Literacy and performance on the Mini-Mental State Examination

The Bangla adaptation of Mini-Mental State Examination (BAMSE): an instrument to assess cognitive function in illiterate and literate individuals

The Mini-Mental State Examination (MMSE) is a brief global instrument used to assess cognitive abilities in the elderly, requiring literacy as a prerequisite. Such a precondition is impractical for populations with widespread illiteracy. The present study aimed to adapt the MMSE for the cultural context of Bangladesh and for use in populations irrespective of literacy skills. In the Bangla Adaptation of Mini-mental State Examination (BAMSE), the MMSE items were changed in such a way that they would be applicable for illiterate individuals, as well as being culturally relevant in Bangladesh. Altogether 672 elderly, 262 literate and 410 illiterate individuals were tested with the BAMSE. To enable comparison between the BAMSE and MMSE, the literate elderly were tested with both instruments. Test-retest reliability of the BAMSE was assessed in 54 randomly selected individuals. The results showed that, in comparison to the MMSE, the BAMSE demonstrated satisfactory test properties, although reliable differences were found on some of the individual items when the two instruments were compared. The association between the two instruments was good (r=0.57) and the test-retest reliability was satisfactory (r=0.70). More importantly, the BAMSE was found to be less sensitive to age and education than the MMSE. Finally, our results suggest that in the socio-cultural context of Bangladesh, irrespective of literacy skills, the BAMSE is an instrument that can be used to assess cognitive function of the normal elderly.

The influence of noncognitive factors on the Mini-Mental State Examination in older Mexican-Americans: findings from the Hispanic EPESE. Established Population for the Epidemiologic Study of the Elderly

Mini-Mental State Examination data from the Hispanic Established Population for the Epidemiologic Study of the Elderly baseline survey, a population-based study of community-dwelling Mexican Americans aged 65 and older, were used to examine the relationship between cognitive impairment, sociodemographics, and health-related characteristics. The rate of cognitive impairment found in this group of older Mexican Americans, using the conventional cut point of 23/24 on the MMSE, was 36.7%. Using a more conservative cut point of 17/18 indicated an overall rate of severe cognitive impairment of 6.7%. Rates of impairment varied significantly with age, education, literacy, marital status, language of interview, and immigrant status and were associated with high and moderate levels of depressive symptoms, and history of stroke. Importantly, although education was strongly related to poor cognitive performance, it was not a significant predictor of severe cognitive impairment. Multivariate analyses further indicated that as a screen for cognitive impairment in older Mexican Americans, the MMSE is strongly influenced by these noncognitive factors. Scores may reflect test bias, secondary to cultural differences or the level of education in this population.

Low Literacy Levels in Adults: Implications for Patient Education

BACKGROUND

Patients are being discharged with the need for more complex care in the home. Written information frequently is used in health education. Patients and caregivers must be able to read and understand this information.

METHOD

A comprehensive literature review of articles on literacy and health education materials was performed.

RESULTS

The literature review revealed that low literacy is more prevalent in the United States than is generally recognized. Health education materials often require a reading level higher than the reading level of most patients. There are a number of tools available for assessing reading levels.

CONCLUSION

Findings indicate there are implications for nursing practice, education, and research. There is a need for nurses to be aware of the prevalence of low literacy. They need to know how to accurately assess reading ability and develop material that is at the appropriate level for patients and caregivers. There is a need for research to investigate possible relationships between health status and low literacy and to examine the effects of remedial reading programs on health practices.

Reading ability, education, and cognitive status assessment among older adults in Harlem, New York City

OBJECTIVES

This study examined reported level of education and current reading ability as predictors of cognitive status among older African Americans in central Harlem, New York City.

METHODS

A probability sample of 164 noninstitutionalized older African Americans was assessed. Mini-Mental State Examination (MMSE) scores were regressed on education and reading ability measures.

RESULTS

Reading ability and educational attainment were significant, independent predictors of MMSE performance. Within any level of education, subjects whose grade-equivalent reading ability exceeded reported level of education scored significantly higher on the MMSE.

CONCLUSIONS

Reading ability may be useful in interpreting the results of cognitive screening among low-educated and minority groups.

Practical assessment of adult literacy in health care

Low literacy is a pervasive and underrecognized problem in health care Approximately 21% of American adults are functionally illiterate, and another 27% have marginal literacy skills. Such patients may have difficulty reading and understanding discharge instructions, medication labels, patient education materials, consent forms, or health surveys. Properly assessing the literacy level of individual patients or groups may avoid problems in clinical care and research. This article reviews the use of literacy assessments, discusses their application in a variety of health care settings, and cites issues providers need to consider before testing. The authors describe informal and formal methods of screening for reading and comprehension in English and Spanish including the Rapid Estimate of Adult Literacy in Medicine, the Wide Range Achievement Test-3, the Cloze procedure, the Test of Functional Health Literacy in Adults, and others. Practical implications and recommendations for specific use are made.

Interpretation of Mini-Mental State Examination scores in community-dwelling elderly and geriatric neuropsychiatry patients

The purpose of this article is to provide data for advanced interpretation of MMSE performance in community-dwelling elderly persons and in geriatric neuropsychiatry inpatients. Age- and education-corrected cutoff scores, standard errors of measurement and standard errors of difference were computed using previously published population normative data (Crum et al., 1993). The supplementary normative table provides a means of interpreting MMSE performance at a single point in time, or at two testing intervals. These same scores were calculated for a sample of 248 elderly inpatients from the geriatric psychiatry division of a psychiatric hospital. Clinical examples are provided.