Mini- Mental State Examination among lower educationl levels and illiterates: transcultural evaluation

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There is a current concept that illiteracy and lower educational levels are risk factors for cognitive decline and dementia. Our aims were to review the association between illiteracy and dementia; and to describe some results on neuropsychological findings in illiteracy. A literature search of the PubMed database was performed. The search terms were “dementia”, “illiteracy”, “neuropsychological evaluation”, “educational levels”, and “education”. Only papers published in Portuguese, English, and Spanish were reviewed. Illiteracy is an incontestable risk factor for dementia. It influences performance on almost cognitive tests. Many other factors could be connected to the high prevalence of dementia among illiterates: low cognitive reserve, poor control of cerebrovascular disease risk factors, difficulties in cognitive evaluation, and poor adaptation of neuropsychological tests for this specific population. Functional tests must be coupled with cognitive tests to ameliorate diagnostic accuracy.

Section: Epidemiologymentioning

confidence: 99%

Illiteracy and dementia

Brucki

2010

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“…Brucki and Nitrini observed a significant difference in MMSE scores between two different samples (from São Paulo and that of a rural sample from the Amazonian region). 15 Moreover, number of years of schooling completed is inaccurate because some people continue their education informally. It is not uncommon to encounter individuals with one or two years of formal education, but who are able to comprehend, make inferences or discuss complex subject matter.…”

mentioning

confidence: 99%

Formal education, health literacy and Mini-Mental State Examination

Brucki

Carthery‐Goulart

2011

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The Mini-Mental State Examination (MMSE) is a widely used screening test for cognitive impairment, but is heavily biased by education. Educational level has frequently been ranked using years of schooling, which may not be a good indirect measure of educational level because there is great heterogeneity in standards of schooling among populations and across regions of the same country. S-TOFHLA is a measure of health literacy with some results indicating that it is a good measure for literacy level.ObjectiveTo evaluate the correlations between years of schooling and scores on the S-TOFHLA and the MMSE.MethodsHealthy subjects without cognitive impairment were submitted to the S-TOFHLA and the MMSE. Correlations and regression analysis were performed to determine possible associations among variables.ResultsBoth years of schooling and S-TOFHLA scores were strongly correlated with MMSE scores, but the strongest association was reached by the S-TOFHLA (r=0.702, p<0.01), where the S-TOFHLA was the best predictor of MMSE scores (R2=0.494, p<0.001).ConclusionsA stronger association between S-TOFHLA scores and MMSE performance was found than between years of education and MMSE scores. This finding justifies further studies incorporating years of schooling together with S-TOFHLA score, to evaluate cognitive performance.

“…Variables concerning the present environment, life history, individual action and subjective assessments are thought to provide multiple old-age realities, within objective and subjective health and physical, social and psychological well-being conditions. 4 , 5 , 12 This leads us to consider that our study sample might have been influenced by a cohort effect whereby this group of old-older adults may have different variables compared to the middle-old.…”

Section: Discussionmentioning

confidence: 99%

Criterion validity of a Wechsler-III scale short form in a sample of Brazilian Elderly

Banhato

Leite

Guedes

et al. 2010

Although a normative process, changes in cognitive functioning vary among older adults. The differential diagnosis between normal and pathological aging must be made early using psychometrically adequate measures.ObjectivesTo assess the evidence of criterion validity of a Short Form (SF) of the Wechsler-III Scale containing eight subtests (SF8) by determining its sensitivity, specificity, positive and negative predictive values and cut-off points for Brazilian elderly from different age groups.Methods168 individuals, aged 60 years or above, living in the community or in an institution, were assigned to case and control groups, and investigated according to age range. Measures included a sociodemographic questionnaire, the Mini-Mental State Examination (MMSE), Verbal Fluency Test, Clock-Drawing Test and the SF8.ResultsMore than two thirds of the sample was women (73.8%), mean age was 74.5 years (SD=8.9), mean education was 6.2 years (SD=4.8) and 40.5% were widows/widowers. In the total sample, the best cut-off point for the SF8 was 142 while cut offs among individuals aged 60 to 69 years, 70 to 79 years, and more than 80 years were 160, 129 and 129, respectively.ConclusionsThe results demonstrated the importance of different cut-off points for different age ranges. Sensitivity and specificity values of the SF8 were sufficiently high to warrant the use of the SF8 as an instrument to identify cognitive impairment in the elderly.