Risk of Undiagnosed Dementia and Care Seeking Behaviors Among Asian Americans with Limited English Proficiency

Abstract

Objective: This study evaluated the relationship between limited English proficiency (LEP) in Asian Americans (AAs) and risk of undiagnosed dementia, memory-related visits, and cognitive testing. Methods: We conducted secondary analyses of data originally extracted for the Electronic Health Records (EHR) Risk of Alzheimer’s and Dementia Assessment Rule (eRADAR) study. The current study included 6,075 AA participants (mean age 69.8 years; 58.5% female) over the age of 65 who were members of Kaiser Permanente Washington from 2013-2019. The exposure variable was LEP or English-preferred language status, which was determined by the individual’s preferred language according to electronic health records (EHR). One primary outcome was the risk of undiagnosed dementia as determined by eRADAR scores, a validated method of using routinely collected EHR data to estimate a person’s risk of having undiagnosed dementia. Other outcomes were whether the individual had at least one memory-related visit and whether they had at least one cognitive test performed. Results: The LEP group (n = 1,321) had a lower estimated risk of undiagnosed dementia (mean eRADAR score = 0.009; SD = 0.016) than the English-preferred group (n = 4,754; mean eRADAR score = 0.011; SD = 0.016; p-value = < 0.001). The two groups had similar rates of having at least one memory-related visit (LEP group = 4.2%; English-preferred = 5.2%; p-value = 0.079). Fewer individuals in the LEP group had a cognitive test performed (0.7%) as compared to the English-preferred group (1.7%; p-value = 0.006). Conclusions: The study found lower risk of undiagnosed dementia as well as lower prevalence of cognitive testing among AAs with LEP. The results could indicate either a truly lower risk of undiagnosed dementia or an underutilization of healthcare among AAs with LEP.