Drawing on her own experience learning English as an adult, 91ÑÇÉ« Professor Josée Rivest is helping expand access to equitable cognitive assessment for francophone Canadians.
Growing up in a small rural town in Quebec, Rivest was surrounded by French. Her parents were unilingual francophones and while she learned some English in school, she was far from fluent.
When she moved to Toronto to pursue graduate studies at 91ÑÇÉ«, Rivest immersed herself in English while working in a research lab and taking language classes. Although she eventually became bilingual, she remembers the challenges of studying and writing in a second language, an experience that now shapes her work as a neuropsychologist.
Those experiences now inform Rivest's efforts to ensure French-speaking Canadians have access to cognitive evaluations designed and validated for their language and cultural context.
One focus of that work is the Toronto Cognitive Assessment (TorCA), a tool used in specialized clinics across the Greater Toronto Area and elsewhere in English-speaking Canada to assess memory, language, attention and other cognitive functions.
Designed to bridge the gap between quick screening tests and lengthy neuropsychological evaluations, it can provide a detailed cognitive profile in less than an hour. The assessment also offers a more accessible alternative to comprehensive neuropsychological evaluations, which can take several hours, cost thousands of dollars and are often not covered by provincial health insurance plans.
Originally developed in English, the TorCA reflects a broader reality in cognitive assessment. Many widely used tools were created and standardized for predominantly English-language populations, leaving comparatively fewer options tailored to people whose first language is not English, including French-speaking Canadians.
For Rivest, who teaches at Glendon College, the issue goes beyond convenience. Many cognitive testing tools rely on verbal tasks, such as asking participants to name as many animals as possible or come up with words beginning with a particular letter within a limited period of time.
Even among people who speak English well, performance can differ depending on whether they are being assessed in their first or second language.
"I consider myself bilingual now," says Rivest. "But I'm definitely much better in French than in English to come up with words."
Determined to help address that imbalance, Rivest is leading an effort to adapt and validate a French Canadian version of the TorCA.
"It became obvious to me that, for fairness, francophone Canadians who have concerns about their cognitive state deserve to be measured with culturally and linguistically appropriate tools that are easily accessible," says Rivest.
Working with collaborators including former Glendon student Sara Raquel Ribeiro Manique and neuropsychologist Mélanie Cohn, Rivest's team aims not simply to translate the testing tool, but to ensure it can be used reliably with francophone populations while maintaining the scientific rigour of the original English version.
Cognitive assessments must be carefully standardized to ensure they measure the same abilities regardless of who administers them. In many cases, a direct translation can inadvertently change the complexity of a task or introduce bias into the results.
One example involved a reading task that asks participants to pronounce words that are spelled differently than they sound aloud, such as colonel in English. Rather than translating the words directly, Rivest and her collaborators had to identify French equivalents with comparable familiarity, frequency of use and level of challenge.
Another challenge emerged in a picture-naming task. A melon in the English version could not simply be translated because French speakers are more likely to name specific types of melons rather than using the broader term. Researchers ultimately replaced the item with a different fruit that better preserved the intent of the evaluation.
After completing the French Canadian version, the team sought feedback from francophone neuropsychologists and made a series of refinements. While minor adjustments continue, Rivest says the assessment is now largely complete.
The project has now entered its next phase: collecting norms for the French Canadian version.
Rivest is recruiting French-speaking adults across Canada to build the reference dataset needed for future clinical use. To help ensure the sample reflects the diversity of Canada's francophone population, she has trained research assistants from Northern Ontario, Algeria and the Democratic Republic of the Congo to reach different communities across the country. The goal is to recruit approximately 300 participants.
Although the project has not yet reached the validation stage, Rivest says the early feedback has reinforced the need for language-appropriate assessment tools.
After testing about 30 Franco-Ontarians, she has heard a recurring observation from participants who had previously completed cognitive tests in English.
"Many of them have said, 'My family doctor gave me a similar test, but it was in English. I thought I had trouble, but now I see I'm fine,'" says Rivest. "It's very encouraging."
Rivest believes part of that response may be tied to familiarity and comfort.
"As people age and they have Alzheimer’s disease, everything from their earlier past becomes more comforting. They remember it better," says Rivest.
For many francophones, she explains, that means returning to the language they learned and used throughout childhood.
While researchers and clinicians, including collaborators at McGill University, are already expressing interest in the French Canadian version of the TorCA, Rivest hopes its impact will extend beyond major urban centres.
She thinks often of the small rural communities she grew up in, where many residents are unilingual francophones and access to specialized care can be limited.
"People in those little towns don't reach out for health care necessarily," says Rivest. "For me, it's making the tests available free, inexpensive to all francophone, including rural people, people that are far away."
"For me, it's helping the francophone community, particularly the people who would not normally reach out for those types of services, nor be offered them because it's just too complicated for them," she says.