University of Plymouth PEARL https://pearl.plymouth.ac.uk 04 University of Plymouth Research Theses 01 Research Theses Main Collection 2018 ASSESSING COGNITIVE FUNCTIONS IN ARABIC AND ENGLISH SPEAKING POPULATIONS Almubark, Bazah http://hdl.handle.net/10026.1/11119 University of Plymouth All content in PEARL is protected by copyright law. Author manuscripts are made available in accordance with publisher policies. Please cite only the published version using the details provided on the item record or document. In the absence of an open licence (e.g. Creative Commons), permissions for further reuse of content should be sought from the publisher or author. This copy of the thesis has been supplied on condition that anyone who consults it is understood to recognise that its copyright rests with its author and that no quotation from the thesis and no information derived from it may be published without the author's prior consent. 1 ASSESSING COGNITIVE FUNCTIONS IN ARABIC AND ENGLISH SPEAKING POPULATIONS by BAZAH MAJED ALMUBARK A thesis submitted to Plymouth University in partial fulfilment of the degree of DOCTOR OF PHILOSOPHY School of Psychology Faculty of Health and Human Sciences March 2018 2 Acknowledgment I would like to express my deepest appreciation and sincere gratitude to my director of studies Dr. Caroline Floccia, who supported me throughout my PhD study. She continually provided me with supervision and help required for my PhD study and related researches. I am extremely lucky to have her as my director of studies and mentor. Without her guidance and persistent help this thesis would not have been possible. I would also like to thank Dr. Allegra Cattani for her valuable advice and help through my PhD study together with Prof. Tim Hollins for his help with the second study. A thank you to Dr. Ahmed Megreya who helped with the stimuli used in the third study. In addition, a thank you to the participants who took part in all my PhD researches. Finally, a special thank you to my mother and the love of my life 'Sultanah Al Saud' without her blessings and support I would not have achieved what I achieved today. Besides, a special thank you to my father 'Majed Almubark' who recently passed away. I wish he was still with me and celebrate the completion my PhD study. I love you dad and God bless your soul. I dedicate all the efforts and thoughts in this thesis to my beloved parents. 3 Author’s declaration At no time during the registration for the degree of Doctor of Philosophy has the author been registered for any other University award without prior agreement of the Graduate Sub-Committee. Work submitted for this research degree at the Plymouth University has not formed part of any other degree either at Plymouth University or at another establishment. All the studies carried out in this thesis were conducted by myself, including literature review, developing tools, selecting of stimuli, designing of experiments, data collection, analysis, and discussion of results. Publications: Almubark, B., Cattani, A., Floccia, C., (submitted). Translation, cultural adaptation and validation of the Cognistat for its use in Arabic-speaking population with acquired brain injury. Almubark, B., Cattani, A., Perfict, T., Floccia, C., (submitted). Development and validation of the Plymouth Saudi Memory Test (PSMT) for Arabic-speaking population with acquired brain injury. Presentation and conference attended: Almubark, B., Floccia, C., Cattani A., & Slade A. (2015). Assessment of cognitive function in Arabic speaking population. Poster presented at the 8th Saudi Student Conference, London, UK, February. 4 Almubark, B., Floccia, C., Cattani A., & Slade A. (2015). Assessment of cognitive function in Arabic speaking population. Poster presented at the Research in Rehabilitation Winter Meeting, Manchester, UK, February. Almubark, B., Floccia, C., Cattani A., & Slade A. (2015). Assessment of cognitive function in Arabic speaking population with stroke: A pilot study. Poster presented at the 24th European Stroke Conference, Vienna, Austria, May. Almubark, B., Floccia, C., Cattani A., & Slade A. (2015). Assessment of cognitive function in Arabic speaking population. Poster presented at the 9th World Congress of the International Society of Physical and Rehabilitation Medicine, Berlin, Germany, June. Almubark, B., Cattani A., & Floccia C. (2017). Translation, cultural adaptation and validation of the Cognistat for its use with Arabic speaking population with Acquired Brain Injury. Official launching of the Arabic Cognistat at the Arab health exhibition and congress, Dubia, UAE, January. Almubark, B., Cattani A., Hollins T., & Floccia C. (2017). Development and validation of the Long Term Memory Test (LTMT) for the Arabic speaking population with acquired brain injury. Poster presented at the 14th Congress of the European Forum for Research in Rehabilitation, Glasgow, UK, May. Almubark, B., Cattani A., & Floccia C. (2017). Translation, cultural adaptation and validation of the Cognistat for its use with Arabic speaking population with Acquired Brain Injury. Poster presented at the 14th Congress of the European Forum for Research in Rehabilitation, Glasgow, UK, May. 5 Word count of main body of thesis: 41 779 Signed…………………………………… Date……………………………………… 6 Bazah Majed Almubark Assessing cognitive functions in Arabic and English speaking populations Abstract The aims of this thesis are to assess cognitive functions in adult Arabic populations for clinical purposes, and to examine resulting cultural differences between Arabic and English speaking populations. In the first study, we translated, culturally adapted and validated an existing cognitive screening tool (Cognistat) for its use with Arabic adults with Acquired Brain Injury (ABI), and we examined the differences in cognitive performance between Arabic and English individuals. A total of 107 healthy Arabic speaking adults and 62 ABI patients (30 stroke and 32 traumatic brain injury; TBI) between 18-60 years were involved in the study. The results indicated that the translated/adapted tool is valid and reliable for its use with Arabic individuals with ABI. Cultural differences between Arabic and English individuals were found in orientation to time, memory, language (repetition and naming), construction, calculation and reasoning (similarities and judgment). In the second study we developed and validated a memory test – the Plymouth Saudi Memory Test (PSMT) – that assesses a wide range of memory domains in Arabic adults with ABI; cultural variations in memory functioning between both Arabic and English individuals were also investigated. A total of 80 healthy Arabic speaking adults and 61 ABI patients (30 stroke and 31 TBI) between 18-60 years were tested. The results demonstrated that the PSMT is a valid and reliable test for detecting memory deficits among Arabic adults with ABI, and the comparison between the 7 Arabic and English individuals revealed variations in working memory, semantic memory, and prospective memory. As a follow-up of cultural differences uncovered in the first two studies, the third and final study investigated the effect of length of stay in the UK on unfamiliar faces recognition, as well as cultural differences in unfamiliar faces recognition between Arabic and British individuals. A face recognition task that involved both Arabic and English faces was designed, and 35 participants (19 Arabs and 16 English) between 18-49 were tested. Typically, Westerners show an external feature advantage when processing unfamiliar faces, while participants from Arabic countries show a greater reliance on internal features. Results showed that the expected internal feature advantage in Arabic participants is more likely to be found for those Arabic immigrants who spend more time back in their home country, suggesting that visual processing biases can be modified with exposure in adulthood. Altogether, these results provide the clinical and research community with new tools to evaluate cognitive skills in Arabic-speaking adults, and add to the body of evidence that some of these skills can be shaped by cultural experience. The findings of the cultural differences further our understanding of the potential variations in cognitive functions among people from different cultural backgrounds. 8 List of Contents Acknowledgment .................................................................................................................................. 3 Author’s declaration ............................................................................................................................. 4 Abstract .................................................................................................................................................. 7 General introduction........................................................................................................................... 17 Chapter 1: Translation, cultural adaptation and validation of the Cognistat ................. 20 Introduction .......................................................................................................................................... 20 Literature review ................................................................................................................................. 22 Cultural differences in perception and cognition ....................................................................... 22 Attention ......................................................................................................................................