Cross-cultural comparison of MMSE and RUDAS in German and Turkish patients with Alzheimer’s disease.

Abstract

Objective: Given the increasing cultural, linguistic diversity in Europe, there is a growing need for cognitive screening tools that minimize the influence of linguistic, cultural, and demographic differences as they are the first means to determine the need for further clinical evaluation of individuals with suspected cognitive impairment. This cross-sectional study compared performance on the Mini-Mental State Examination (MMSE) and the Rowland Universal Dementia Assessment Scale (RUDAS) in Alzheimer's Disease (AD) patients in relation to cultural, demographic, and immigration-related factors (acculturation, bilingualism). Method: The study comprised Turkish immigrant (n = 21) and monolingual, nonimmigrant German (n = 20) and Turkish (n = 24) patients with AD. All participants were administered cognitive screening tools, measures of depression, and dementia severity. Results: The mean MMSE total score was significantly higher in German patients with AD compared to both patient groups, but did not differ between native-born Turkish and Turkish immigrant groups. After adjustment for years of education, differences in MMSE performance were no longer significant between groups. Furthermore, bilingualism was associated with better performance on the MMSE in Turkish-immigrant patients. The mean RUDAS in conceptualization, methodology, project administration, and writing of review and editing. Birgit Teichmann played lead role in funding acquisition and supervision, supporting role in project administration and equal role in conceptualization, methodology and writing of review and editing.

Comparing MMSE and RUDAS in detecting cognitive impairment: A population-based study from Punjab, North India

“…Hence, it also suggests that both the tools were performing in relatively higher concordance and no discrepancy in detecting CI among elderly group in the studied sample. Various other related studies which were conducted on patients suffering from neurological and mental health disorders also suggested a good correlation and concordance in the test performance of MMSE and RUDAS among the patients of dementia and Alzheimer's disease [13,24,25].…”

The Effect of Translation and Cultural Adaptations on Diagnostic Accuracy and Test Performance in Dementia Cognitive Screening Tools: A Systematic Review

“…On the other hand, Torkpoor et al (2022) study, based on a smaller group of immigrants, reported that educational background and immigrant status do not influence the RUDAS, but the MMSE cognitive performance [ 43 ]. In contrast, Celik et al (2022) found no difference when adjustments were made to account for years of education in RUDAS scores ( p = 0.622) but did find that years of education were significantly associated with total MMSE scores ( p < 0.001), where German natives performed better [ 47 ]. Thus, it could be important to consider to what extent level of education may be correlated with immigrant background, i.e., some studies have found lower test performance scores to be associated with lower levels of education related to lack of opportunity available within lower economically developed countries (LEDCs) [ 48 ].…”

“…The impact of bilingualism in cognitive testing also appeared to be relevant. Thus, bilingual people performed significantly better on the MMSE as opposed to those who were monolingual ( p = 0.046) [ 47 ]. However, when bilinguals were removed from the analyses, results demonstrated that Turkish (TR) and Turkish immigrant (TI) groups performed significantly worse than German participants (TR, p = 0.021; TI, p = <0.001).…”

“…Despite some evidence which implies that higher degrees of acculturation could positively impact test performance [ 58 ], the findings from this review did not come to the same conclusion. On the contrary, the level of acculturation was not related to total scores in one study [ 47 ]. However, this was the only study within the review which formally assessed the impact of acculturation using the Frankfurt Acculturation Scale (FRAKK) [ 59 ], and therefore warrants further investigation.…”

“…There were mixed findings relating to the effect of education across studies. Some findings reported that adjusted cut-off scores to account for education were helpful in improving diagnostic accuracy [ 40 ], whereas other reported no difference when scores were adjusted for the same test [ 47 ]. However, it appeared that higher performance on some tests (such as the MMSE) were significantly associated with years of education, and this seems to be mediated by the Historical Index of Human Development of the participants’ country of birth (which reflects economic, health, and educational potential of a country at the time of birth) [ 8 ].…”