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July 8, 2020

Requisite Skills and the Meaningful Measurement of Cognition

Author Affiliations
  • 1Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
  • 2Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles
  • 3Miller School of Medicine, University of Miami, Miami, Florida
  • 4Research Service, Bruce W. Carter VA Medical Center, Miami, Florida
JAMA Psychiatry. Published online July 8, 2020. doi:10.1001/jamapsychiatry.2020.1618

In 1931, the noted neuropsychologist Alexander Luria, along with his supervisor Lev Vygotsky, led an expedition from Moscow to Uzbekistan with an honorable objective: to understand cognition in a population with low educational levels.1 However, they concluded that the minimal educational background of the population could prevent these individuals from engaging in the basic elements of a cognitive evaluation and that existing cognitive tests were not valid for their study population, so they created specialized tests that would be more appropriate. The study by Stone et al2 shares features of this expedition 90 years ago. Some of our era’s leading scientists have conducted an equally honorable collaborative project in the rural province of Ningxia, China, to assess individuals with chronic schizophrenia who have never received antipsychotic medications. By examining this population, the authors aimed to address the problem of the exclusion of underserved individuals from research on serious mental illness and to examine the longitudinal cognitive trajectory of schizophrenia in its natural untreated condition. The authors found that, in their cross-sectional sample, the duration of untreated psychosis was associated with worse cognitive performance. They specifically reported the association between cognition and the duration of chronic untreated psychosis as having partial Spearman correlation coefficients of 0.35 for the Brief Assessment of Cognition in Schizophrenia, Symbol Coding subtest; 0.24 for the Neuropsychological Assessment Battery, Mazes subtest; and 0.02 for the Brief Visuospatial Memory Test–Revised. These 3 assessments are conceptualized in western cultures as tests of processing speed, reasoning and problem solving, and visual memory. As with the findings of Luria and Vygotsky, given the distinct population in the Stone et al2 study, it is important to consider whether the assessments were suitable to the investigators’ purpose. The most relevant considerations are the validity of the tests for this group of individuals with low educational levels and the consequences of factors that could be associated with the passage of time itself, such as aging and changes in educational quality and opportunity.

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