Specific Cultural Considerations
Less attention has been paid to cultural variants of the cognitive dis-orders than to other psychopathological forms, probably because of the widespread assumption that this group of disorders is influenced exclusively by biological factors. Nevertheless, these disorders show several kinds of social, cultural and ethnic influences. Given the etio-logically based subtyping of the cognitive disorders, these influences are exerted, first, by effects on the nature and rates of the diseases that are the causative agents of these disorders (Lin and Fábrega, 1997).
Socioeconomic factors influence the prevalence rates of diseases affecting the brain. Low industrialization of a country or the poverty of a particular social group tends to increase the rates of infectious diseases, nutritional disorders, toxic exposures (e.g., lead), head injuries, endo-crinological abnormalities and seizure disorders among others (Cruick-shank and Beevers, 1989). This, in turn, may result in differences in the rates of the subtypes of dementia, of delirium, and of other specific cognitive syndromes (Spector, 1979; Westermeyer and Canino, 1997).
Cultural factors, such as prohibitions against substance use and variations in sexual mores, also affect the rates of alcohol- and drug-related syndromes as well as of acquired immu-nodeficiency syndrome (AIDS) related organic mental disorders (Agarwal and Goedde, 1990; Kaslow and Francis, 1989). Ethnic determinants are also important. Hypertension and strokes have been suggested to be more prevalent among the African-Ameri-cans and some Asian groups; this may result in different rates of multi-infarct dementia (de la Monte et al., 1989). In addition, research on Alzheimer’s dementia is currently evaluating reports of lower rates among the Chinese and the Chinese-Americans as well as the African-Americans (de la Monte et al., 1989; Zhang et al., 1990). The detection and assessment of the cogni-tive disorders are also influenced by social and cultural factors. Social groups that tolerate and even expect substantial decreases in decision-making and self-care among older persons may not be regarded as pathological milder degrees of disorientation among the elderly (Ikels, 1991). Educational level and cultural differences appear to exert separate but intermingled effects on the inappropriately high identification of cognitive impairment with the Mini-Mental State Examination (MMSE) among sev-eral ethnic groups, including the Hispanic, Taiwanese, Chinese, Southeast Asian (Williams, 1987), and Afro-Caribbean popula-tions (Richards et al., 2000). Based on a review of the literature and consultations with members of the aboriginal community Cattarinich and colleagues (2001) note that differing degrees of acculturation within and between aboriginal groups create prob-lems for cognitive evaluations. On the basis of these and other findings, some researchers have begun to question the adequacy of the MMSE and other cognitive assessment instruments, and as a consequence some practitioners have begun modifying their methods.