Methodological issues in screening for dementia: The problem of education adjustment

Kittner, Steven J.; White, Lon R.; Farmer, Mary E.; Wolz, Michael; Kaplan, Edith; Moes, Elisabeth J.; Brody, Jacob A.; Feinleib, Manning

doi:10.1016/0021-9681(86)90019-6

Cited by 189 publications

(103 citation statements)

References 11 publications

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“…This is unlikely to be explained only by their superior test-taking abilities (52)(53)(54)(55)(56)(57)(58). Our results also confirm such an association with education, although in our data this was especially marked in very elderly subjects.…”

Section: Discussionsupporting

confidence: 71%

Variables Associated with Cognitive Function in Elderly California Seventh day Adventists

Fraser

Singh

Bennett

1996

American Journal of Epidemiology

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From a cohort of white, non-Hispanic California Seventh-day Adventists, 99 subjects over age 75 years in 1991 were randomly selected. Dietary habits and educational status had been measured in 1976. Subjects completed the Mini-Mental State Examination (MMSE) in 1991, and at that time, they or caregivers also gave information on current medical problems and drug therapy. Those who ate more calories in 1976 had lower MMSE scores in 1991 (p = 0.03), an association strengthened by excluding those with previous stroke or Parkinson's disease by 1991. This raises the possibility that higher consumption of calories in middle age may accelerate the decline in cognitive function seen with aging, as apparently occurs in some animals. Less-educated subjects had lower MMSE scores, especially among the very elderly. The statistical model predicts that the negative association between use of psychotropic drugs and MMSE score (p = 0.004) is particularly potent in those cognitively impaired for other reasons. If causal, this suggests that physicians should use these agents very cautiously in such subjects.Keywords caloric intake; dementia; education; psychotropic drugs; Seventh-day Adventists In different cross-sectional studies, the reported prevalence of dementia ranges from 10 to 50 percent in elderly subjects over age 85 years (1). The increasing number of elderly in both the United States and developing nations over the last 2 decades will undoubtedly further increase the social burden of dementia in the future. While age and family history of a dementing illness are the only unequivocally identified risk factors, the wide international variation in the rates of dementia suggests a possible etiologic role for environmental factors as well (1, 2). Previous studies of Alzheimer's disease and other dementias have identified associations with education, smoking, alcohol use, head trauma, meat consumption, aluminum, comorbid psychiatric disorders, hypertension, diabetes mellitus, and hypothyroidism (2-7). However, these factors need further confirmation as etiologic agents. A higher prevalence of vascular dementia has been observed in populations with a high prevalence of risk factors for vascular disease (8-11). The identification of modifiable risk factors may allow not only the reduction of excess morbidity due to the dementia itself but also the reduction of other problems associated with dementia such as decreased functional capacity (12, 13) and adverse drug effects (14).

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Section: Discussionsupporting

confidence: 71%

Variables Associated with Cognitive Function in Elderly California Seventh day Adventists

Fraser

Singh

Bennett

1996

American Journal of Epidemiology

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“…The prevalence of cognitive deficit (30%), as assessed by the MMSE, was comparable with results from a survey in Canada 10 , in which 33% of a sample of elderly residents presented some degree of cognitive impairment. For the purpose of the present study it was decided to use a standard cut-off at 24 points, although there is controversy in the literature as to whether different cut-offs should be used for different educational levels 4,17,19,35 . Given the relatively high level of education of this cohort, the prevalence of cognitive impairment might not be the same in a less educated sample, as education seems to be a risk factor for more rapid and more severe cognitive decline in old age 1,7,33 .…”

Section: Discussionmentioning

confidence: 99%

Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results

et al. 1998

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IntroductionPrevious cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil's rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of crosssectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented.

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“…Different specificities were observed for AfricanAmericans (0.78) and Whites (0.94) which the authors attribute to an artifact of education: The sample contained a high proportion of African-Americans who had received relatively less education. Kittner et al [32] showed that cognitive screening measures are more specific, less sensitive and have more false negatives among the highly educated, while more false positives are observed among those with low education. Fillenbaum et al [5] examined seven cognitive screening or neuropsychological tests in relation to clinical diagnosis.…”

Section: Statistical Approachmentioning

confidence: 99%

Use of Latent Class Analyses for the Estimation of Prevalence of Cognitive Impairment, and Signs of Stroke and Parkinson’s Disease among African-American Elderly of Central Harlem: Results of the Harlem Aging Project

Teresi

Albert²,

Holmes³

et al. 1999

Neuroepidemiology

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A probability sample (response rate of 79.4%) of 164 African-American elderly residing in central Harlem was assessed using several standard cognitive screening measures and scales measuring stroke and Parkinson’s symptoms, respectively. Both traditional cutting scores and the methods of latent class analysis were used to estimate point prevalence. The latent class prevalence ratio estimates range from 10 to 14%. The confidence intervals for cognitive impairment ranged from 5 to 18% with an average estimate of 12%. The latent class estimate for stroke effects was 11% and for two measures of neurological signs associated with Parkinson’s disease 7 and 12%. About 2–3% of the sample were communication disordered, and 5% had significant ambulation disorder. These results indicate that a relatively large proportion of elderly community residents of central Harlem evidenced or reported health problems, any or all of which may constitute a public health challenge.

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Methodological issues in screening for dementia: The problem of education adjustment

Cited by 189 publications

References 11 publications

Variables Associated with Cognitive Function in Elderly California Seventh day Adventists

Variables Associated with Cognitive Function in Elderly California Seventh day Adventists

Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results

Use of Latent Class Analyses for the Estimation of Prevalence of Cognitive Impairment, and Signs of Stroke and Parkinson’s Disease among African-American Elderly of Central Harlem: Results of the Harlem Aging Project

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