Interpreter Communication Quality in Cognitive Assessments for Dementia
Authors: Bianca Brijnath, Simona Markusevska, Joanne Enticott, Parneet Sethi, Andrew S. Gilbert, Erika Gonzalez, Jim Hlavac, Lee-Fay Low, Dina LoGiudice, Robyn Woodward-Kron, Josefine Antoniades, Xiaoping Lin, Kerry Hwang, Jennifer White, Marina Cavuoto
Journal: JAMA Network Open (2025)

Importance With increasing dementia prevalence due to population aging, interpreters are needed to facilitate timely dementia diagnosis by supporting the complex verbal and nonverbal interplay between clinicians and patients during cognitive assessments. However, to our knowledge, no randomized clinical trials have previously evaluated interventions to improve interpreter communication during cognitive assessments for dementia. Objective To assess whether online training codesigned by interpreters, clinicians, and multilingual family carers improves the quality of interpreter communication during cognitive assessments for dementia. Design, Setting, and Participants The Improving Interpreting for Dementia Assessments (MINDSET) study was a single-blind, parallel-group randomized clinical trial including certified interpreters and certified provisional interpreters of Arabic, Cantonese, Greek, Italian, Mandarin, or Vietnamese with at least 6 months’ experience. The trial was community based and conducted online across Australia between June 26, 2022, and April 2, 2023, with follow-up at 3 and 6 months after baseline. Intervention Participants were randomized 1:1 to receive interpreter training during the study or, if assigned to the waiting list control, after their 6-month assessment. Main Outcomes and Measures The primary outcome was change in the quality of interpreted communication, as measured by a weighted score comprising 5 domains: (1) knowledge of dementia, (2) cross-cultural communication, (3) briefings and debriefings, (4) interpreting skills for cognitive assessments, and (5) ethical principles relevant during a cognitive assessment. Mixed-effects generalized linear regression was conducted with random effects accounting for repeated measures from participating interpreters. Secondary analyses were conducted for differences in individual interpreting domains. A secondary per-protocol analysis included only participants who completed at least 70% of the training in the intervention group. Results At baseline, there were 126 participants (106 [84.1%] women); mean (SD) age was 44.13 (12.71) years, mean years of interpreting experience was 8.57 (8.48) years, and 106 of 120 (88.3%) lived in an urban area. A total of 22 (17.5%) were Arabic interpreters; 14 (11.1%), Cantonese; 6 (4.8%), Greek; 14 (11.1%), Italian; 64 (50.8%), Mandarin; and 6 (4.8%), Vietnamese. The primary outcome of communication quality in the main analysis did not significantly improve in the intervention group compared with controls (mean score difference, 2.10; 95% CI, −0.43 to 4.62; P = .10). Per-protocol findings showed a significant intervention effect (mean score difference, 2.73; 95% CI, 0.14-5.31; P = .04), suggesting that the MINDSET-trained interpreters benefited in the primary outcome when they completed at least 70% of the training. Of the 5 domains, a significant intervention effect was shown in only domain 1 (knowledge of dementia) in the main analysis (mean score difference, 1.15; 95% CI, 0.54-1.77; P &amp;amp;lt; .001) and per-protocol analysis (1.03; 95% CI, 0.27-1.79; P = .008) at 3 months. Conclusions and Relevance In this randomized clinical trial, results of the primary, intention-to-treat analysis showed that interpreters’ overall interpreting communication quality did not improve in the intervention group compared with controls, but in the secondary, per-protocol analysis, it was improved when at least 70% of the training was completed. These findings suggest that an online training intervention can improve interpreters’ communication quality during cognitive assessments for dementia if at least 70% of training is completed. Trial Registration ANZCTR Identifier: ACTRN12621001281886