Distance assessment of cognitive deficits in older immigrants

BACKGROUND: In European memory clinics, requests for assessing people with cognitive complaints in a foreign language are becoming frequent. Currently, over one million people living in EU are older migrants presenting with possible cognitive deterioration. The assessments of cognitive functions is the gateway to diagnosis, and the main tool for monitoring progression of neurocognitive disorders. However, the limitations of older migrants in the language of the host country add hurdles to the diagnostic process. This represents an emerging problem for the EU healthcare systems. In several EU countries, the current best approach is to involve a translator, who assists the healthcare personnel with the assessment. This practice is far from perfect. METHODS: We convened a multidisciplinary and international team, including experts in neurocognitive disorders and in digital tools, to develop a user-friendly process aimed at connecting clinicians dealing with the diagnosis of people affected by cognitive deficits in different languages or countries. The initial network included countries with great prevalence of immigrants (DE, F, I, UK) and referents from partner specialists from the main immigrant nationalities. This network is planned to expand. RESULTS: This preliminary network convened on a reference procedure to be supported with digital tools. The procedure includes referral of migrants with cognitive complaints to a colleague from the established network, for remote assessment in their mother-tongue using tools appropriate for their cultural background. The outcome of the referral is sent to the clinicians in the adopted country who could take a better informed decision on the diagnosis and handling of the symptoms presented by the migrant. DISCUSSION: The proposed procedure overcomes several limitations of the current assessment of migrants via a translator, relative to time, languages availability, linguistic and cultural specificity of materials and norms used for the assessment. Assessment would improve thank to greater empathy allowed through the process, and the specific medical background will allow to detect issues that could emerge during the interview or the formal testing. The proposed process solves several problems identified within the current practice, with considerable benefit on detection of neurocognitive disorders in a heterogeneous population.