Diagnostic Accuracy of Usual Cognitive Screening Tests Versus Appropriate Tests for Lower Education to Identify Alzheimer Disease

Abstract

Introduction: The accuracy of commonly used screening tests for Alzheimer’s disease (AD) has not been directly compared to those that could be more appropriate for lower schooling. Objective: To compare the diagnostic accuracy of usual screening tests for AD with instruments that might be more appropriate for lower schooling among older adults with low or no literacy. Methods: The study included a clinical sample of 117 elderly outpatients from a Geriatric Clinic classified as literate controls (n = 39), illiterate controls (n = 30), literate AD (n = 30) and illiterate AD (n = 18). The tests were compared as follows: Black and White versus Colored Figure Memory Test; Clock Drawing Test versus Clock Reading Test; Verbal Fluency (VF) animal versus grocery category; CERAD Constructional Praxis versus Stick Design Test. Results: The means of literate and illiterate controls did not differ in the Black and White Figure Memory Test (immediate recall), Colored Figure Memory Test (delayed recall), Clock Reading Test and VF animals and grocery categories. The means of the clinical groups (controls versus AD), in the 2 schooling levels, differed significantly in most of the tests, except for the CERAD Constructive Praxis and the Stick Design Test. Diagnostic accuracy was not significantly different between the compared tests. Conclusion: Commonly used screening tests for AD were as accurate as those expected to overcome the education bias in a sample of older adults with lower or no education.

Recall of Pictures Test included in the European Cross-Cultural Neuropsychological Test Battery

“…This suggestion is an old one 5 and has been supported by several studies, including two by one of the signers of the letter. 6 , 7 Interestingly, Ortega et al 6 directly compared tests included in the BCSB and the CNTB and stated that “data from the present study suggest that the use of colored stimuli seems to be a relevant strategy in the evaluation of memory among people with low schooling, as they may facilitate encoding.” It is noteworthy, that the name of the RPT was changed to the “Colored Figure Memory Test” in this publication.…”

The Montreal Cognitive Assessment in Spanish-speaking countries in Latin America and the Caribbean: A Systematic Review

“…The high prevalence of lower educational achievement and socioeconomic disparities in LAC could explain the lowest performance of loweducated individuals on neuropsychological tests and contribute to misdiagnosis (50,51). In these population, the di culties of employing diagnostic batteries requires cultural adaptation of neuropsychological instruments considering cognitive skills predominantly used in the daily context of life is essential to understanding the cognitive skills of learning and information management, and, consequently, to identifying pathologic cognitive impairment (52).…”

The Use of Verbal and Nonverbal Memory Tests for Alzheimer’s Disease Screening in Taiwan Chinese

“…35,36 These abilities also decline in non-demented elderly individuals so CP copying is not as sensitive for discriminating AD from non-demented elderly individuals. 37 Clinically, verbal cognitive tests are most used in evaluation of memory. Studies suggested difficulty retrieval words confound performance on verbal cognitive measures and may lead to the impression of memory impairment.…”

“… 35 , 36 These abilities also decline in non-demented elderly individuals so CP copying is not as sensitive for discriminating AD from non-demented elderly individuals. 37 …”