Neuropsychological Considerations of the Cultural and Linguistic Challenges of Working with a Bilingual/Bicultural Patient with Multiple System Atrophy (MSA): A Case Report.

Objective This case highlights the importance of understanding bilingualism, English as a second language (ESL), immigration as an older adult, and acculturation, in light of neuropsychological test results of an individual with MSA. Case Description Mrs. X is a right-handed, 73-year-old, South African woman. Her first language is Afrikaans while her second language is English. She has a history of MSA (2015). She reported a significant decline in her previously mastered English fluency. Challenges with language (i.e. reading comprehension, conversation), focus, balance, and activities of daily living, bilateral arm jerks, and difficulties with ambulation, Pisa Syndrome (left), loss of appetite, incontinence, fluctuating temperature, depression, personality changes, and suspected auditory hallucinations were also expressed. Diagnostic Impressions and Outcomes The neurocognitive findings indicated global impairment. Aside from an average score in her reading recognition, and low-average in a test of mental flexibility, Mrs. X had impairment in attention, learning, immediate and delayed memory, executive functioning, receptive and expressive language, confrontation naming, and visuospatial abilities. Mrs. X's motoric difficulties and parkinsonism made it difficult for her to participate in testing comfortably. Language barriers were prominent: Mrs. X occasionally required English-Afrikaans translation and multiple repetitions of prompts. Summary and impressions of test results acknowledged the cultural and linguistic limitations of the evaluation. She was diagnosed with Major Neurocognitive Disorder secondary to MSA. Discussion In patients with diffuse impairment, it is essential to understand the role of dual language processes, ESL, and cultural limitations of assessments in order to accurately differentiate between neurodegenerative processes (i.e. Alzheimer's Disease vs. other disorders), as well as to determine the impact of MSA on the linguistic abilities of bilingual individuals. [ABSTRACT FROM AUTHOR]