Toronto, Canada is one of the most culturally diverse cities in the world and provides clinical neuropsychologists with the opportunity to examine the impact of culture on the practice of neuropsychology. In this symposium, we will discuss how our research findings 1) can influence performance-based test selection and interpretation, 2) can impact our approach to clinical interviewing, and 3) how we can incorporate the patient’s lived experience into our case conceptualization and diagnosis.

We conducted retrospective chart reviews of patients with advanced Parkinson’s disease (PD) who completed neuropsychological assessments to determine candidacy for Deep Brain Stimulation (DBS) at Toronto Western Hospital (n = 764).

Our initial research demonstrated that a number of performance-based neuropsychological tools which are often considered “culture-free” or “culture-fair” are in fact biased against individuals who were born outside of Anglosphere cultures (e.g., USA, UK, Canada), where these tools are typically developed and normed (Statucka, & Cohn, 2019). Importantly and counterintuitively, tools which are language-based are not inherently biased and those that rely on visuospatial skills are not necessarily more “fair.” 

Our most recent work examines the subjective elements of neuropsychological assessment including reports of subjective cognitive decline (SCD) and ability to perform instrumental activities of daily living (iADLs) in individuals with PD. These subjective elements are just as important as our performance-based tools when it comes to applying diagnostic criteria and making treatment decisions. However, it is unclear if patients from different cultures report their experience of SCD and iADL difficulties in the same way.

Performance on common neuropsychological tools can be biased against culturally diverse individuals but the subjective report of cognitive decline and ability to perform iADLs appears to be less susceptible to these cultural influences. This symposium will provide a supervisor’s perspective on teaching trainees to incorporate subjective elements from the clinical interview and questionnaires into their neuropsychological assessments.