The CAMCOG for patients with Alzheimer's disease with low levels of education

Abstract

We would like to congratulate Aprahamian et al. (2011) for their initiative to investigate the psychometric properties of the Cambridge Cognition Examination (CAMCOG) in assessing the cognitive status of the Brazilian elderly. This instrument is very frequently used in Brazil, but its measure characteristics have not yet been fully determined. Of course, cross-cultural adaptation and validation are rarely a simple procedure, often demanding a research program to completely adapt the tool to the specific language, culture, and selected population. In our opinion, the paper “Can the CAMCOG be a good cognitive test for patients with Alzheimer's disease with low levels of education?” (Aprahamian et al., 2011) is welcome as another trial by Brazilian scientists in this ongoing process. Notwithstanding, we believe that some comments about the methodological aspects of the paper are in order.

Is the Cambridge Cognitive Examination - Revised a good tool for detection of dementia in illiterate Brazilian older adults?

“…This variable might be responsible for the sample bias that selected a group of older adults with lower educational level with better cognitive performance. 38,39 With regard to the average time of test application (44.5 ± 9.3 min), our sample landed a value twice as high as that taken by the British one (20 min). 40 This fact can be explained by the low level of literacy and the higher number of participants with dementia seen in our sample, as well as additional items incorporated into the CAMCOG-R, when compared with the version used by Roth et al 7 The long period of time allocated to the test could hinder its use in epidemiological studies or reserve it to a second phase for covering subjects with more conclusive, positive results in screening tests.…”

“…can be reliably linked to higher levels of socioeconomic status that characterize this sample, selected amongst individuals who sought medical attention at a private geriatrics outpatient facility. This variable might be responsible for the sample bias that selected a group of older adults with lower educational level with better cognitive performance …”