Background: Dementia as a neurocognitive disorder is becoming increasingly common worldwide, and minority groups are more vulnerable than the general population. Many factors may contribute to their vulnerability such as misconceptions, language barriers, cultural factors, invalid assessment tools, lack of knowledge, or assigning spiritual beliefs to dementia symptoms. Therefore, this scoping literature review aimed to clarify how empirical studies reflect the meaning of dementia, language, and translation among minority ethnic groups. Summary: The PRISMA extension for the scoping review protocol was used. Thirty-eight studies published in English were reviewed and analysed. The findings revealed that lack of knowledge about dementia and attributing the disease to the normal ageing process were frequent among minority groups. Furthermore, their cultural-specific perspectives and worldviews of wellness and well-being can impact the way dementia is perceived, consequent help-seeking behaviours, or caregiving. Facilitating educational programs to enhance the knowledge and experiences of ethnic communities might be beneficial. Moreover, language is shown to be an important aspect in dementia assessment and participants’ educational level could significantly impact their functional capacity when responding to cognitive measures. Even though there are some useful screening tests, diagnosis barriers might be eased by assessment tool development, modifications, and accurate translations for ethnic communities. Key Messages: A promising pathway to support ethnically diverse communities regarding dementia can be raising awareness, providing ethnic-specific services, developing cultural-specific tools to assess dementia or any cognitive impairment by considering perceptions, language, and culture among ethnic groups. Cultural and spiritual considerations could also encourage engagement during assessment.

Dementia or neurocognitive disorder [1] is a common late-life neurodegenerative disorder characterized by cognitive and functional impairment [2]. This prevalent age-related chronic syndrome became a universal challenge for people and health systems. Globally, around 55 million people are suffering from dementia, with over 60% living in low- and middle-income countries [3]. A prevalence rate of 78 million is expected in 2030 and 139 million in 2050 [4]. There are about 7.7 million new cases of dementia every year [5]. In general, dementia primarily affects older people, with prevalence rates ranging between 5% and 7% among people over 60 increasing exponentially with age; around 20% of people over 85 suffer from dementia [5]. The prevalence of dementia has almost doubled every 20 years, reaching 65.7 million in 2030 and 115.4 million in 2050 [6]. Moreover, costly and challenging illnesses such as dementia require complex care and resources [7, 8]. For example, more than 11 million caregivers provided unpaid care and support for people living with Alzheimer’s disease (AD) and related dementias (15.3 billion hours) which was approximately $257 billion globally [9].

Dementia describes a range of cognitive dysfunction severe enough to hinder an individual’s ability to do everyday tasks [6]. Among the significant symptoms of dementia are cognitive impairments and difficulties with everyday activities [10‒12] that are affected by dementia, most often memory, but also language abilities, attention, orientation, judgment, and planning [13]. AD is one of the most common types of dementia with 75% of cases alone or in combination with other pathologies [5]. A person with dementia, their families, carers, and other people in their social networks may face many challenges such as pain experiences, driving challenges, caregivers’ mental health, or spousal caregiving [14‒17]. These challenges might be more difficult to handle for minority communities as they may have less access to information about dementia services [18], experiencing a lack of cultural sensitivity from health professionals and culturally appropriate care options to families with dementia [18, 19], as well as insufficient support for family caregivers [20]. Evidently, dementia patients and those with cognitive impairment with diverse racial backgrounds receive less specialized treatment [18, 21].

Even though dementia prevalence rates are clearly lower in developed countries [22], minority groups are more vulnerable to dementia than the general population [23‒26]. To give an example, research in New Zealand has indicated that Māori, Pasifika, and Asian communities (as diverse minority ethnic groups) are experiencing dementia at a higher rate than European New Zealanders [27]. Māori and Pacific patients were, respectively, 8.5 and 5.3 years younger than NZ European patients when they registered in a memory service in New Zealand, and Pacific patients had more advanced dementia than NZ European patients [28]. Compared to Europeans (36.1%), Māori (55.8%) and Pacific people (58.7%) are more likely to not receive official care [29]. Despite having more severe dementia and higher levels of comorbidity, Māori and Pacific adults with dementia were less likely to move into elderly residential care [29]. There may be factors that prevent minority groups’ help-seeking for dementia or receiving services such as a lack of linguistically competent services [18], the misconceptions regarding dementia symptoms and causes can contribute to families and individuals waiting until there was a clear problem before seeking treatment [18], and a shortage of valid culturally appropriate or translations of screening tests [30]. As reported, the areas of concern for healthcare professionals in the case of Pacific people in New Zealand were Pacific people’s access to services, getting a diagnosis, and communication and language [31]. Therefore, the overarching aim of this scoping review was to align studies’ findings on the meaning, language, and translation of diagnostic tools that may affect dementia among minority groups.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [32] was implemented to report this scoping review. Through a methodical approach, this extension offers a type of information synthesis that represents the body of knowledge already known about a subject and identifies essential ideas, theories, sources, and knowledge gaps [32]. We used a five-stage scoping review methodology [33] which involved developing research questions, identifying related studies, identifying relevant parts of the literature, charting the data, as well as gathering and summarizing results. The sections that follow provide information on these phases.

Creating Research Questions

The current scoping review aimed to give a thorough overview of studies on dementia in ethnically minority communities by examining the following research questions:

  • 1.

    How is dementia described, understood, and perceived among diverse ethnic groups?

  • 2.

    How does language affect dementia (diagnosis and assessment) in diverse linguistic and ethnic minority communities?

  • 3.

    What are the features of translated dementia assessment tools?

Identifying Related Studies

Two databases were chosen to discover the pertinent studies: Scopus and Web of Sciences. Due to time constraint and avoiding many duplicated documents, these databases were chosen as the most comprehensive core databases. The publication period did not include a time limit, and the target was detecting peer-reviewed English documents. The selected databases were searched till 27 July 2023. The terms used for database search included dementia, assess, measure, screen, rest, tool, meaning, translate, language, indigenous, minority, and marginalise in their title, abstract, and keywords. As an example of data extraction from the Web of Sciences database, this syntax was used: ((AB=(Dementia)) AND AB=(assess* OR measur* OR screen* OR test* OR tool)) AND AB=(meaning OR translat* OR language)) AND AB=(indigenous OR minority OR marginali*).

Identifying Relevant Parts of the Literature

Figure 1 illustrates that a total of 276 documents from the years 1990 to 2023 were identified and exported at the identification stage. These papers were extracted from the databases and exported as Excel files. The duplicate documents were then removed (n = 68) after they had initially been arranged in a single sheet. The relevant articles were next found by screening the titles and abstracts of the remaining documents; however, for some documents, particularly older documents, full-text screening was required at this point. Then, at this screening stage, which included 160 records, any irrelevant records were removed. Forty-eight eligible records were then taken into consideration for full-text evaluation. Some of these records were removed because they failed to address the topic or violated the eligibility requirements (n = 11). In the reference list of the papers under evaluation, one additional document pertinent to the subject of this study was discovered. Thirty-eight papers in all were included in the analysis.

Fig. 1.

PRISMA-ScR flowchart for the scoping review process. PRISMA-ScR, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Fig. 1.

PRISMA-ScR flowchart for the scoping review process. PRISMA-ScR, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Close modal

Charting the Data

The included records in a single Excel sheet were organized by headings of authors, title, abstract, year published, aim/objective, methodology/method, participants/sample size, location, and outcomes (see online supplementary material; for all online suppl. material, see https://doi.org/10.1159/000539446). The findings are reported in the section that follows.

The results of collected and eligible studies are summarized in this section. Of all 38 included studies, 19 (50%) employed quantitative approach, 13 (34.2%) used qualitative approach, and 6 (15.8%) conducted their research by mixed-method approach. Of the studies that were included, 15 (39.5%) were utilized to achieve objective 1, 14 (36.8%) were included in objective 2, and 7 (18.4%) were part of objective 3. However, one study (2.6%) was shared between objectives 1 and 2. Another study (2.6%) was shared between objectives 2 and 3. Moreover, studies included in objective 1 were mostly carried out by quantitative approach (n = 12, 75%), followed by qualitative (n = 2, 12.5%) and mixed-method (n = 2, 12.5%) approaches. Similarly, quantitative studies accounted for the majority of research employed in objective 2 (n = 15, 88.2%), with qualitative (n = 1, 5.9%) and mixed-method (n = 1, 5.9%) techniques coming in second and third, respectively. Likewise, most of the researches listed in objective 3 were carried out using quantitative methods (n = 4, 50%), followed by mixed-method designs (n = 3, 37.5%) and qualitative methods (n = 1, 12.5%). The synthesis process of reviewed empirical studies shaped three domains (related to our objectives) that included the meaning and perceptions of dementia, the role of language in dementia diagnosis and assessment, as well as translation of cognitive tests for minority groups.

Objective 1: The Meaning and Perceptions of Dementia

According to studies, ethnic groups can have diverse interpretations of what dementia is and how it is perceived. In terms of the terminology of dementia, many studies explored whether any native word or phrase defines the disease in different cultures and the findings established such differentiation in labelling dementia [34‒36]. For example, African American, Latino, and Chinese caregivers reported words such as old timer’s disease, el loco (craziness), and hu tu (becoming forgetful in old age) [35] and older Samoan adults in USA used the phrase Lemautonu (uncertainty about anything) to describe dementia in their own language [36]. The importance of using a native term to define dementia disease has been shown by a recent study in New Zealand where the researchers found a preference for using a Māori (an ethnic group in New Zealand) phrase to explain dementia that reflects behavioural changes like forgetfulness and absentmindedness since the words “dementia” and “Alzheimer’s” were confusing for the participants. Therefore, the term mate wareware (becoming forgetful and unwell) was found to accurately capture the holistic meaning of dementia for Māori people [34].

Furthermore, some researchers also explored minority groups’ perceptions of dementia among older people (with or without dementia or cognitive impairment) and/or their families [34, 36‒38] as well as other key informants such as caregivers or community workers [35, 39‒42] and healthcare providers [6, 43‒45]. For instance, studies conducted among demented or non-demented elderlies and/or their families as well as caregivers of people with dementia revealed a frequent lack of knowledge about dementia (e.g., early stages of the disease, behavioural and psychological symptoms of dementia, needs for medical care, etc.) and attributing the disease to the normal ageing process [6, 35, 36, 38, 44]. However, culture plays a key role in the ways ethnic groups perceive and experience memory loss problems such as cultural taboos against discussing illness or difficulties [43]. In this regard, one study found that African American caregivers deliberated racism and its unfavourable effects on delaying the use of medical services, while Chinese caregivers mentioned how stigma tied to mental illness in their communities, and Latino respondents brought up the cultural commitment of family caregiving [35]. Due to such ethnic differences in understanding and perceiving dementia, the pattern of caregiving can also be diverse [39, 41, 42]. In this context, the perspectives and experiences of community workers about the factors affecting and patterns of dementia care in linguistically and culturally diverse families among four Australian-based ethnic communities (Arabic, Chinese, Italian, and Spanish) revealed that caring for a family member with dementia is culturally normal for these ethnic groups, especially by women in the family, and caregiving in the family protects them from being judged by the community [39]. The pattern of caregiving within these ethnic groups was mostly known as children or spouses as main carers and family sharing care [39]. In dealing with challenges, caregivers in minority groups also rely on social support, religion, and adaptive coping strategies [41, 42].

Nonetheless, not all families and caregivers can overcome the challenges and many factors can impact their perceptions regarding help-seeking and support. Barriers to help-seeking can have roots at different levels from the individual (e.g., lack of knowledge about memory loss) and societal (e.g., perceptions of stigma regarding mental illness) to the healthcare system (e.g., unawareness regarding the availability of health services) [44]. Studies have found that family and caregivers’ dissatisfaction with healthcare systems resulted from feelings of discrimination [40, 43], language barriers [6, 36, 40, 43, 44], lack of sensitivity such as feeling of being ignored or poor consultation services [6, 35, 40, 43, 44], deficiency of culturally appropriate help [44], and unfamiliarity with the Western healthcare system [36]. Delayed help-seeking from families or caregivers could be embedded in health professionals’ limited expertise, inadequate information and usage of suitable diagnostic tools, and difficult assessment circumstances (e.g., cognitive test administration with individuals in unknown situations and difficulties with interpretation that may impact their performance) [6].

Although cultural, individual, societal, and health systems may impact racially different communities’ perceptions about dementia-related disease, intervention-based educational programmes were found promising in promoting their attitudes. For example, researchers attempted to increase access to services by Asian and Pacific caregivers of patients with memory illness residing in the USA [46]. These researchers first assessed the participants’ perceptions towards dementia and then provided culturally appropriate educational materials (videos, brochures, or discussions) based on the information collected from the literature, related agencies, and people from the target ethnic communities. The findings showed the effectiveness of the program by raising awareness regarding the definition of dementia diseases, symptoms (e.g., memory loss in dementia is not a part of ageing), medical service providers, and community services [46]. Likewise, another study [47] evaluated the effectiveness of a culturally appropriate dementia education program and its effects in a sample of ethnically diverse people and the results revealed that participants’ general knowledge, particularly regarding the early signs and attributions of memory impairments to the ageing process, had significantly improved. Participants of another study requested instructional materials in their original language and were culturally appropriate due to language barriers and low knowledge of health topics [36]. Indeed, lack of communication and language barriers can significantly impact people with dementia, their relatives, and their relationships with healthcare providers. In the next section, this point is elaborated more.

Objective 2: The Role of Language in Dementia Diagnosis and Assessment

Many researchers examined how language is used in evaluation processes and interactions between patients with memory loss, their families, or caregivers when they are receiving residential care. This field of research has mainly been carried out among linguistically diverse communities by comparing assessment tools to determine the most valid and reliable test for an ethnic group to prepare a translated version [48], evaluating the effectiveness and diagnosis strength of cognitive tests among non-demented people [49, 50], or estimating the prevalence of cognitive impairments in linguistic diverse communities [51, 52]. For instance, in an Australian-based study, researchers have found that all four commonly used cognitive tests (such as Cogstate, PEBL Corsi Block-tapping Task, Rowland Universal Dementia Assessment Scale [RUDAS], and Story Memory Recall Test) showed acceptable reliabilities among aboriginal people [48]. However, many participants reported difficulties with the language of the tests (which was English) that could impact their understanding of the questions and cause confusion regarding some words that did not exist in their own language [48]. Other studies also reported better performance in cognitive tests among English-speaker participants than their counterparts for whom English was not their primary language [49, 50] and higher prevalence of cognitive impairment among respondents from non-English-speaking backgrounds [51].

Research conducted among people with dementia shows the importance of language in patients’ lives, especially those in residential care homes. In this context, one Australian research carried out a comparative study between eighty-two people with dementia in mainstream care facilities and ethno-specific care facilities (patients with Greek or Italian backgrounds) [53]. Ethno-specific care provides services based on the care receivers’ ethnicity, language, culture, and religion. The findings revealed more than half (63%) reported failing in their English language skills since the beginning of dementia. The preference for speaking other languages than English was considerably higher in ethno-specific facilities than in mainstream facilities, and staff in the ethno-specific facilities reported higher rates of speaking Greek or Italian than mainstream facilities. Moreover, patients in ethno-specific facilities significantly communicated more, especially in their native language and with others (co-residents and their visitors, and staff) compared with their counterparts in the mainstream service providers. Additionally, patients in mainstream facilities were found to use more antipsychotic medications [53]. Speaking English as a secondary language among demented patients can cause higher agitation and neuropsychiatric symptoms (e.g., delusions, hallucinations, etc.) for residents in care homes that can be caused by the unmet cultural needs of ethnically diverse patients [54]. Getting care in unfamiliar environments, such as institutional settings, might make dementia patients feel excluded and raise conflicts between staff and relatives, given the transition from a collective/communal home setting to a clinical environment which may cause distress, communication difficulties, language barriers, and a shortage of consistency in care (such as a lack of long-standing relationships with trusted medical personnel) [45].

Language barriers also can impact early and more accurate diagnoses among non-English speakers from ethnically different groups. In this sense, researchers compared the accuracy of physicians and the Mini-Cog assessment tool in the diagnosis of dementia or mild cognitive impairment among 371 elderlies from diverse ethnicities (e.g., Asian-American, African American, and Hispanic) and the results showed that except for severe dementia, the Mini-Cog test accurately detected 97% of demented cases, although physicians identified 58% of them. Indeed, physicians’ ability to make the right identification was significantly impacted by the participants’ non-English-speaking status [55]. However, according to previous studies, the educational level of non-English speakers may contribute to predicting and timely diagnosis of dementia as well as being accurately assessed by Westernized assessment tools in ethnically diverse groups [48, 52, 55]. The potential impact of education in dementia and related research areas is evaluated in the next section.

Along with the role that language plays in the diagnosis, evaluation, and caregiving of dementia, people’s educational backgrounds can also have an impact on these processes [56, 57]. Studies in this regard appeared decades ago, wherein the researchers found the level of education as a significant factor in evaluating cognitive impairment among lingually diverse racial groups [58‒60]. More recently, some researchers used the visual association test (VAT) which evaluates memory performance (especially to distinguish AD from other types of dementia) through black-and-white drawings and a modified visual association test (mVAT) that characterized the same drawings but in coloured pictures to assess the psychometric properties of the VAT among non-Western, low-educated memory clinic population in a case-control experiment in the Netherlands [61]. These researchers compared two groups of non-Western immigrants that included seventy-three outpatients of memory clinics and fourteen healthy Turkish elderlies over 50 years old (as the control group). The findings showed that both versions (VAT and mVAT) were valid and reliable tools but slightly correlated with education. When the participants were classified into two groups of lower educated (lower than primary school) and higher educated (primary school and higher), mVAT was found to be positively correlated with low education meaning that higher education improves performance in this modified version which could be linked to the fact that black-and-white line drawings demand a certain level of education and training [61].

However, choosing a more accurate and appropriate evaluation tool may help the assessment procedure among patients with dementia from minority groups regardless of their educational level. In this context, one study compared Turkish and German people’s performance on MMSE and the RUDAS in patients with AD by considering their demographic characteristics (e.g., education and bilingualism) [62]. The participants were 50 years and older (n = 66) with diagnosed AD from diverse backgrounds including native-born Turkish patients (n = 24), native-born Germans (n = 20) without immigration background, and Turkish immigrant patients (n = 21). The result revealed that the groups’ mean RUDAS total scores were comparable (even with and without adjusting for educational level). However, the mean score of MMSE was considerably higher in German patients compared to Turkish native-born and Turkish immigrants who performed similarly on MMSE. Interestingly, after adjusting for years of education, differences in MMSE performance between the groups were no longer significant. Moreover, among the Turkish sample, bilingualism was significantly correlated with a better performance on the total MMSE score [62]. Likewise, in a study conducted among non-demented Turkish elderlies (n = 76 aged 50 or more) in Denmark, although both tests were translated into participants’ native language, the findings showed years of education can impact participants’ MMSE scores in comparison with the RUDAS scores [63]. Therefore, there may be some benefits or drawbacks to translating existing cognitive tests for use with minority groups. Selecting a reliable and valid tool can impact the performance and evaluation of cognitive impairment. For such reason, many researchers in the field made efforts to develop ethnic-specific assessment tools or to translate the most practical existing neuropsychological tests for a minority group. This point will be further elaborated in the next section.

Objective 3: Translation of Cognitive Tests for Minority Groups

Researchers have investigated the availability and use of culturally validated assessment tools and translated resources (e.g., brochures containing information about dementia and medication) in memory assessment services [64] and how translated versions of a test are culturally appropriate to be used in a minority group [65]. Undeniably translated materials and tools could help accurate assessment as was reported by a group of researchers in the Netherlands [66]. In detail, they assessed the reliability of the Dementia Knowledge Scale (DKS) among family caregivers with immigrant backgrounds from Turkey (n = 117) or Morocco (n = 110) in which DKS was translated for the Turkish sample, and Moroccan respondents answered the Dutch version. The findings revealed that both versions had different internal consistencies and rates of successfully answering the items. In part, the Turkish version’s Cronbach’s alpha (0.69) was higher and more satisfactory than the Dutch version’s (0.59). Both versions, though, could perform better if items were dropped. The researchers emphasized the value of adopting assessment tools that are cross-culturally relevant for the target population and trustworthy for immigrant groups [66]. Similarly, in another comparative study, the researchers found that although English-speaking respondents completed the English version of the Dementia Rating Scale-Second edition (ST-DRS-2) and the Spanish-speaking participants (who were originally from 15 countries) filled out the translated version, except for one subscale, the English-speaking group considerably outperformed their Spanish-speaking counterparts on the DRS-2 total and subscale scores [57]. The researchers highlighted that the Memory subscale revealed a substantial distinction between English- and Spanish-speaking groups which includes items of naming politicians. Therefore, the researchers suggested considering the factor of acculturation since many ethnic or immigrant groups might not be involved in the host politics or have difficulties recalling culture-specific names [57]. Likewise, one research compared the scores of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Neuropsychology Battery among a sample of demented and non-demented Japanese Americans (n = 768) [67]. Although they could distinguish non-demented individuals from those with dementia through the tests, they also highlighted the significance of language and culture in translating assessment tools. They indicated that components of the word list tasks may not be equally familiar to speakers of English and Japanese [67].

A study of developing a culturally and linguistically appropriate cognitive test for indigenous people [68] appeared in this scoping review as well. In this regard, for older Indigenous Australians living in remote and rural areas, the Kimberley Indigenous Cognitive Assessment(KICA) testing as a culturally relevant testing tool was developed and translated it into the language of the target population. The cognitive assessment subdivision of the test (KICACog) proved to be useful in identifying people with dementia and cognitive impairment. The unique feature of this tool was evaluating language and memory abilities in the incorporation of real-world objects and images which made memory and language assessments easier for the participants [68]. In a further study, the researchers modified the KICA-Cog for aboriginal indigenous people living in urban areas of Australia (n = 235, mean age = 65.8) and named the teat as mKICA [69]. When comparing the respondents’ scores on the mKICA, MMSE, and RUDAS tests, all of the tests were discovered to be clinically appropriate instruments for evaluating cognitive status. Although all tests were provided in English, the researchers recommended employing mKICA as a good substitute for the MMSE for dementia screening, especially where literacy, language proficiency, or cultural factors make the MMSE not applicable [69]. Recently, some researchers adapted KICA to develop the Canadian Indigenous Cognitive Assessment (CICA) for indigenous older Anishinaabe adults in Canada [70]. Each KICA question was examined for cultural appropriateness, language and translation, and cultural safety. Every area must be modified to reflect cultural values, language specificity, tone, and a culturally acceptable approach. Most modifications were necessary for the domains of orientation, verbal understanding and fluency, praxis, and naming. The face validity of the first pilot led to additional revisions, and the second pilot confirmed that all changes had been appropriately implemented [70].

Overall, studies highlighted how ethnically diverse communities use native phrases to define dementia and memory loss and how differently people perceive this disease. Based on the many reviewed studies, people from minority communities may have a lack of knowledge regarding memory loss and relate it to normal ageing. Indeed, cultural-specific perspective may impact the ways dementia is perceived (e.g., cultural taboos and stigma associated with mental illness, or a threat to community well-being) and consequent help-seeking behaviours (e.g., delayed help-seeking because of feeling discrimination; language barriers; poor health systems and healthcare providers’ characteristics) or caregiving (e.g., cultural norms of family caregiving, using strategies to deal with the challenges, unawareness/unfamiliarity about the availability of health services). However, providing educational programmes to promote ethnic communities’ knowledge and experiences could be promising. Furthermore, among ethnically varied communities, language is found as a substantial factor in dementia assessment as well as providing care and support for both patients and their families. Although some validated tests might be useful, being evaluated and speaking in a secondary language can impact early and accurate diagnosis besides providing services. Since the educational level of non-English speakers’ dementia influences diagnosis and assessment, tool modifications and more importantly accurate translation may help the assessment process. However, respondents’ cultural backgrounds can affect how well they do on assessment instruments; therefore, it may be preferable to construct/develop a test that takes the native language and culture of the ethnic population into account.

Based on the findings of this study, scholars are recommended to develop cultural-specific tools to assess dementia or any cognitive impairment by considering their perceptions, language, and culture among ethnic groups. This may help other researchers adopt and validate the test for another ethnic community in a similar culture, language, or context. Future studies are also encouraged to concentrate on efficient approaches to decrease language barriers and communication difficulties among healthcare professionals, patients with memory loss, and their families/caregivers. This might be accomplished by looking into how interpreters or community projects affect minimizing language barriers. Additionally, researchers are recommended to employ mixed-methods approaches since qualitative studies provide a deep understanding of the ethnic groups’ culture and needs, whereas quantitative approaches help implement the collected information to construct assessment tools [71].

To our knowledge, this is the first scoping review with an emphasis on how ethnic groups perceive dementia and the role of language and translation when dealing with dementia. The main limitation of conducting this review was separating some of the selected studies into one of the themes of perception, language, and translation. To elaborate, some studies examined all these factors in their studies. These studies needed to be organized into a theme that seemed to cover it effectively. Therefore, readers or the authors of selected studies may have a different attitude from our synthesis approach. This point might be perceived as a bias in reporting the results. Furthermore, we sought out a comprehensive analysis of all previous research which led to the use of diverse groups in this study (e.g., individuals with dementia and non-demented people). However, each population (e.g., patients, non-demented elderly, caregivers, or healthcare professionals) can demonstrate different perspectives and needs. To elaborate, while assessing a test necessitates a sample of individuals with cognitive impairment or dementia, broader topics can include minority group or community perception on dementia. For example, in our study, the primary concern of non-demented elderly people may have been understanding about dementia, but knowledge and perception of dementia could have an impact on caregivers’ patterns of providing care. To put it simply, various groups may have different concerns, which might result in different outcomes. Future reviews may focus separately on the populations of each minority group (e.g., patients, memory clinic population, older people without dementia, caregivers, or medical professionals). Additionally, numerous ethnic groupings continue to receive little research, which is another cause for concern. Although we expected more studies including minority groups from various nations, this field of study is extremely small. Scholars are encouraged to investigate and assess subjects associated with dementia and cognitive impairment in underrepresented populations. Ultimately, the researchers of this study searched two databases, and future studies may consider examining more databases.

We appreciate the time and work invested by each reviewer.

The study was approved by the Auckland Health Research Ethics Committee (number AH26011).

The authors have no conflicts of interest to declare.

This work was supported by the funding from the Health Research Council, Auckland, New Zealand.

A.K. conceived the scoping review and drafted the full manuscript. A.K. and M.T.L. contributed to screening records. M.T.L. carried out the initial review. F.F. and S.W. profoundly reviewed the manuscript and approved final submission.

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