Home › Research › Disparities
Culture, Ethnicity, and Level of Education in Alzheimer's Disease
Rosselli M, Uribe IV, Ahne E, Shihadeh L.. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 2022-01-01
Topic: Amyloid, tau and blood-test diagnosis
Alzheimer's disease (AD) is the most frequent cause of dementia, where the abnormal accumulation of beta-amyloid (Aβ) and tau lead to neurodegeneration as well as loss of cognitive, behavioral, and functional abilities. The present review analyzes AD from a cross-cultural neuropsychological perspective, looking at differences in culture-associated variables, neuropsychological test performance and biomarkers across ethnic and racial groups. Studies have found significant effects of culture, preferred language, country of origin, race, and ethnicity on cognitive test performance, although the definition of those grouping terms varies across studies. Together, with the substantial underrepresentation of minority groups in research, the inconsistent classification might conduce to an inaccuratte diagnosis that often results from biases in testing procedures that favor the group to which test developers belong. These biases persist even after adjusting for variables related to disadvantageous societal conditions, such as low level of education, unfavorable socioeconomic status, health care access, or psychological stressors. All too frequently, educational level is confounded with culture. Minorities often have lower educational attainment and lower quality of education, causing differences in test results that are then attributed to culture. Higher levels of education are also associated with increased cognitive reserve, a protective factor against cognitive decline in the presence of neurodegeneration. Biomarker research suggests there might be significant differences in specific biomarker profiles for each ethnicity/race in need of accurate cultural definitions to adequately predict risk and disease progression across ethnic/racial groups. Overall, this review highlights the need for diversity in all domains of AD research that lack inclusion and the collection of relevant information from these groups.
Key findings
- Studies have found significant effects of culture, preferred language, country of origin, race, and ethnicity on cognitive test performance, although the definition of those grouping terms varies across studies.
- Together, with the substantial underrepresentation of minority groups in research, the inconsistent classification might conduce to an inaccuratte diagnosis that often results from biases in testing procedures that favor the group to which test developers belong.
- Minorities often have lower educational attainment and lower quality of education, causing differences in test results that are then attributed to culture.
- Higher levels of education are also associated with increased cognitive reserve, a protective factor against cognitive decline in the presence of neurodegeneration.
- Biomarker research suggests there might be significant differences in specific biomarker profiles for each ethnicity/race in need of accurate cultural definitions to adequately predict risk and disease progression across ethnic/racial groups.
Why it matters
This review finds that culture, preferred language, country of origin, race and ethnicity all affect scores on memory and thinking tests. It says testing procedures can favour the group the tests were developed in, and that this bias persists even after adjusting for education, income, health-care access and stress, which can lead to inaccurate diagnosis. It also notes that lower education is often mistaken for a cultural difference, and that biomarker profiles may differ between groups, so it calls for more diverse research. It is a review, not a trial, and reports no treatment.
New to this subject? Start with our plain-English guide: Disparities →
Study details
- Evidence strengthLow
How this study scored 48/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on senior author's track record, so that was left out: it earned 46 of the 96 points we could judge it on, which is 48 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics) |
| Journal's citation record | 2 / 4 | Neurotherapeutics: journal h-index 156 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2022 — within 6 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 140 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 23.3 citations a year over 6 year(s) since 2022 |
| Impact for its field and year | 4 / 6 | Cited 17.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 11 other studies in this library |
| Still being cited | 3 / 4 | Cited 105 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | OpenAlex's profile for last-listed author Layaly Shihadeh holds only 5 work(s), too few to judge a track record — left out of this score |
| Institution's track record | 0 / 3 | Florida Atlantic University: institution h-index 410 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 35347644) |
| Free to read | 2 / 2 | Free to read |
| Points | 46 / 96 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 46 of the 96 points we could judge it on is 48 out of 100. |
| Total | 48 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1007/s13311-022-01193-z
- PubMed: 35347644
- Original source →
- Free full text: Neurotherapeutics →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Rosselli, M., Uribe, IV., Ahne, E., & Shihadeh, L. (2022). Culture, Ethnicity, and Level of Education in Alzheimer's Disease. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics. https://doi.org/10.1007/s13311-022-01193-z
Vancouver
Rosselli M, Uribe IV, Ahne E, Shihadeh L. Culture, Ethnicity, and Level of Education in Alzheimer's Disease. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics. 2022. doi:10.1007/s13311-022-01193-z. PMID: 35347644.
BibTeX
@article{rosselli2022-35347644,
author = {Rosselli, M. and Uribe, IV. and Ahne, E. and Shihadeh, L.},
title = {{Culture, Ethnicity, and Level of Education in Alzheimer's Disease}},
journal = {Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics},
year = {2022},
doi = {10.1007/s13311-022-01193-z},
pmid = {35347644},
url = {https://doi.org/10.1007/s13311-022-01193-z}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here. Showing 12 of 20.
Later studies that cite this one
11 studies in the alzhub library list this one in their references. Showing the 8 highest-scoring.
Related studies in Disparities
Also in Disparities
98 studies in the library are filed under Disparities with no topic tag they share with another; these are this study's neighbours in a fixed tour of them. The Disparities hub.