Abstract
Objective: Cognitive assessment tools are important for understanding cognitive performance and identifying cognitive impairment. However, many commonly used cognitive assessment tools were developed and validated within Western cultural and linguistic contexts, which may limit their validity and cultural appropriateness for Indigenous populations. This review examines the existing literature on cognitive assessment tools used with Indigenous populations and evaluates the methodological quality of these studies and the cultural adaptations made to these tools. Method: A systematic search was conducted across six databases and was limited to studies examining cognitive performance in Indigenous populations. Citations were imported into Covidence, where titles and abstracts were screened for relevance. Data were extracted by two independent reviewers; study selection was documented using a PRISMA flow diagram. Studies were evaluated for risk of bias and methodological rigour using the NOS-xs, NOS, and CCAT critical appraisal tools. Results: Sixty studies were included, from North America (n=21), South America (n=10), and Oceania (n=29). Studies demonstrating greater methodological rigour frequently employed community-based participatory research (CBPR) approaches, involving community consultation to develop, adapt, and administer tests in culturally appropriate ways. Methodological rigour varied across studies, largely because of limited sample sizes in these populations. Conclusions: Establishing appropriate normative data can provide more valid reference points for interpreting cognitive performance in Indigenous populations. Cognitive assessments should be adapted to reflect cultural and linguistic differences, and further research on diverse Indigenous populations globally is needed. Risk of bias scores should be interpreted with caution, as existing critical appraisal approaches may not adequately capture culturally relevant methodological considerations. Future research should aim to develop more appropriate tools for critically appraising research involving Indigenous populations. This systematic review was registered in the OSF registry, with registration number 10.17605/OSF.IO/436Q8.