Neuropsychological Assessment of Older Adults in Nepal for Population-Based Dementia Ascertainment: Needs, Challenges, and Opportunities

Article type: Review Article

Authors: Briceño, Emily M.^a | Dhakal, Usha^b | Sharma, Uttam^c | Adhikari, Nabin^c | Pradhan, Meeta S.^c | Shrestha, Lochana^d | Jalan, Pankaj^e | Rai, Janak^f | Langa, Kenneth M.^{g; h; i} | Lee, Jinkook^j | Ghimire, Dirgha^{c; k} | Mendes de Leon, Carlos F.^l

Affiliations: [a] Departments of Physical Medicine & Rehabilitation and Neurology, University of Michigan Medical School, Ann Arbor, MI, USA | [b] Department of Sociology & Gerontology, Miami University, Oxford, OH, USA | [c] Institute for Social and Environmental Research-Nepal (ISER-N), Bharatpur-15, Chitwan, Nepal | [d] Nepalese Army Institute of Health Sciences, Kathmandu, Nepal | [e] Norvic International Hospital, Kathmandu, Nepal | [f] Central Department of Anthropology, Tribhuvan University, Nepal | [g] Survey Research Center, University of Michigan Institute for Social Research, Ann Arbor, MI, USA | [h] Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA | [i] Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA | [j] Department of Economics, University of Southern California, Los Angeles, CA, USA | [k] Institute for Social Research, University of Michigan, Ann Arbor, MI, USA | [l] Department of Oncology, Georgetown University, Washington DC, USA

Correspondence: [*] Correspondence to: Emily M. Briceño, PhD, University of Michigan Medical School, Department of Physical Medicine & Rehabilitation, 325 E. Eisenhower Blvd, 3^rd Floor, Ann Arbor, MI 48108, USA. Tel.: +1 734 763 6496; Fax: +1 734 936 7048; E-mail: emily.briceno@umich.edu.

Abstract: The population of Nepal is rapidly aging, as in other low and middle-income countries, and the number of individuals living with Alzheimer’s Disease and related dementias (ADRD) is expected to increase. However, information about the neuropsychological assessment of ADRD in Nepal is lacking. We first aimed to examine the needs, challenges, and opportunities associated with the neuropsychological assessment of older adults in Nepal for population-based ADRD ascertainment. Second, we introduce the Chitwan Valley Family Study-Study of Cognition and Aging in Nepal (CVFS-SCAN), which is poised to address these needs, and its collaboration with the Harmonized Cognitive Assessment Protocol (HCAP) international network. We reviewed the existing literature on the prevalence, risk factors, available neuropsychological assessment instruments, and sociocultural factors that may influence the neuropsychological assessment of older adults for ADRD ascertainment in Nepal. Our review revealed no existing population-based data on the prevalence of ADRD in Nepal. Very few studies have utilized formal cognitive assessment instruments for ADRD assessment, and there have been no comprehensive neuropsychological assessment instruments that have been validated for the assessment of ADRD in Nepal. We describe how the CVFS-SCAN study will address this need through careful adaptation of the HCAP instrument. We conclude that the development of culturally appropriate neuropsychological assessment instruments is urgently needed for the population-based assessment of ADRD in Nepal. The CVFS-SCAN is designed to address this need and will contribute to the growth of global and equitable neuropsychology and to the science of ADRD in low- and middle-income countries.

Keywords: Alzheimer’s disease and related dementias, cognitive aging, cultural neuropsychology, global health, mild cognitive impairment

DOI: 10.3233/JAD-230906

Journal: Journal of Alzheimer's Disease, vol. 96, no. 4, pp. 1339-1352, 2023