Identifying cognitive disorder and dementia in users of sign languages - moving away from spoken language tests T Denmark, J Atkinson, B Woll, J Marshall, A Young, E Ferguson-Coleman, K Rogers, R Geall, J Keady and A Burns DCAL, University College London, 49 Gordon Square, London WC1H 0PD, UK SORD, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK This work is funded by the Alzheimer’s Society BSL naming task elicits signs with low iconicity and familiarity ratings (Vinson et al, 2008) to ensure that targets cannot be guessed due to visual iconicity or gesturability. Establishing parameters of normal cognition and ageing Data was collected from 226 cognitively healthy deaf adults aged years attending a holiday camp. Inclusion criteria specified no history of neurological disease or injury, mental illness, substance abuse or additional disability. Matrix Reasoning (WASI) was used as a control task to check distribution of intellectual ability. Background Using tests developed for speakers of spoken languages to identify cognitive disorders and dementia in deaf users of signed languages is a fallacy. Differences in language modality and sensory input during development influence cognition in ways that are not yet fully understood. Available tests focus on cognitive Test development Developed by Deaf led team of neuropsychologists, linguists and community consultant. All native or highly fluent users of BSL BSL Video instructions ensure standardised administration Well understood across UK: sign used in instructions and test have low regional variability and historic change No English language requirement Domains tested include: orientation, memory, attention, executive function, language and visuospatial cognition Format partially adapted from the ACE-r, suitable items adapted from ACE-r and Montreal Cognitive Assessment (MoCa). Unproblematic items were borrowed and a strict back translation procedure was used to ensure conceptual equivalence. Additional items were developed from scratch to ensure cultural and linguistic relevance Culturally appropriate memory screen using biographical information about a Deaf man, rather than a written name and address Retrograde memory questions about historical figures and events which are universally known and relevant to the Deaf community – e.g. death of Princess Diana (Patron of British Deaf Association) Sign language tasks Picture description, sentence repetition, comprehension and picture naming Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR (2006), The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening, International Journal of Geriatric Psychiatry 21(11): Vinson DP, Cormier K, Denmark T, Schembri A, Vigliocco G, (2008), BSL Norms for Age of Acquisition, Familiarity and Iconicity, Behavior Research Methods, 40(4), Preliminary results (n=200) Test scores ranged from from a possible total of 101. There were no ceiling or floor effects. Scores significantly correlate with age (r=.35, p<.01) and matrix reasoning (r=.46 p<.01) showing that the BSLCS is sensitive to both cognitive ageing and intellectual ability. Next stage More detailed analysis of the parameters of normative cognition and ageing within each domain Normative Z scores are now used at a Cognitive Disorders Clinic for deaf patients, to detect levels of change associated with neurodegeneration and dementia Planned collection of clinical data from deaf patients with suspected dementia to establish diagnostic validity Conclusions Existing cognitive batteries would look very different had they been originally developed for signers rather than speakers. Taking sign language as a starting point for developing cognitive tests for deaf people is imperative for clinical accuracy and for profiling unique patterns of cognition in deaf people which would be overlooked by employing spoken language frameworks. It is vital that we identify and account for phenomena in deaf signers, to vigorously test existing models of human language and cognition, and to allow theoretical advance. Examples of novel items Sign fluency tasks using handshapes rather than asking for words starting with an English letter strengths found in speakers while ignoring aspects of cognition that may be more developed in signers. Cultural and educational differences mean that current tests lack validity. Using interpreters is unreliable and error prone, particularly as communication itself is part of the assessment. Norms for deaf signers do not exist rendering scores clinically meaningless. Diagnosis of deaf patients is typically late with adverse consequences for access to treatment. Here we present a new cognitive screening test specifically developed in British Sign Language (BSL), akin to the widely used tests such as the Mini Mental State Examination and Addenbrookes Cognitive Examination (ACE-r, Mioshi, Dawson et al. 2006).