Building Neuropsychological Capacity in Rwanda: Methodological Reflections on the Adaptation of Cognitive Assessment Tools in a Nonexistent Practice Context

Over the past decades, clinical neuropsychology has expanded substantially worldwide, contributing to improved patient care and diagnostic accuracy. However, this development has progressed unevenly across regions. While advanced training programs, professional recognition, and standardized assessment tools are well established in North America, Europe, and Australia, neuropsychology remains emerging or largely nonexistent in many low- and middle-income countries. In these contexts, access to training, supervision, and culturally appropriate assessment tools remains limited. A central challenge concerns the widespread use of neuropsychological tests developed and normed in Western settings, which may not adequately account for differences in language, education, culture, and lived experience. When applied without appropriate adaptation, such tools risk misclassifying cognitive functioning and overestimating impairment. This methodological paper addresses these issues by presenting a framework for the selection, adaptation, and preliminary evaluation of neuropsychological measures in Rwanda, a country facing a growing need for cognitive assessment due to demographic aging and the high prevalence of neurological disorders, yet where neuropsychological tools are currently scarce. Drawing on cross-cultural neuropsychological principles and existing African initiatives, we developed a context-appropriate cognitive screening battery targeting core domains, including attention, executive functions, memory, and language. Task selection prioritized open-access measures, minimal logistical demands, and reduced cultural bias, while ensuring accessibility across diverse educational levels, socioeconomic backgrounds, and rural–urban contexts. Pilot data collected in Rwanda were used to assess the feasibility and relevance of the adapted battery. Most tasks elicited expected cognitive effects, supporting their suitability as screening tools. However, culturally unfamiliar stimuli in naming tasks highlighted the need for further adaptation. Overall, this work provides a practical, theory-driven approach to developing culturally fair neuropsychological assessments and offers a foundation for future norming efforts and similar initiatives in other settings.