Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds

Abstract

Objective: This study examined the influence of Hispanic ethnicity and language/cultural background on performance on the NIH Toolbox Cognition Battery (NIHTB-CB).

Method: Participants included healthy, primarily English-speaking Hispanic (n = 93; Hispanic-English), primarily Spanish-speaking Hispanic (n = 93; Hispanic-Spanish), and English speaking Non-Hispanic white (n = 93; NH white) adults matched on age, sex, and education levels. All participants were in the NIH Toolbox national norming project and completed the Fluid and Crystallized components of the NIHTB-CB. T-scores (demographically-unadjusted) were developed based on the current sample and were used in analyses.

Results: Spanish-speaking Hispanics performed worse than English-speaking Hispanics and NH whites on demographically unadjusted NIHTB-CB Fluid Composite scores (ps < .01). Results on individual measures comprising the Fluid Composite showed significant group differences on tests of executive inhibitory control (p = .001), processing speed (p = .003), and working memory (p < .001), but not on tests of cognitive flexibility or episodic memory. Test performances were associated with language/cultural backgrounds in the Hispanic-Spanish group: better vocabularies and reading were predicted by being born outside the U.S., having Spanish as a first language, attending school outside the U.S., and speaking more Spanish at home. However, many of these same background factors were associated with worse Fluid Composites within the Hispanic-Spanish group.

Conclusions: On tests of Fluid cognition, the Hispanic-Spanish group performed the poorest of all groups. Socio-demographic and linguistic factors were associated with those differences. These findings highlight the importance of considering language/cultural backgrounds when interpreting neuropsychological test performances. Importantly, after applying previously published NIHTB-CB norms with demographic corrections, these language/ethnic group differences are eliminated.

Keywords: Acculturation; cognition; cultural aspects; language; toolbox.

Figure 1

NIHTB-CB Performances by ethnic and language group on the Fluid Composite, Crystallized Composite, and individual tests. T-scores represent demographically-unadjusted scores, which were created by converting raw scores based on the present sample (i.e., they are not based on NIHTB CB normative standards). Note. DCCS: Dimensional Change Card Sort Test; Flanker: Flanker Inhibitory Control and Attention Test; List Sort: List Sorting Working Memory; Picture Memory: Picture Sequence Memory; Pattern Comparison: Pattern Comparison Processing Speed Test * Hispanic-Spanish (Hispanics tested in Spanish) differed from both Hispanic-English (Hispanics tested in English) and NH White (Non-Hispanic White) (ps<0.05) + NH White differed from Hispanic-English and Hispanic-Spanish (ps<0.05).