Questioning the universal application of neurocognitive tests

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Human interactions are enabled by a set of neurocognitive mechanisms defined by

Human interactions are enabled by a set of neurocognitive mechanisms defined by the notion of social cognition. Ryoji Iwata / Unsplash

Human interactions are enabled by a set of neurocognitive mechanisms defined by the notion of social cognition. In order to detect patients with social cognition disorders, specialists use internationally validated evaluation tests. However, most of these tests have been developed in industrialized Western countries, which raises questions about the relevance of generalizing them to the whole of humanity. A research team from Inserm, the University Hospital of Lille and the University of Lille within the Lille Neuroscience & Cognition laboratory has studied the impact of cultural differences on performance on two tests.cultural differences on performance on two of the most widely used neurocognitive tests worldwide, by comparing the results of almost 600 healthy participants across 12 countries. Their study, to be published in Neuropsychology , points to significant differences in performance across countries and calls for greater consideration of social sciences in the development of neurocognitive tests.

The notion of social cognition refers to all the cognitive processes (perception, memorization, reasoning, emotion...) that are involved in social interactions. Social cognition disorders are found in many diseases such as schizophrenia or Parkinson’s disease, and in neurodevelopmental disorders such as autism. They are at the origin of very incapacitating interpersonal difficulties that have a strong impact on the lives of patients and their families. Consequently, the detection, quality of assessment and treatment of these disorders represent a major challenge for mental health specialists.

To assess social cognition skills and diagnose a possible disorder, there are internationally used tests that measure so-called cognitive functions, i.e. the abilities that allow us to interact effectively with other people.


However, most of these reference cognitive tests were developed in Western and industrialized democracies. Their norms are therefore defined for the most part on the basis of profiles of white, well-off and highly educated people. Insofar as these people constitute only 12% of humanity, their over-representation in the development of neuropsychological tests calls into question the relevance of applying them to other populations.

A research team led by Inserm researcher Maxime Bertoux at the Lille Neuroscience & cognition laboratory (Inserm/CHU Lille/University of Lille) sought to determine whether cultural differences have a significant impact on the results of the most commonly used social cognition tests. To do so, the researchers conducted a large international study on 587 healthy participants, aged 18 to 89, from 12 countries (Argentina, Brazil, Canada, Chile, China, Colombia, England, France, Germany, Italy, Russia, Spain). Neuropsychologists subjected the participants to two types of tests evaluating abilities considered to be of primary importance in social cognition.

The first, created in the United Kingdom, aims to evaluate the ability to decode social rules and to understand the mental state of an interlocutor by asking participants to identify, in various small scenarios, if one of the protagonists commits a social faux pas (for example, confusing a customer with a waiter in a restaurant).The first test, created in the United Kingdom, aims to evaluate the ability to decode social rules and to understand the mental state of an interlocutor by asking participants to identify, in various small scenarios, if one of the protagonists commits a social faux pas (for example, confusing a customer with a waiter in a restaurant). The second test, created in the United States, evaluates the ability to recognize the emotions expressed by the face of an interlocutor, by asking participants to identify various facial expressions on photographs.

The results of the study show that a significant portion of the differences in performance on these two tests (about a quarter for the misstep test and more than 20% for the emotion recognition test) can be attributed to differences in nationality among the participants.

The best performance on the misstep test was achieved by the English participants, with no impact on the results from literal translation from English to the other participants’ native language.

For example, 100% of English participants consider it a faux pas to confuse a customer with a waiter in a restaurant, compared to only 65% of Canadian participants. Or, while 100% of English participants consider it normal to give up a seat on a bus to an elderly person, 21% of Chinese participants consider it a faux pas.

In the results of the test of recognition of emotional facial expressions, the comparison between countries reveals that some emotions are not identified in a consensual way by all participants: while positive expressions, such as joy, are unambiguously interpreted across countries, the interpretation of negative emotions is much more variable. For example, fear is confused with surprise by the majority of Canadian and Brazilian participants, whereas English and Argentinean participants have almost no difficulty in differentiating between them.

This study shows that individual and cultural factors have a strong impact on measures of social cognition," says Maxime Bertoux. Beyond the effect of age, gender and education, there is an influence of local concepts, norms and habits on the categorization of emotions, the identification of intentions and the understanding of other people’s behavior . Thus, the use of tests designed by white, affluent American or English scientists would favor the performance of participants from the same country, culture, and social level.

Of course, this doesn’t mean that people in one country are better or worse than those in another," he says. Our study shows that a test created in a particular context favors people who are familiar with that context. For example, identifying a misstep requires detecting that an implicit social rule has been broken, and social rules vary from country to country.
These results therefore question the international applicability of a neuropsychological test designed and validated in a particular country for the assessment and diagnosis of cognitive disorders.


In future studies, the research team would like to enrich their data by including more participants and countries - especially from regions of the world not represented in this work, such as Africa and the Middle East - but also by exploring neurocognitive and cultural variations within large countries such as China or Canada. Neurosciences must interact more with social sciences in the knowledge and consideration of cultural diversities in order to build a more rigorous, relevant and inclusive neuropsychology, concludes Maxime Bertoux.

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