India is a land of extreme diversity with different languages, religions and cultural patterns. India writes in many languages and speaks in many more voices, and bilingualism and multilingualism are the norm, with more than one thousand indigenous languages. India also experiences challenges of low literacy with the largest illiterate population in the world. Neuropsychological assessment of the diverse population in India is a daily reality and special considerations are required when tests are adapted and administered.

Recommendations based on latest findings from the Indian Council of Medical Research (ICMR) Neurocognitive Tool Box and from the NIH-funded Joint Indo-U.S. Dementia Research Project in Mumbai will be discussed. Special methods to assess low literacy elders from the clinic and community will be evaluated.

We found that in a low-income group of people with epilepsy in our epilepsy surgery programs, the lack of test taking sophistication or test wiseness required elaboration of all test instructions and inability to utilize standardized instructions. In the multilingual context, even if language tests were performed in the most proficient language, there was a frequent occurrence of borrowed and language-mixed words. We discuss the development ofappropriate adaptations, multiple translations for the literate group and other ‘fair’ testing methods for low literacy/illiterate groups who are unable to perform in a formal testing situation and show floor effects.

Modifications in test instructions and stimuli are needed when faced with linguistic and educational diversity, in addition to allowing responses in multiple languages as acceptable for multilingual populations.