Is the Mini-Mental State Examination the best cognitive screening test for less educated people?

ABSTRACT. Diagnosis of cognitive impairment is usually difficult in low-educated individuals. The Brief Cognitive Screening Battery (BCSB) was designed as a screening tool for the evaluation of cognitive impairment in low-educated individuals, but it may also be used for evaluating individuals with high educational level. Objectives: To perform a narrative review analyzing the origin of the BCSB, to report all studies that have used the Figure Memory Test (FMT) of the BCSB, and to demonstrate that it is a useful battery for regions where populations have heterogeneous educational background. Methods: We performed a search in PubMed, SciELO, and LILACS using the terms “Brief Cognitive Screening Battery” and “Brief Cognitive Battery”. Results: We obtained 49 papers from PubMed, 32 from SciELO, and 28 from LILACS. After the exclusion of duplicate papers, 54 publications were obtained; five more studies were included from previous knowledge of the authors. Twenty-four papers were related to the impact of education on performance, diagnostic accuracy, cutoff scores and normative studies. The delayed recall of the FMT showed the best accuracy for the diagnosis of dementia with a cutoff score of ≤5 in different education levels. In 35 papers, the FMT of the BCSB was used in clinical studies with different settings, from outpatient memory clinics to epidemiological studies and evaluation of Amazon river basin dwelling individuals, and it was always considered to be easy to apply. Conclusions: The FMT of the BCSB is an easy and short tool for the diagnosis of dementia in populations with heterogeneous educational background.

Section: Influence Of Education Construct Validity and Normative Studiesmentioning

confidence: 99%

The Figure Memory Test: diagnosis of memory impairment in populations with heterogeneous educational background

Nitrini

Bucki

Yassuda

et al. 2021

“…Although the results presented regarding the MMSE have been controlled in terms of age and education, the TMF stands out because it is an instrument that in itself has little influence on the education variable. [30][31][32] According to the ANOVA, however, the three clusters do not show any difference concerning the score results. Thus, we understand that although the groupings may differ in terms of global cognition, this difference does not appear to be due to mnemonic changes.…”

Section: Discussionmentioning

confidence: 90%

Patterns of instrumental activities of daily living between community-dwelling older adults

Sigrist¹,

Becattini-Oliveira²,

Fichman³

2021

The ability to perform instrumental activities of daily living (IADLs) is an important marker within the aging process, as it reflects the level of independence to perform in the real world. However, there is a scarcity of studies that investigate the different performance profiles among older adults. Objective: To investigate the heterogeneity present in the community of elderly people, grouping them based on characteristics and patterns observed through an objective performance-based assessment. Methods: Participants were selected according to the following inclusion criteria: fluency in Portuguese, 360 years, regular participation in a social program offered by the government of Rio de Janeiro, and absence of a caregiver. The evaluation of IADLs was determined by the total and brief version of the University of California, San Diego Performance-Based Skills Assessment (UPSA) and the Lawton and Brody IADL scale. The Brief Cognitive Screening Battery and the Mini-Mental State Examination were used to characterize the sample, in addition to the Geriatric Depression Scale. A total of 61 elderly people with an average age of 72.5 years, predominantly females (85.2%), and average education of 11.2 were evaluated and grouped according to their performance at UPSA through clustering analysis. Results: The analysis revealed three grouping patterns, subdividing the sample into subgroups that differed significantly in terms of age, education, global cognition, and all instrumental activities assessed by UPSA — planning, finance, communication, transportation, and household chores. Conclusions: This study was able to identify the heterogeneity present between the elderly people in the different factors that compose the IADLs through a performance-based assessment.

“…Small cross-sectional studies suggested that CDT is not sensitive enough to detect very mild dementia neither in educated people 7 nor in those with limited education. 5 Illiterate patients can be successfully screened for Alzheimer’s disease using well-known screening instruments in combined protocols (e.g., CDT and MMSE). 21 A study that analyzed the qualitative elements of CDT, rather than the sole score, showed that among participants without cognitive impairment, those with lower education often presented graphic difficulties, conceptual deficits, and spatial deficits.…”

Section: Discussionmentioning

confidence: 99%

“…The 5-item score Shulman system was considered as an accurate method for the widespread use in the diagnosis of dementia, requiring a substantial understanding of its scoring system. 6 In contrast, small cross-sectional studies suggested that CDT is not sensitive enough to detect very mild dementia neither in educated people 7 nor in those with limited education, 5 even though the CDT version employed in the last study had a complicated scoring system. Moreover, additional uses for the several CDT versions have been described in terms of evaluating the progression of cognitive decline, 8 differentiating types of dementia, 9 and even classifying qualitatively the elements of CDT according to the educational level.…”

Section: Introductionmentioning

confidence: 94%

“…3 There are several cognitive screening tools for identifying cognitive decline and dementia, but the validation of these tests in illiterate and low-educated older adults is a challenge. 4,5 One of the most simple of them is the clock drawing test (CDT), which has more than one version with different scoring methods. The 5-item score Shulman system was considered as an accurate method for the widespread use in the diagnosis of dementia, requiring a substantial understanding of its scoring system.…”

Section: Introductionmentioning

confidence: 99%

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Clock drawing test: comparison between the Pfizer and the Shulman systems

Graeff

Lui

Zucco

et al. 2021

Cognitive decline can be screened by the clock drawing test (CDT), which has several versions. Objective: This survey aimed to analyze the correlation between two simple methods for scoring the CDT. Methods: This cross-sectional study was nested in the Elo-Creati cohort from Passo Fundo, Brazil and comprised 404 subjects. Two raters underwent previous training and scored the subjects’ CDT according to both the Pfizer and Shulman systems. The inter-observer and intra-observer concordance within each method was analyzed with the Spearman’s rank correlation coefficient, as well as the concordance of the scores between the two methods. Age and scholarity were also correlated with the scores. Results: Most of the participants were women (93.8%) and Caucasian (84.6%), with a mean age of 66.9 (±7.8) years and a scholarity of 10.9 years (±5.6). There was significant inter-observer (Pfizer: r=0.739, p£0.001; Shulman: r=0.727, p£0.001) and intra-observer correlation (Pfizer: rater 1, r=0.628, p≤0.001; rater 2, r=0.821, p≤0.001; Shulman: rater 1, r=0.843, p≤0.001; rater 2: r=0.819; p≤0.001). Intra-observer correlation was also observed comparing Pfizer and Shulman methods (rater 1: r=0.744; p≤0.001; rater 2: r=0.702; p≤0.001). There was weak correlation of the scores with scholarity (Pfizer: r=0.283, p£0.001; Shulman: r=0.244, p£0.001) and age (Pfizer: r=-0.174, p£0.001; Shulman: r=-0.170, p£0.001). More participants were classified with decreased cognition through the Pfizer system (rater 1: 44.3 vs. 26.5%; rater 2: 42.1 vs. 16.3%; p≤0.001). Conclusions: For this population, our results suggest that the Pfizer system of scoring CDT is more suitable for screening cognitive decline.