Culturally and linguistically diverse patients in an Italian memory clinic: lessons learned from the ImmiDem project

Background: Increasing migration and population ageing pose growing challenges for dementia diagnosis in culturally and linguistically diverse (CALD) populations. This study evaluated changes in diagnostic practices in an Italian Centre for Cognitive Disorders and Dementia following implementation of the ImmiDem project and culturally adapted cognitive tools. Methods: A retrospective observational study was conducted including all CALD patients assessed between 2016 and 2024. Collected data included demographic and linguistic characteristics, country of origin, type of cognitive assessment, and use of standard versus cross-cultural tools. Diagnostic practices were compared between T1 (2016–2020) and T2 (2021–2024), corresponding to ImmiDem implementation. Results: A total of 163 CALD patients (4.2% of referrals) were identified, with a marked increase in T2 (+ 180%). Mean age was 65.2 ± 13.8 years; 35.2% had low education. Patients originated from 46 countries and spoke 26 languages, with no significant demographic differences between T1 and T2. Cognitive screening was performed in 81.6% and extensive testing in 33.1%. Use of cultural mediators and cross-cultural tools rose significantly in T2. Importantly, diagnoses in T2 more frequently involved milder cognitive impairment, likely reflecting earlier referral and the increasing use of more sensitive cross-cultural cognitive assessment tools. The Rowland Universal Dementia Assessment Scale (RUDAS) showed weaker correlations with age and education than the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), with generally good concordance across tools. Conclusions: Referrals of CALD patients increased substantially, with earlier detection of cognitive impairment and wider use of culturally appropriate assessment. Persistent gaps in validated tools and cultural competence highlight the need for further multicentre prospective studies to support equitable diagnostic practices.