A new study published in the American Journal of Geriatric Psychiatry found that Spanish-speaking patients are less likely to receive a timely diagnosis of cognitive impairment than English-speaking patients.
Ideally, patients are evaluated first by their primary care providers, then by cognitive disorder specialists (e.g., neuropsychologists, geriatric psychiatrists, behavioral neurologists, etc.). Following diagnosis, patients’ loved ones or caregivers would play a pivotal role in decision-making and planning.
The researchers examined a sample of 12,080 English- and Spanish-speaking patients at Yale New Haven Health who were diagnosed with mild cognitive impairment (MCI) or dementia between July 2017 – June 2019.
Findings indicate several factors that contribute to delayed diagnosis for Spanish speakers.
“First, language barriers present significant obstacles in effective communication between patients and healthcare providers, hindering the accurate expression of symptoms and understanding of symptoms and understanding of medical information,” said Carmen Carrión, PsyD, assistant professor of neurology, and co-author of the study. “Cultural differences may also influence attitudes toward cognitive impairment and help-seeking behaviors, potentially leading to delayed medical consultations.”
Study co-author Jason Silva-Rudberg (Department of Psychiatry, Yale School of Medicine) and colleagues pointed to additional factors that delayed the delivery of medical care for Spanish speakers, including disparities in access to bilingual healthcare providers and interpreter services; lower educational levels; and lower socioeconomic status.
Faced with disproportionate challenges and systemic problems in healthcare, Spanish-speaking patients are at risk for missing the early interventions that are critical to achieving the best outcome with cognitive impairment and dementia.
“Of particular importance,” notes Silva-Rudberg and colleagues, “with the advent of anti-amyloid beta therapies and recent FDA approval of Lecanemab (Leqembi™) for the use in the early stages of Alzheimer’s disease (MCI and mild dementia), a timely diagnosis is paramount.”
In addition to allowing for the prompt administration of medication, Silva-Rudberg and colleagues explain that an early diagnosis can give patients and their loved ones enough time to plan for the future, seek non-pharmacological therapies like speech therapy and occupational therapy, and preserve cognitive function for as long as possible.
One way to help deliver efficient care for Spanish speakers and reduce the disparities identified in the study is through culturally informed neuropsychological evaluations, as Carrión outlines:
“In my clinical practice, I integrate the ECLECTIC framework (Fuji, 2017), which provides a structured approach to understanding various cultural factors relevant to conducting culturally competent neuropsychological evaluations…For example, I assess education and literacy levels, acknowledging their influence on cognitive functioning. Understanding clients’ culture and acculturation offers a window into their experiences, beliefs, and values. Additionally, I consider language proficiency and fluency, recognizing how linguistic differences affect communication. Socioeconomic factors, including lived environment and neighborhood disadvantage, are also considered, impacting access to medical care and healthy lifestyle implementation.”
These added layers of detail supply healthcare providers with thorough and meaningful insight. Given that Spanish-speaking patients face unique barriers to diagnosis compared to their English-speaking counterparts, it is important to understand Spanish speakers’ cultural differences to identify opportunities for providing swift treatment.
Silva Rudberg and colleagues also propose some policy changes that would supplement cultural competency in evaluations and counter disparities on a larger scale.
Within the healthcare system, for instance, healthcare facilities could invest in interpretation and translation services, and insurers could adequately cover those services. Healthcare facilities could also commit to reporting on the success of culturally inclusive initiatives.
Furthermore, public programming focused on improving health literacy and reducing stigma of cognitive impairment and dementia could provide Spanish-speaking patients with tools to navigate medical settings with confidence and effectively communicate with providers.
Ultimately, key improvements to the healthcare delivery system and targeted community outreach can help bridge the gap between a Spanish-speaking patient population and the providers who can deliver the best possible care as quickly as possible.