Bias in Neuropsychological Assessment Among Low-Education and Underserved Populations: Challenges, Adaptations, and Implications

Neuropsychological assessment is a central pillar in clinical decision-making, research, and public health policy. However, growing evidence indicates that standardized cognitive instruments are not universally valid across populations. Many were created and normed within Western, urban, and highly educated groups, which limits their suitability for individuals with low formal education, limited literacy, or sociocultural contexts that diverge from these normative samples. When applied in low-education or underserved populations, conventional neuropsychological tools may underestimate cognitive performance and increase false-positive diagnoses of impairment, leading to clinical misinterpretation, misguided rehabilitation planning, and restricted access to appropriate care. These challenges are particularly critical in the evaluation of dementia, mild cognitive impairment, acquired brain injury, neurodevelopmental disorders, and other neuropsychiatric conditions.Educational, linguistic, and sociocultural diversity fundamentally influence how individuals approach and respond to cognitive testing. When such variables are not considered in test design and interpretation, they introduce bias that undermines both diagnostic accuracy and the equity of healthcare services. Misclassification or overestimation of deficits can distort epidemiological data, hinder appropriate resource allocation, and deepen existing health disparities. Recent technological and methodological advances, including digital neuropsychological assessment and culturally adapted instruments, offer promising strategies to mitigate bias, improve accessibility, and enhance fairness in global cognitive evaluation.This Research Topic aims to advance the understanding of bias in neuropsychological assessment among populations with limited education or from underserved sociocultural contexts, and to promote the development of equitable, culturally sensitive, and contextually valid approaches to cognitive evaluation. It seeks to bring together interdisciplinary research exploring how education, literacy, language, socioeconomic background, and cultural factors shape cognitive test outcomes.Specifically, the Topic will encourage submissions that (1) identify mechanisms underlying disparities in neuropsychological assessment; (2) propose methodological or technological innovations to improve validity and fairness; and (3) examine the implications of unequal test validity for clinical practice, rehabilitation, public health, and policy development.This Research Topic will encompass a broad range of theoretical, methodological, and applied perspectives addressing how educational and sociocultural diversity influence neuropsychological test interpretation and cognitive assessment outcomes. While focused primarily on low-education or underserved populations, contributions offering scalable solutions and insights applicable across contexts are welcome. The collection encourages collaborations that bridge psychology, neuroscience, linguistics, education, and public health.To gather further insights into equitable and culturally adapted cognitive assessment, we welcome articles addressing, but not limited to, the following themes:• Educational and literacy influences on neuropsychological test performance and interpretation• Cross-cultural adaptation, validation, and norming of cognitive assessment tools• Linguistic, socioeconomic, and cultural determinants of diagnostic bias and misclassification• Development and validation of digital or AI-assisted assessment tools in diverse populations• Novel frameworks for equity-focused normative data• Community- and field-based neuropsychological evaluations in low-resource or rural settings• Ethical, clinical, and policy implications of bias in neuropsychological testing• Training initiatives for building culturally competent neuropsychological practice Topic editors: Herlinda Aguilar-Zavala, Silvia Solis-Ortiz Source: https://www.frontiersin.org/research-topics/81812/bias-in-neuropsychological-assessment-among-low-education-and-underserved-populations-challenges-adaptations-and-implications