Screening for cognitive impairment and depression in ethnically diverse older populations.

Considerable advances have been made over the past decade in developing and adapting instruments to measure cognitive functioning in individuals with a wide range of educational and racial/ethnic backgrounds in different countries. Similar approaches can be used to extend these assessments to groups that have not yet been studied. The critical issues are to ensure that methods are appropriately harmonized to the local context, that local norms are established, and that local expertise is brought to bear in instrument development/adaptation. Effective instruments are also available to screen for depression in the elderly but closer attention should be made to possible ethnic differences in item response on these scales. The ideal screening tool should be quick, inexpensive, painless, and socially/culturally acceptable to the population. It should also have desirable psychometric properties. Examples are provided from several international studies. The context, costs, and objectives of screening a given population should be considered when selecting a screening instrument and a threshold on the scale, whether for clinical or research purposes.