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Petri M, Messinis L, Patrikelis P, Nousia A, Nasios G. Illiteracy, Neuropsychological Assessment, and Cognitive Rehabilitation: A Narrative Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:477-484. [PMID: 37581821 DOI: 10.1007/978-3-031-31986-0_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECT Νeuropsychological assessment is particularly important for the accurate discrimination of cognitive abilities and weaknesses of patients in order to determine the appropriate therapeutic intervention. However, the reliability and validity of neuropsychological assessment appears to be influenced by a wide range of factors, including literacy and educational level. AIM This systematic review evaluates neuropsychological tests appropriate for the valid assessment of illiterate individuals and the effectiveness of cognitive rehabilitation programs for illiterate and/or low-educated individuals according to the results of English language studies that have been published in the PubMed/Medline electronic database until August 2022 (no initiation date). RESULTS 49 studies were included for neuropsychological assessment and 4 studies for cognitive rehabilitation. In terms of investigating the validity and reliability of neuropsychological tests for the assessment of healthy illiterate individuals, most studies concluded that for the majority of neuropsychological tests there is a significant difference in performance between healthy illiterate and literate individuals. However, there was consensus among studies that the performance of illiterate subjects was equivalent to the performance of literate subjects on tasks depicting colored and real objects. Regarding cognitive rehabilitation programs, all four studies concluded that they are effective in improving the cognitive functions of illiterate and/or low-literate patients with mild cognitive impairment and/or mild dementia. CONCLUSIONS For the assessment of illiterate individuals, it is imperative that neuropsychological tests with high ecological validity (i.e., tests related to activities of daily living) be administered so as not to underestimate their cognitive functioning. At the same time, cognitive enhancement/stimulation programs seem to be effective in this population group; however, this area needs further investigation.
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Affiliation(s)
- Maria Petri
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lambros Messinis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Panayiotis Patrikelis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Nousia
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Staios M, Nielsen TR, Kosmidis MH, Papadopoulos A, Kokkinias A, Velakoulis D, Tsiaras Y, March E, Stolwyk RJ. Validity of Visuoconstructional Assessment Methods within Healthy Elderly Greek Australians: Quantitative and Error Analysis. Arch Clin Neuropsychol 2022; 38:598-607. [DOI: 10.1093/arclin/acac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 12/05/2022] Open
Abstract
Abstract
Aims
Visuospatial skills are frequently assessed with drawing tests. Research has suggested that the use of drawing tasks in low educated groups may lack the ability to discriminate healthy individuals from clinical populations. The aims of this study were to investigate the validity of visuoconstructional tests in a sample of older Greek Australian immigrants and compare their performances to a matched sample of patients with Alzheimer’s disease (ad).
Method
We assessed visuoconstructional performances in a sample of 90 healthy older Greek Australians, with a primary school level of education, and compared performances to a demographically matched sample of 20 Greek Australians with a diagnosis of ad on four visuoconstructional drawing tests: Greek cross, four-pointed star, intersecting pentagons, and the Necker Cube.
Results
While healthy participants tended to outperform the ad group on most copy tasks, high fail rates within the healthy sample were observed for the intersecting pentagons and Necker cube (78% and 73% fail rates, respectively) when using established clinical cut-off scores. High rates of curved angle, omission, distorted relation between elements, spatial disorganization and three-dimensional design errors were found across the four-pointed star, intersecting pentagons, and the Necker cube in both healthy participants and those with ad. Exploratory receiver operating characteristic curve analysis revealed that, with perhaps the exception of the Greek cross, meaningful sensitivity and specificity could not be reached for the four-pointed star, intersecting pentagons, and Necker cube.
Conclusion
Cognitively healthy immigrants with low education appear to be at a disadvantage when completing visuoconstructional drawing tests, as their performance may be misinterpreted as indicating cognitive impairment. Future research is needed to identify alternative approaches to assess visuoconstructional ability in culturally and linguistically diverse older cohorts with limited education.
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Affiliation(s)
- Mathew Staios
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
| | - T Rune Nielsen
- Danish Dementia Research Centre, Neuroscience Centre, Copenhagen University Hospital Department of Neurology, , Rigshospitalet, Copenhagen, Denmark
| | - Mary H Kosmidis
- School of Psychology, Aristotle University of Thessaloniki Lab of Cognitive Neuroscience, , Thessaloniki, Greece
| | - Alexandra Papadopoulos
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
| | - Arthur Kokkinias
- The Royal Melbourne Hospital, Inner West Area Mental Health Service , Parkville, Australia
| | - Dennis Velakoulis
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health Department of Psychiatry, , Melbourne, Australia
- The Royal Melbourne Hospital Neuropsychiatry, , Melbourne, Australia
| | - Yiannis Tsiaras
- School of Psychology, Aristotle University of Thessaloniki Lab of Cognitive Neuroscience, , Thessaloniki, Greece
| | - Evrim March
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University , Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre , Melbourne, Australia
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Abstract
OBJECTIVES We investigated the utility of traditional neuropsychological tests in older uneducated/illiterate individuals without dementia to determine the possibility that they are likely not appropriate for this group. METHODS We assessed the neuropsychological performance of 1122 older adults [≥65 years old; mean age: 74.03 (SD = 5.46); mean education: 4.76 (SD = 2.5) years; women: n = 714], in the context of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD), a population-based study conducted in Greece. RESULTS We based our analyses on three groups: high-functioning/cognitively healthy (i.e., without dementia) uneducated/illiterate individuals (n = 80), high-functioning/cognitively healthy educated/literate individuals (n = 932), and low-functioning/cognitively impaired educated/literate individuals (presumably with dementia; n = 110). We used binary regression analyses with Bonferroni correction to investigate whether test performance differentiated uneducated/illiterate from educated/literate individuals. Models were adjusted for age and sex; raw test scores were the predictor variables. The uneducated/illiterate cohort was at a disadvantage relative to the healthy educated/literate group on all variables but verbal memory recognition and consolidation, congruent motor responses, and phonological fluency clustering (p > .002). Moreover, only word list learning immediate and delayed free recall and delayed cued recall differentiated the high-functioning/cognitively healthy uneducated/illiterate from the low-functioning/cognitively impaired educated/literate group, favoring the former (p's < .002). CONCLUSIONS Our findings suggest that only particular verbal memory test variables are fair in determining whether older uneducated/illiterate individuals have functional/cognitive impairment suggestive of a neurodegenerative process. On all other neuropsychological variables, this cohort was at a disadvantage. Therefore, we highlight the need for identifying appropriate methods of assessment for older uneducated/illiterate individuals.
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Malcorra BLC, Wilson MA, Schilling LP, Hübner LC. Lower Education and Reading and Writing Habits Are Associated With Poorer Oral Discourse Production in Typical Adults and Older Adults. Front Psychol 2022; 13:740337. [PMID: 35369132 PMCID: PMC8972065 DOI: 10.3389/fpsyg.2022.740337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
During normal aging there is a decline in cognitive functions that includes deficits in oral discourse production. A higher level of education and more frequent reading and writing habits (RWH) might delay the onset of the cognitive decline during aging. This study aimed at investigating the effect of education and RWH on oral discourse production in older adults. Picture-based narratives were collected from 117 healthy adults, aged between 51 and 82 years (68.6 ± 6.38) with 0-20 years of formal education (10.1 ± 5.69). Measures of macro, microlinguistic and modalizations were computed and entered as dependent variables in hierarchical regression analyses that included age, education and RWH as regressors. Results revealed that higher education explained a better performance at the macrostructure and microstructure dimensions. Higher frequency of RWH explained the production of fewer modalizations. These results demonstrate the positive effect of education and RWH in oral discourse production in older adults. Therefore, higher attention should be given to these social factors.
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Affiliation(s)
| | - Maximiliano A. Wilson
- Département de Réadaptation, Faculté de Médecine, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Université Laval, Quebec, QC, Canada
| | - Lucas Porcello Schilling
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Lilian Cristine Hübner
- Department of Linguistics, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- National Council for Scientific and Technological Development (CNPq), Brasília, Brazil
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Maher C, Calia C. The effect of illiteracy on performance in screening tools for dementia: A meta-analysis. J Clin Exp Neuropsychol 2022; 43:945-966. [PMID: 35200100 DOI: 10.1080/13803395.2022.2040433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Research indicates that many tools designed for screening dementia are affected by literacy level. The objective of this study was to estimate the overall effects of this confounding factor. A meta-analysis was conducted to evaluate differences in performance in dementia screening tools between literate and illiterate individuals. METHOD Electronic databases were searched from 1975 to June 2021 to identify empirical studies examining performance in dementia screening tools in literate and illiterate individuals over 50 years old. Data for effect sizes, participant demographic information, and study information were extracted. RESULTS We identified 27 studies methodologically suitable for meta-analysis. Multi-level random-effects modeling demonstrated a significant overall effect, with literate participants scoring significantly higher than illiterate participants (g = -1.2, 95% CI = -1.47, -0.95, p < .001). Moderator analyses indicated significant effects of test type and the presence of cognitive impairment on the extent of the difference in performance between literate and illiterate participants. The difference in performance between groups was smaller in screening tests modified for illiterate individuals (p < .01), and in individuals with cognitive impairment (p < .001). CONCLUSIONS Our findings substantiate the unsuitability of many dementia screening tools for individuals who are illiterate. The results of this systematic review and meta-analysis emphasize the need for the development and validation of tools that are suitable for individuals of all abilities.
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Affiliation(s)
- Caragh Maher
- Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Clara Calia
- Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Ortega LV, Aprahamian I, Martinelli JE, Cecchini MA, Cação JDC, Yassuda MS. Diagnostic Accuracy of Usual Cognitive Screening Tests Versus Appropriate Tests for Lower Education to Identify Alzheimer Disease. J Geriatr Psychiatry Neurol 2021; 34:222-231. [PMID: 32969281 DOI: 10.1177/0891988720958542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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.
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Affiliation(s)
- Luciane Viola Ortega
- 67791Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Ivan Aprahamian
- Division of Geriatrics, Department of Internal Medicine, 146840Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - José Eduardo Martinelli
- Division of Geriatrics, Department of Internal Medicine, 146840Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - Mário Amore Cecchini
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Mônica Sanches Yassuda
- 67791Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil.,School of Arts, Sciences and Humanities, 28133University of São Paulo (USP), São Paulo, Brazil
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Leong SL, Robertson IH, Lawlor B, Vanneste S. Associations between Hypertension, Treatment, and Cognitive Function in the Irish Longitudinal Study on Ageing. J Clin Med 2020; 9:jcm9113735. [PMID: 33233792 PMCID: PMC7699900 DOI: 10.3390/jcm9113735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/18/2022] Open
Abstract
Epidemiological studies have produced conflicting results regarding the associations between the use of different hypertensive drugs and cognition. Data from the Irish Longitudinal Study on Ageing (TILDA), a nationwide prospective longitudinal study of adults aged 50 or more years, was used to explore the associations between hypertensive status, categories of antihypertensive and cognitive function controlling for age, education, and other demographic and lifestyle factors. The study sample included 8173 participants. ANCOVAs and multivariate regressions were used to assess the cross-sectional and longitudinal associations between cognitive function and hypertension status and the different categories of hypertensive medication. Hypertension was not associated with decline in global cognitive and executive functions and were fully explained by age and education. Different hypertensive medications were not associated with cognitive function. Consistent with previous studies, changes in cognition can largely be explained by age and education. The use of antihypertensive medications is neither harmful nor protective for cognition.
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Affiliation(s)
- Sook Ling Leong
- Global Brain Health Institute & Trinity Institute of Neuroscience, Trinity College Dublin, DO2 PN40 Dublin, Ireland; (S.L.L.); (I.H.R.); (B.L.)
- School of Psychology, Trinity College Dublin, DO2 PN40 Dublin, Ireland
| | - Ian H. Robertson
- Global Brain Health Institute & Trinity Institute of Neuroscience, Trinity College Dublin, DO2 PN40 Dublin, Ireland; (S.L.L.); (I.H.R.); (B.L.)
| | - Brian Lawlor
- Global Brain Health Institute & Trinity Institute of Neuroscience, Trinity College Dublin, DO2 PN40 Dublin, Ireland; (S.L.L.); (I.H.R.); (B.L.)
| | - Sven Vanneste
- Global Brain Health Institute & Trinity Institute of Neuroscience, Trinity College Dublin, DO2 PN40 Dublin, Ireland; (S.L.L.); (I.H.R.); (B.L.)
- School of Psychology, Trinity College Dublin, DO2 PN40 Dublin, Ireland
- Correspondence:
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Demographic and Lifestyle Factors and Memory in European Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234727. [PMID: 31783491 PMCID: PMC6926502 DOI: 10.3390/ijerph16234727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/25/2022]
Abstract
Objectives: To investigate associations between demographic and lifestyle factors and memory performance in European people aged ≥60 years. Methods: Data from 23,641 people with a mean age of 70.2 (95 % CI 70.1–70.3) were analyzed and drawn from the fourth wave of the Survey of Health, Ageing, and Retirement in Europe (SHARE). Generalized linear models were carried out to estimate the associations for both men and women. Memory performance was tested using two word-list learning tests with immediate and delayed recall in SHARE. Results: age, severe limitations in physical activities, and any past alcohol problem were all negatively associated with memory performance. Contrarily, education level, higher nonalcoholic fluid intake, and engagement in sports activities more than once a week and in activities requiring a moderate level of energy were all positively associated with memory performance. Smoking showed a significant negative association only in the immediate recall test for both men and women together, whilst long-term illness showed association only in the delayed recall. Alcohol consumption was positively associated with memory performance in women, but in men, it depended on the drinking frequency. Conclusions: Demographic and lifestyle factors are associated with memory performance in the older population.
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Nepal GM, Shrestha A, Acharya R. Translation and cross-cultural adaptation of the Nepali version of the Rowland universal dementia assessment scale (RUDAS). J Patient Rep Outcomes 2019; 3:38. [PMID: 31321572 PMCID: PMC6639471 DOI: 10.1186/s41687-019-0132-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/19/2019] [Indexed: 11/12/2022] Open
Abstract
Background Mild Cognitive Impairment (MCI) is a transitional state between normal cognition and dementia during ageing process. Early screening of elderly for MCI can help for early prevention and treatment of dementia. Rowland Universal Dementia Assessment Scale (RUDAS) is a brief cognitive assessment tool with excellent psychometric properties and is particularly useful in culturally and linguistically diverse (CALD) populations. The purpose of this study was to translate RUDAS into Nepali and to evaluate internal consistency of Nepali version of RUDAS. Methods RUDAS was translated to Nepali following recommended guidelines for translation and cross-cultural adaptation of patient reported measures. The pre-final Nepali version of RUDAS was tested on 30 elderly and appropriate changes were made by expert committee. The final Nepali version of RUDAS was developed and was administered on 100 elderly populations (mean age 67.70) to assess internal consistency. Results The rating of the participants upon their understanding of each 6 items of Nepali version of RUDAS on a 10-point Likert scale received a good score of more than 8 except ‘cube drawing’ which only received a mean score of 5.5. Additionally, only 8(27%) elderly have responded to the item ‘cube drawing’. The preference test was done and cube drawing was replaced by stick design test. Nepali version of RUDAS showed acceptable internal consistency with Cronbach’s alpha 0.7. Conclusion The results of our study presents translated and cross-culturally adapted Nepali version of RUDAS that has been proved to be an appropriate assessment tool for screening cognitive impairment among elderly. Electronic supplementary material The online version of this article (10.1186/s41687-019-0132-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Govinda Mani Nepal
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.
| | | | - Ranjeeta Acharya
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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Lee IC, Chang CS, Du PL. Do healthier lifestyles lead to less utilization of healthcare resources? BMC Health Serv Res 2017; 17:243. [PMID: 28359277 PMCID: PMC5374670 DOI: 10.1186/s12913-017-2185-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/23/2017] [Indexed: 11/22/2022] Open
Abstract
Background Governments are urged to determine methods to control the use of medical resources and curb the rise of healthcare costs. The question is, do health behaviors have an impact on the use of medical resources? This study aims to identify and understand the difference in the number of outpatient visits and health examinations based on various health behaviors and to determine whether patients seek medical care for illness from the same physicians. Methods This study used the dataset derived from the Department of Budget, Accounting and Statistics of Kaohsiung, Taiwan in 2005. Persons older than 15 years were surveyed using an on-site questionnaire. A total of 2911 persons were enrolled in this study. Independent t-tests, chi-square tests, one-way ANOVA, multiple linear regression and binominal logistic regression were used in the data analysis. Results The regression model for the frequency of doctor visits, health examinations, and whether the same physician is sought for medical care has demonstrated significant correlations with gender, age and education-level variables. Four health behaviors (i.e., exercise habits, dietary habits, regular blood pressure measurement, drinking habits) exhibited a significant correlation with healthcare utilization (P <0.05). Conclusions Healthy lifestyles lead to an increase in the utilization of preventive health services. However, there is not much significantly reducing the number of outpatient visits in people with health behaviors. Specifically, people with regular exercise habits and who take their blood pressure measurement regularly have an increased number of outpatient visits. It is suggested that more available and accessible health consultation services be provided to inculcate in the general public the importance of maintaining a healthy lifestyle.
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Affiliation(s)
- I-Chen Lee
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 807, Taiwan
| | - Chao-Sung Chang
- Department of Hematology-Oncology, E-Da Cancer Hospital; School of Medicine for International Students, I-Shou University, No.21, Yi-Da Road, Jiao-Su Village, Yan-Chao District, Kaohsiung City, 824, Taiwan
| | - Pey-Lan Du
- Department of Sport and Leisure, National Quemoy University, No.1, Daxue Rd., Jinning Township, Kinmen County, Kinmen, 892, Taiwan.
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Julayanont P, Ruthirago D. The illiterate brain and the neuropsychological assessment: From the past knowledge to the future new instruments. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 25:174-187. [PMID: 27841690 DOI: 10.1080/23279095.2016.1250211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The lifetime learning of illiterate and low-educated individuals shapes their cognitive skills, which are challenging to grade by the current available neuropsychological tools. Eight hundred million of the global population are illiterate. It is very challenging to interpret the cognitive performance of this population by the available formal neuropsychological tests, mainly developed for higher educated people. From extensive literature investigation, we reviewed the cognitive process and performance of illiterate and low-educated population on various cognitive domains including language, executive function, memory, visual-related function, and motor skills. We also suggested the concept in the development of the appropriate tools for the cognitive assessment among this population. Finally, we provide the available cognitive screening tools validated in the illiterate and low-educated subjects within the last three decades.
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Affiliation(s)
- Parunyou Julayanont
- a Department of Neurology , Texas Tech University Health Sciences Center , Lubbock , Texas , USA
| | - Doungporn Ruthirago
- a Department of Neurology , Texas Tech University Health Sciences Center , Lubbock , Texas , USA
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A pilot study of performance among hospitalised elderly patients on a novel test of visuospatial cognition: the letter and shape drawing (LSD) test. Ir J Psychol Med 2016; 34:169-175. [PMID: 30115145 DOI: 10.1017/ipm.2016.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Conventional bedside tests of visuospatial function such as the clock drawing (CDT) and intersecting pentagons tests (IPT) are subject to considerable inconsistency in their delivery and interpretation. We compared performance on a novel test - the letter and shape drawing (LSD) test - with these conventional tests in hospitalised elderly patients. METHODS The LSD, IPT, CDT and the Montreal Cognitive Assessment (MoCA) were performed in 40 acute elderly medical inpatients at University Hospital Limerick The correlation between these tests was examined as well as the accuracy of the visuospatial tests to identify significant cognitive impairment on the MoCA. RESULTS The patients (mean age 81.0±7.71; 21 female) had a median MoCA score of 15.5 (range=1-29). There was a strong, positive correlation between the LSD and both the CDT (r=0.56) and IPT (r=0.71). The correlation between the LSD and MoCA (r=0.91) was greater than for the CDT and IPT (both 0.67). The LSD correlated highly with all MoCA domains (ranging from 0.54 to 0.86) and especially for the domains of orientation (r=0.86), attention (0.81) and visuospatial function (r=0.73). Two or more errors on the LSD identified 90% (26/29) of those patients with MoCA scores of ⩽20, which was substantially higher than for the CDT (59%) and IPT (55%). CONCLUSION The LSD is a novel test of visuospatial function that is brief, readily administered and easily interpreted. Performance correlates strongly with other tests of visuospatial ability, with favourable ability to identify patients with significant impairment of general cognition.
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Nielsen TR, Waldemar G. Effects of literacy on semantic verbal fluency in an immigrant population. AGING NEUROPSYCHOLOGY AND COGNITION 2016; 23:578-90. [DOI: 10.1080/13825585.2015.1132668] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- T. Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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The Stick Design Test on the assessment of older adults with low formal education: evidences of construct, criterion-related and ecological validity. Int Psychogeriatr 2013; 25:2057-65. [PMID: 23905545 DOI: 10.1017/s1041610213001282] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The assessment of visuospatial abilities is usually performed by drawing tasks. In patients with very low formal education, the use of these tasks might be biased by their cultural background. The Stick Design Test was developed for the assessment of this population. We aim to expand the test psychometric properties by assessing its construct, criterion-related and ecological validity in older adults with low formal education. METHOD Healthy older adults (n = 63) and Alzheimer's disease patients (n = 92) performed the Stick Design Test, Mini-Mental State Examination, Digit Span Forward and the Clock Drawing Test. Their caregivers answered Personal Care and Instrumental Activities of Daily Living). Construct validity was assessed by factor analysis, convergent correlations (with the Clock Drawing Test), and divergent correlations (with Digit Span Forward); criterion-related validity by receiver operating characteristic curve analysis and binary logistic regression; and Ecological validity by correlations with ADL. RESULTS The test factor structure was composed by one component (R 2 = 64%). Significant correlations with the Clock Drawing Test and Digit Span Forward were found, and the relationship was stronger with the first measure. The test was less associated with formal education than the Clock Drawing Test. It classified about 76% of the participants correctly and had and additive effect with the Mini-Mental State Examination (84% of correct classification). The test also correlated significantly with measures of ADL, suggesting ecological validity. CONCLUSIONS The Stick Design Test shows evidence of construct, criterion-related and ecological validity. It is an interesting alternative to drawing tasks for the assessment of visuospatial abilities.
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Kim J, Yoon JH, Kim SR, Kim H. Effect of literacy level on cognitive and language tests in Korean illiterate older adults. Geriatr Gerontol Int 2013; 14:911-7. [PMID: 24261573 DOI: 10.1111/ggi.12195] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2013] [Indexed: 11/30/2022]
Abstract
AIM Illiterate individuals represent a significant proportion of the world's population. Acquisition of reading and writing skills influences the functional status of the brain, and consequently alters the performance on cognitive and language tests. Thus, it is important to identify the degree of the impact of levels of both illiteracy and education as potential confounders on test performance in people with neurological communication disorders. METHODS A total of 203 community-dwelling older adults aged 65 years and older were recruited for the present study. Participants were classified into four groups based on the literacy level; pure illiterate (n=29), semi-illiterate (n=67), literate (n=75) and high-level literate (n=32). The participants completed the Mini-Mental State Examination, Boston Naming Test, Controlled Oral Word Association Test (animal), verb naming, and sentence comprehension tests. RESULTS The pure illiterate group showed the lowest performance on all five tests. Regression analysis showed that literacy level was the variable that best predicted the performance on cognitive and language tests. CONCLUSIONS These findings suggest that literacy in performance on cognitive and language tests is an important factor in neuropsychological evaluations for older adults.
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Affiliation(s)
- JungWan Kim
- Department of Speech and Language Pathology, College of Rehabilitation Sciences, Daegu University, Gyeongsan, Korea
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Nielsen TR, Jørgensen K. Visuoconstructional abilities in cognitively healthy illiterate Turkish immigrants: a quantitative and qualitative investigation. Clin Neuropsychol 2013; 27:681-92. [PMID: 23379740 DOI: 10.1080/13854046.2013.767379] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Assessment of visuospatial function is an integral part of most neuropsychological assessments and is frequently assessed by visuoconstructional tests. A significant impact of limited schooling and illiteracy has been found on numerous neuropsychological tests and it can be difficult to interpret test results from illiterate individuals. In this study, quantitative and qualitative aspects of performance of elderly cognitively healthy illiterate and literate Turkish immigrants were compared on five commonly used visuoconstructional tests. Significantly poorer performances of illiterate compared to literate subjects were found in copying of two- and three-dimensional geometric designs, and in Clock Drawing Test performance. A systematic qualitative analysis found lacking three-dimensionality, "curved angles", omissions, distorted relation between elements, and spatial disorganization to be common error types in illiterate subjects. Performances were not found to be influenced by duration of residence in Denmark or level of acculturation. The results warrant caution in the interpretation of visuoconstructional test performances in illiterate subjects, as they can easily be misinterpreted as signs of cognitive dysfunction.
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Affiliation(s)
- T Rune Nielsen
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Parra MA, Ascencio LL, Urquina HF, Manes F, Ibáñez AM. P300 and neuropsychological assessment in mild cognitive impairment and Alzheimer dementia. Front Neurol 2012; 3:172. [PMID: 23227021 PMCID: PMC3514532 DOI: 10.3389/fneur.2012.00172] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 11/13/2012] [Indexed: 11/25/2022] Open
Abstract
Only a small proportion of individuals with Mild Cognitive Impairment (MCI) will convert to dementia. Methods currently available to identify risk for conversion do not combine enough sensitivity and specificity, which is even more problematic in low-educated populations. Current guidelines suggest the use of combined markers for dementia to enhance the prediction accuracy of assessment methods. The present study adhered to this proposal and investigated the sensitivity and specificity of the electrophysiological component P300 and standard neuropsychological tests to assess patients with Alzheimer's disease (AD) and MCI recruited from a low-income country. The neuropsychological battery comprised tests of memory, attention, language, praxis, and executive functions. The P300 was recorded using a classical visual odd-ball paradigm. Three variables were found to achieve sensitivity and specificity values above 80% (Immediate and Delayed recall of word list - CERAD - and the latency of P300) for both MCI and AD. When they entered the model together (i.e., combined approach) the sensitivity for MCI increased to 96% and the specificity remained high (80%). Our preliminary findings suggest that the combined use of sensitive neuropsychological tasks and the analysis of the P300 may offer a very useful method for the preclinical assessment of AD, particularly in populations with low socioeconomic and educational levels. Our results provide a platform and justification to employ more resources to convert P300 and related parameters into a biological marker for AD.
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Affiliation(s)
- Mario A. Parra
- Scottish Dementia Clinical Research NetworkPerth, Scotland, UK
- Human Cognitive Neuroscience, Psychology Department, University of EdinburghEdinburgh, UK
- Neuropsy and Biomedical Unit, Health Faculty, Surcolombiana UniversityNeiva, Colombia
| | | | - Hugo Fenando Urquina
- Neuropsy and Biomedical Unit, Health Faculty, Surcolombiana UniversityNeiva, Colombia
- Laboratory of Experimental Psychology and Neurosciences, Institute of Cognitive Neurology and Institute of Neuroscience, Favaloro UniversityBuenos Aires, Argentina
| | - Facundo Manes
- Laboratory of Experimental Psychology and Neurosciences, Institute of Cognitive Neurology and Institute of Neuroscience, Favaloro UniversityBuenos Aires, Argentina
| | - Agustín M. Ibáñez
- Laboratory of Experimental Psychology and Neurosciences, Institute of Cognitive Neurology and Institute of Neuroscience, Favaloro UniversityBuenos Aires, Argentina
- Laboratory of Cognitive and Social Neuroscience, Universidad Diego PortalesSantiago, Chile
- National Scientific and Technical Research CouncilBuenos Aires, Argentina
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