Group Identity

Group Resources/ Ties

Material Conditions

Psychological Stressors

Cognitive Engagement

Test Taking Skills

Medical Access

Physical Health

Health Behaviors

Cognitive Function,

Impairment, and Change

Diagnosis of Cognitive

Impairment

Distal Socially Patterned Mediators

Individual Mediators

Proximal Mediators

Glymour & Manly, 2008

Deconstructing Race/Ethnicity and Education

• Socioeconomic status• Years of school• School quality• Exposure to

mainstream culture• Geographic region• Motivation• Racial socialization• Stereotype threat• Early life SES

• Genetics• Early life nutrition• Access to health care• Cerebrovascular function• Chronic medical illness• Accelerated aging• Racial discrimination

Conclusions

• Critical knowledge gaps in cultural neuropsychology must be addressed• To understand mechanisms and reduce disparities in cognitive test

performance and neurocognitive disorders• To improve diagnostic accuracy of neuropsychological tests• To understand brain behavior relationships

• Social justice and health equity• Training in interdisciplinary science is fundamental• Lifecourse model of cultural neuropsychology• Race/ethnicity are meaningful variables in neuropsychology