Effects of language of test administration as a predictor of progression to Alzheimer’s disease in bilingual Hispanic Americans: A pilot study

This pilot study investigated whether language of test administration (English versus Spanish) influences story recall sensitivity for early detection of Alzheimer's disease (AD) in Hispanic Americans. Participants included 18 progressors who were initially cognitively normal or had mild cognitive impairment but later diagnosed with AD, and 27 healthy controls who were cognitively stable for at least two years. During annual neuropsychological evaluations, participants completed the Logical Memory Test in English or Spanish. Immediate and delayed recall for Story A were assessed via whole story, primacy, and recency scores. Whole story immediate recall provided the highest diagnostic sensitivity. Planned language-specific ANCOVA and ROC curves revealed descriptive patterns of higher diagnostic sensitivity for participants tested in English than for those tested in Spanish, although the language × group interaction was not statistically significant, likely due to limited sample size. While all participants exhibited primacy and recency effects during immediate recall, the primacy effect was absent in delayed recall. These findings provide preliminary evidence that while story recall predicts AD risk in Spanish-English bilingual Hispanic older adults, its diagnostic sensitivity is moderated by administration language. This highlights the need for large-scale validation to ensure equitable and accurate cognitive assessment in diverse populations.