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Beltran-Najera I, Thompson JL, Matchanova A, Woods SP. Racial differences in scores on the HIV Dementia Scale: mediating effects of literacy and screening utility among Black and White persons with HIV disease. AIDS Care 2023; 35:1724-1731. [PMID: 36314429 PMCID: PMC10148926 DOI: 10.1080/09540121.2022.2132373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/28/2022] [Indexed: 05/01/2023]
Abstract
There are many obstacles to screening for HIV-associated neurocognitive disorders (HAND), including the influence of various sociodemographic effects on screening measures. This study examined possible racial bias on the HIV Dementia Scale (HDS) in screening for HAND among 39 Black and 84 White persons living with HIV (PLWH). Black PLWH had significantly lower raw HDS scores than White PLWH, which was mediated by lower oral word reading scores. Nevertheless, HDS scores were comparably predictive of clinical HAND diagnoses for Black and White PLWH as determined by a comprehensive battery; overall, individuals who failed the HDS were three times as likely to have HAND as compared to those who performed within normal limits (sensitivity = .26, specificity = .94). Consistent with prior literature exploring race-group differences, findings suggest that lower scores among Black PLWH compared to White PLWH on a commonly-used screening measure for HAND are partly explained by reading scores, perhaps reflecting differences in educational quality and opportunities. However, race-group differences did not affect the classification accuracy of the HDS in detecting HAND, although overall diagnostic accuracy was modest in both groups. Future work should determine the optimal neurocognitive screening methods for Black PLWH and other under-represented ethnoracial groups.
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Geissler KH, Evans V, Cooper MI, Shaw SJ, Yarrington C, Attanasio LB. Content Analysis of Patient-Facing Information Related to Preeclampsia. Womens Health Issues 2023; 33:77-86. [PMID: 36328927 PMCID: PMC9772133 DOI: 10.1016/j.whi.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous research has shown pregnant people are not knowledgeable about preeclampsia, a significant cause of maternal morbidity and mortality. This lack of knowledge may impact their ability to report symptoms, comply with recommendations, and receive appropriate follow-up care. Pregnant people commonly seek information from sources outside their treating clinician, including pregnancy-specific books and online sources. We examined commonly used preeclampsia information sources to evaluate whether pregnant people are receiving up-to-date, guideline-based information. METHODS We conducted a content analysis of preeclampsia-related information in top-ranking websites and bestselling pregnancy books. We used American College of Obstetricians and Gynecologists preeclampsia guidelines to construct a codebook, which we used to examine source content completeness and accuracy. For each source, we analyzed information about preeclampsia diagnosis, patient-reported symptoms, risk factors, prevention, treatment, and complications. RESULTS Across 19 included sources (13 websites and 6 books), we found substantial variation in completeness and accuracy of preeclampsia information. We found high rates of mentions for preeclampsia symptoms. Risk factors were more commonly included in online sources than book sources. Most sources mentioned treatment options, including blood pressure medication and giving birth; however, one-third of online sources positively mentioned the nonrecommended treatment of bed rest. Prevention methods, including prenatal aspirin for high-risk pregnancies, and long-term complications of preeclampsia were infrequently mentioned. CONCLUSIONS Varying rates of accuracy in patient-facing preeclampsia information mean there is substantial room for improvement in these sources. Ensuring pregnant people receive current guideline-based information is critical for improving outcomes and implementing shared decision-making.
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Affiliation(s)
- Kimberley H Geissler
- Department of Health Promotion and Policy, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts.
| | - Valerie Evans
- Department of Health Promotion and Policy, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Michael I Cooper
- Department of Health Promotion and Policy, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Susan J Shaw
- Department of Health Promotion and Policy, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Christina Yarrington
- Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Laura B Attanasio
- Department of Health Promotion and Policy, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts
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Jin R, Pilozzi A, Huang X. Current Cognition Tests, Potential Virtual Reality Applications, and Serious Games in Cognitive Assessment and Non-Pharmacological Therapy for Neurocognitive Disorders. J Clin Med 2020; 9:E3287. [PMID: 33066242 PMCID: PMC7602094 DOI: 10.3390/jcm9103287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022] Open
Abstract
As the global population ages, the incidence of major neurocognitive disorders (major NCDs), such as the most common geriatric major NCD, Alzheimer's disease (AD), has grown. Thus, the need for more definitive cognitive assessment or even effective non-pharmacological intervention for age-related NCDs is becoming more and more pressing given that no definitive diagnostics or efficacious therapeutics are currently unavailable for them. We evaluate the current state of the art of cognitive assessment for major NCDs, and then briefly glance ahead at potential application of virtual reality (VR) technologies in major NCD assessment and in cognition training of visuospatial reasoning in a 3D environment, as well as in the alleviation of depression and other symptoms of cognitive disorders. We believe that VR-based technologies have tremendous potentials in cognitive assessment and non-pharmacological therapy for major NCDs.
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Affiliation(s)
| | | | - Xudong Huang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA; (R.J.); (A.P.)
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Stoner CR, Knapp M, Luyten J, Kung C, Richards M, Long R, Rossor M. The cognitive footprint of medication: A review of cognitive assessments in clinical trials. J Clin Pharm Ther 2020; 45:874-880. [PMID: 32338773 DOI: 10.1111/jcpt.13151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/09/2020] [Accepted: 04/06/2020] [Indexed: 01/31/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Polypharmacy is common, and many medications have cognitive side effects. Such effects can be transient and subside when the drug in question is discontinued or can be long-lasting with effects present for years afterwards. Although formal assessment of cognition is feasible and often undertaken in neuropsychiatric trials, these effects are usually neglected in the evaluation of any non-neuropsychiatric health intervention. Medication effects can be assessed within a cognitive footprint framework, to account for the magnitude and the duration of cognitive side effects, with some likely to have a greater and more lasting effect than others. COMMENT Adverse event reporting suggests that many medications may be indirectly associated with cognitive effects, for example due to headaches, somnolence and 'dizziness'; however, inferring causation from adverse event reporting can be problematic. In order to better understand the impact of investigational drug and concomitant medications effect on cognition, it would be essential to ensure cognition is prioritized in drug development evaluation. It is suggested that simple instruments that can be easily incorporated into existing trial designs are used to assess the cognitive footprint of medication. WHAT IS NEW AND CONCLUSION We present an overview of existing measures of cognition that can be integrated into drug trials in order to provide a cognitive footprint. Like quality of life testing, such tests should be administered as a standard throughout the key assessment stages of the design of the trial to ensure that any effects on this equally important outcome are also documented. Furthermore, employing routine cognition testing may also enable researchers to identify unanticipated beneficial and non-beneficial effects on cognition. Provision of such a cognitive footprint profile of drugs may provide the necessary evidence to enable decision-makers to make informed decisions on risk-benefit analysis that can subsequently make trade-offs between different drug regimens.
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Affiliation(s)
- Charlotte R Stoner
- Department of Neurodegenerative Diseases, Queen Square Institute of Neurology, UCL, London, UK.,Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Jeroen Luyten
- Department of Public Health and Primary Care, KU Leuven Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Claryn Kung
- Monash Business School, Centre for Health Economics, Monash University, Clayton, Vic., Australia
| | - Marcus Richards
- Medical Research Council (MRC) Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, UCL, London, UK
| | - Raj Long
- Bill and Melinda Gates Foundation, London, UK
| | - Martin Rossor
- Department of Neurodegenerative Diseases, Queen Square Institute of Neurology, UCL, London, UK.,National Office of the Director for Dementia Research, National Institute for Health Research, UCL, London, UK
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Karim Y, Siddique AE, Hossen F, Rahman M, Mondal V, Banna HU, Hasibuzzaman MM, Hosen Z, Islam MS, Sarker MK, Nikkon F, Saud ZA, Xin L, Himeno S, Hossain K. Dose-dependent relationships between chronic arsenic exposure and cognitive impairment and serum brain-derived neurotrophic factor. ENVIRONMENT INTERNATIONAL 2019; 131:105029. [PMID: 31352261 DOI: 10.1016/j.envint.2019.105029] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Arsenic poisoning is a public health problem worldwide. A few studies have reported the effects of arsenic exposure on adult cognitive function, but with limitations in the subject selection and exposure markers. Moreover, information regarding the association between arsenic exposure and biomarker of cognitive impairment is scarce. OBJECTIVES We examined the associations between arsenic exposure and adult cognitive impairment using the Mini-Mental State Examination (MMSE) and the serum levels of brain-derived neurotrophic factor (BDNF), a potential biomarker of cognitive health status. METHODS We designed a cross-sectional study that recruited 693 adult (18-60 years old) subjects from the areas of low- and high‑arsenic exposure in rural Bangladesh. The subjects' arsenic exposure levels (drinking water, hair, and nail arsenic concentrations) were measured by inductively coupled plasma-mass spectroscopy. The Bangla version of the MMSE was used as a cognitive assessment tool. Serum BDNF (sBDNF) levels were assessed by immunoassay. RESULTS In this study, we found that average MMSE score and sBDNF level of the subjects in arsenic-endemic areas were significantly (p < 0.001 for both) lower than those of the subjects in non-endemic area. Our analyses revealed that both MMSE scores and sBDNF levels were decreased with the increasing concentrations of arsenic in drinking water, hair, and nails in a dose-dependent fashion. In regression analyses, significant associations of arsenic exposure metrics with MMSE scores and sBDNF levels were observed even after adjustment for several variables. Intriguingly, MMSE scores showed a significantly positive correlation with sBDNF levels. CONCLUSION Our findings demonstrate that chronic exposure to arsenic dose-dependently decreases cognitive function in adults, with a concomitant reduction of sBDNF levels. A decreased BDNF level may be part of the biochemical basis of chronic arsenic exposure-related cognitive impairment.
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Affiliation(s)
- Yeasir Karim
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Abu Eabrahim Siddique
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Faruk Hossen
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Mizanur Rahman
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Victor Mondal
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Hasan Ul Banna
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - M M Hasibuzzaman
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Zubaer Hosen
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia 7003, Bangladesh
| | - Md Shofikul Islam
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia 7003, Bangladesh
| | | | - Farjana Nikkon
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Zahangir Alam Saud
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Lian Xin
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima 770-8514, Japan
| | - Seiichiro Himeno
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima 770-8514, Japan
| | - Khaled Hossain
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi 6205, Bangladesh.
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Uemura K, Yamada M, Okamoto H. Effects of Active Learning on Health Literacy and Behavior in Older Adults: A Randomized Controlled Trial. J Am Geriatr Soc 2018; 66:1721-1729. [DOI: 10.1111/jgs.15458] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/26/2018] [Accepted: 04/24/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Kazuki Uemura
- Department of Liberal Arts and Sciences, Faculty of Engineering; Toyama Prefectural University; Imizu Japan
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences; University of Tsukuba; Tokyo Japan
| | - Hiroshi Okamoto
- Department of Liberal Arts and Sciences, Faculty of Engineering; Toyama Prefectural University; Imizu Japan
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Nawagi F, Söderberg M, Berggren V, Midlöv P, Ajambo A, Nakasujja N. Sociodemographic Characteristics and Health Profile of the Elderly Seeking Health Care in Kampala, Uganda. Curr Gerontol Geriatr Res 2018; 2018:4147509. [PMID: 29861722 PMCID: PMC5976942 DOI: 10.1155/2018/4147509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/11/2018] [Indexed: 12/14/2022] Open
Abstract
Aging entails health challenges globally, but pertinent data from low-income countries like Uganda remains scarce. A cross-sectional study was carried out at Mulago National Referral Hospital in Kampala, among 134 patients (38% men and 62% women) aged ≥60 years. Data was collected on sociodemographic characteristics, medical disorders, cognitive function, hearing handicap, and functional status, that is, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). The participants had high independency in BADL (89%) and IADL (75%). The most common medical conditions were bone/joint pain (35%), hypertension (24%), and visual problems (20%). More women (54%) than men (37%) reported bone and joint pain. The majority (80%) of the participants did not report any hearing handicap, and half (54%) did not have any cognitive impairment. Dependency in IADL was associated with advanced age, being female, and being financially dependent, and the risk of having a hearing handicap was higher among those above the median age (68 years). In adjusted models, the effects remained similar although statistical significance was only achieved for advanced age versus dependency in IADL (RR: 2.38, 95% CI: 1.12-5.08) and hearing handicap (RR: 2.67, 95% CI: 1.17-6.12). Thus, socioeconomic status and gender are relevant aspects when attempting to understand the health profile of the elderly in Kampala, Uganda.
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Affiliation(s)
- Faith Nawagi
- Euclid University Global Health Institute, Washington, DC, USA
| | - Martin Söderberg
- Faculty of Social Sciences, Child Rights Institute, Lund University, Lund, Sweden
| | - Vanja Berggren
- Research Group Clinical Health Promotion, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Lund University, Lund, Sweden
| | - Aidah Ajambo
- Makerere University-Johns Hopkins Research Collaboration, PMTCT Program, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda
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Abstract
UNLABELLED ABSTRACTBackground:To expand on prior literature by examining how various education parameters (performance-based reading literacy, years of education, and self-rated quality of education) relate to a cognitive screening measure's total and subscale scores of specific cognitive abilities. METHODS Black adults (age range: 55-86) were administered self-rated items years of education and quality of education, and a measure of performance-based reading literacy. The Mini-Mental State Examination (MMSE) was used to screen for overall cognitive functioning as well as performance on specific cognitive abilities. RESULTS Sixty-nine percent of the sample had reading grade levels that were less than their reported years of education. Lower years of education and worse reading literacy are associated with poorer MMSE performance, particularly on the attention and calculation subscales. CONCLUSIONS Years of education, a commonly used measure for education, may not be reflective of Black adults' educational experiences/qualities. Thus, it is important to account for the unique educational experiences of adults that could influence their MMSE performance. Incorporating quality and quantity of education will provide a more comprehensive understanding of the individual's performance on cognitive measures, specifically as it relates to sociocultural differences.
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Bernier PJ, Gourdeau C, Carmichael PH, Beauchemin JP, Verreault R, Bouchard RW, Kröger E, Laforce R. Validation and diagnostic accuracy of predictive curves for age-associated longitudinal cognitive decline in older adults. CMAJ 2017; 189:E1472-E1480. [PMID: 29203616 DOI: 10.1503/cmaj.160792] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Mini-Mental State Examination continues to be used frequently to screen for cognitive impairment in older adults, but it remains unclear how to interpret changes in its score over time to distinguish age-associated cognitive decline from an early degenerative process. We aimed to generate cognitive charts for use in clinical practice for longitudinal evaluation of age-associated cognitive decline. METHODS We used data from the Canadian Study of Health and Aging from 7569 participants aged 65 years or older who completed a Mini-Mental State Examination at baseline, and at 5 and 10 years later to develop a linear regression model for the Mini-Mental State Examination score as a function of age and education. Based on this model, we generated cognitive charts designed to optimize accuracy for distinguishing participants with dementia from healthy controls. We validated our model using a separate data set of 6501 participants from the National Alzheimer's Coordinating Center's Uniform Data Set. RESULTS For baseline measurement, the cognitive charts had a sensitivity of 80% (95% confidence interval [CI] 75% to 84%) and a specificity of 89% (95% CI 88% to 90%) for distinguishing healthy controls from participants with dementia. Similar sensitivities and specificities were observed for a decline over time greater than 1 percentile zone from the first measurement. Results in the validation sample were comparable, albeit with lower sensitivities. Negative predictive value was 99%. INTERPRETATION Our innovative model, which factors in age and education, showed validity and diagnostic accuracy for determining whether older patients show abnormal performance on serial Mini-Mental State Examination measurements. Similar to growth curves used in pediatrics, cognitive charts allow longitudinal cognitive evaluation and enable prompt initiation of investigation and treatment when appropriate.
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Affiliation(s)
- Patrick J Bernier
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Christian Gourdeau
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Pierre-Hugues Carmichael
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Jean-Pierre Beauchemin
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - René Verreault
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Rémi W Bouchard
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Edeltraut Kröger
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que
| | - Robert Laforce
- Services Gériatriques Spécialisés (Bernier), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale; CÉGEP de Limoilou (Gourdeau); Centre d'excellence sur le vieillissement de Québec (Carmichael, Verreault, Kröger); Institut universitaire de cardiologie et de pneumologie de Québec (Beauchemin); Faculté de médecine (Verreault, Laforce), Université Laval; Clinique interdisciplinaire de mémoire (Bouchard, Laforce), Centre hospitalier universitaire (CHU) de Québec; Faculté de pharmacie (Kröger), Université Laval, Québec, Que.
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Walker KA, Brown GG. HIV-associated executive dysfunction in the era of modern antiretroviral therapy: A systematic review and meta-analysis. J Clin Exp Neuropsychol 2017; 40:357-376. [PMID: 28689493 DOI: 10.1080/13803395.2017.1349879] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE While some reports suggest that HIV+ individuals continue to display executive function (EF) impairment in the era of cART, findings have been contradictory and appear to differ based on the aspect of EF being measured. To improve the understanding of how discrete executive abilities may be differentially affected or spared in the context of HIV infection, we conducted a systematic review and meta-analysis to (a) determine whether and to what extent HIV+ adults experience deficits in EFs, and (b) understand how demographic and clinical characteristics may modify the associations between HIV infection and executive abilities. METHOD Studies comparing HIV+ and HIV-uninfected groups on measures of working memory, set-shifting, inhibition, decision-making, and apathy between 2000 and 2017 were identified from three databases. Effect sizes (Cohen's d) were calculated using inverse variance weighted random effects models. Meta-regression was used to examine the moderating effect of demographic and clinical variables. RESULTS Thirty-seven studies (n = 3935 HIV+; n = 2483 HIV-uninfected) were included in the meta-analysis. Pooled effect sizes for deficits associated with HIV infection were small for domains of set-shifting (d = -0.34, 95% CI [-0.47, -0.20]) and inhibition (d = -0.31, 95% CI [-0.40, -0.21]), somewhat larger for measures of decision-making (d = -0.41, 95% CI [-0.53, -0.28]) and working memory (d = -0.42, 95% CI [-0.59, -0.29]), and largest for apathy (d = -0.87, 95% CI [-1.09, -0.66]). Meta-regression demonstrated that age, sex, education, current CD4 count, and substance dependence differentially moderated the effects of HIV infection on specific EFs. However, lower nadir CD4 count was the only variable associated with greater deficits in nearly all EF domains. CONCLUSIONS Our results suggest that discrete domains of EF may be differentially affected by HIV infection and moderating demographic and clinical variables. These findings have implications for the development of targeted cognitive remediation strategies.
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Affiliation(s)
- Keenan A Walker
- a Department of Neurology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Gregory G Brown
- b Department of Psychiatry , University of California San Diego , San Diego , CA , USA
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11
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Lopez MN, Charter RA, Mostafavi B, Nibut LP, Smith WE. Psychometric Properties of the Folstein Mini-Mental State Examination. Assessment 2016; 12:137-44. [PMID: 15914716 DOI: 10.1177/1073191105275412] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Criterion-referenced (Livingston) and norm-referenced (Gilmer-Feldt) techniques were used to measure the internal consistency reliability of Folstein’s Mini-Mental State Examination (MMSE) on a large sample (N = 418) of elderly medical patients. Two administration and scoring variants of the MMSE Attention and Calculation section (Serial 7s only and WORLD only) were investigated. Livingston reliability coefficients (r s) were calculated for a wide range of cutoff scores. As necessary for the calculation of the Gilmer-Feldt r, a factor analysis showed that the MMSE measures three cognitive domains. Livingston’s r for the most widely used MMSE cutoff score of 24 was .803 for Serial 7s and .795 for WORLD. The Gilmer-Feldt internal consistency reliability coefficient was .764 for Serial 7s and .747 for WORLD. Item analysis showed that nearly all of the MMSE items were good discriminators, but 12 were too easy. True score confidence intervals should be applied when interpreting MMSE test scores.
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Affiliation(s)
- Michael N Lopez
- Department of Veterans Affairs Healthcare System, Long Beach, California 90822, USA.
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Choosing a Reliable Cognitive Test for Community Screening of Dementia in Pakistan. AGEING INTERNATIONAL 2016. [DOI: 10.1007/s12126-015-9238-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zhang D, Wu S, Zhang Y, Yang P, MacIntyre CR, Seale H, Wang Q. Health literacy in Beijing: an assessment of adults' knowledge and skills regarding communicable diseases. BMC Public Health 2015; 15:799. [PMID: 26286549 PMCID: PMC4545561 DOI: 10.1186/s12889-015-2151-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/13/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There have been a number of studies conducted to date looking at the issue of health literacy, but none have been conducted in Beijing, China. The aim of this study was to evaluate the communicable diseases health literacy (CDHL) levels of Beijing residents towards three key areas: knowledge, adoption of preventative measures/behaviours, and health skills. METHODS A structured survey was undertaken with Beijing residents aged ≥18 years. A multistage stratified sampling approach was used to identify and recruit residents. Participants were excluded if they were foreigners, residents of Hong Kong, Macau or Taiwan, or were unable to communicate in Mandarin. RESULTS The questionnaire was completed by 11052 participants, with a moderate accuracy rate (average: 61.3 %) and a good discrimination level (average: 0.428). Cronbach's alpha was 0.748. The items were grouped into three subscales representing knowledge, adoption of preventative measures and behaviours, and health skills. Correlations of the subscales and the Total Score is significant (P < 0.01), and all the three subscales correlate strongly with the Total Score The mean CDHL score of Beijing inhabitants was 15.28. The percentage of those who were identified as having adequate CDHL was 41 %. CONCLUSIONS The total CDHL level of residents in Beijing was relatively low, particularly in those residing in the suburbs, those above 60 years of age, manual workers, and the illiterates. Gender, age-group, level of education, occupation, self-reported health status and region were all shown to be significantly predictive of CDHL. It is important that more resources are dedicated to improving the CDHL in Beijing, given the risk of emerging and re-emerging infectious diseases in the region.
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Affiliation(s)
- Daitao Zhang
- Beijing Center for Disease Prevention and Control, No.16 He Pingli Middle Street, Dongcheng District, Beijing, 100013, China.
| | - Shuangsheng Wu
- Beijing Center for Disease Prevention and Control, No.16 He Pingli Middle Street, Dongcheng District, Beijing, 100013, China.
| | - Yi Zhang
- Beijing Center for Disease Prevention and Control, No.16 He Pingli Middle Street, Dongcheng District, Beijing, 100013, China.
| | - Peng Yang
- Beijing Center for Disease Prevention and Control, No.16 He Pingli Middle Street, Dongcheng District, Beijing, 100013, China.
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, Australia.
| | - Holly Seale
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, Australia.
| | - Quanyi Wang
- Beijing Center for Disease Prevention and Control, No.16 He Pingli Middle Street, Dongcheng District, Beijing, 100013, China.
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Is bilingualism associated with a lower risk of dementia in community-living older adults? Cross-sectional and prospective analyses. Alzheimer Dis Assoc Disord 2015; 28:326-32. [PMID: 24614266 DOI: 10.1097/wad.0000000000000019] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether bilingualism is associated with dementia in cross-sectional or prospective analyses of older adults. METHODS In 1991, 1616 community-living older adults were assessed and were followed 5 years later. Measures included age, sex, education, subjective memory loss (SML), and the modified Mini-mental State Examination (3MS). Dementia was determined by clinical examination in those who scored below the cut point on the 3MS. Language status was categorized based upon self-report into 3 groups: English as a first language (monolingual English, bilingual English) and English as a Second Language (ESL). RESULTS The ESL category had lower education, lower 3MS scores, more SML, and were more likely to be diagnosed with cognitive impairment, no dementia at both time 1 and time 2 compared with those speaking English as a first language. There was no association between being bilingual (ESL and bilingual English vs. monolingual) and having dementia at time 1 in bivariate or multivariate analyses. In those who were cognitively intact at time 1, there was no association between being bilingual and having dementia at time 2 in bivariate or multivariate analyses. CONCLUSIONS We did not find any association between speaking >1 language and dementia.
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Iatraki E, Simos PG, Lionis C, Zaganas I, Symvoulakis EK, Papastefanakis E, Panagiotakis S, Pantelidakis H, Papadopoulos K, Tziraki C. Cultural adaptation, standardization and clinical validity of the test your memory dementia screening instrument in Greek. Dement Geriatr Cogn Disord 2014; 37:163-80. [PMID: 24157823 DOI: 10.1159/000355376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To adapt and standardize the Test Your Memory (TYM) dementia screening instrument in Greek. METHODS Normative data on the Greek version of the TYM were obtained from a community sample of 239 adults aged 21-92 years. Clinical validity was assessed in a cohort of 134 Neurology Clinic patients. Concurrent validity was examined through comparisons with the Mini-Mental State Examination (MMSE) and the Greek Everyday Function Scale. RESULTS Correlations between the TYM and the MMSE were 0.73 and 0.82 in the community and patient samples, respectively. Scores on both tests were moderately associated with everyday functional capacity. Using age- and education-corrected cutoff scores ranging from 26/50 to 45/50 points, the sensitivity of the TYM for Alzheimer's disease detection was found to be higher than that of the MMSE (0.82 vs. 0.70), although its specificity was lower (0.71 vs. 0.90). CONCLUSION Findings are consistent with previous reports in a variety of cultural settings supporting the potential utility of the TYM as a dementia screening tool.
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Affiliation(s)
- Eliza Iatraki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
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The impact of illiteracy on the assessment of cognition and dementia: a critical issue in the developing countries. Int Psychogeriatr 2014; 26:2051-60. [PMID: 25166718 DOI: 10.1017/s1041610214001707] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Dementia and Alzheimer's disease (AD) is considered a major public health challenge in this decade and in the future. Early detection of AD through appropriate screening tools would be valuable approach in facing the burden of disease specifically in developing societies with insufficient resources. Selecting a screening tool which is non-expensive, non-invasive and implementable by trained primary healthcare providers is the first and probably the most important step in detecting high risk individuals. The goal of this review is to address the key issues in assessment tools in developing countries with a high level of illiteracy. METHOD We set about a review on literature on the subject of cognitive function assessment among minorities, people with low or no education, and people who live in underdeveloped societies. We also reviewed the studies on validation of such tests in a new society. RESULTS The most popular assessment tools are more or less biased by the level of education; not all of them are useful for any type of dementia as they assess only some domains of cognitive function. CONCLUSION Even though people with lower level of education have a higher rate of developing dementia, cognitive function cannot be accurately assessed because of limitations of current available tools. It is strongly suggested that special attention be paid to assess them by functional scales and activity daily living scales. For a more efficient assessment, cognitive tests can also benefit from illustrative questions, proverbs, metaphors, traditions, religious rituals and historical events.
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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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Sallam K, Amr M. The use of the mini-mental state examination and the clock-drawing test for dementia in a tertiary hospital. J Clin Diagn Res 2013; 7:484-8. [PMID: 23634401 DOI: 10.7860/jcdr/2013/4203.2803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 01/17/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION An early and a quick identification of dementia is desirable to improve the overall care to the affected persons in the developing countries. The aim of this study was to evaluate the discriminative abilities of the Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT) in differentiating the demented patients from the controls and also the differentiation between the different types of dementia. PATIENTS AND METHODS This study was designed to evaluate the patients with varied types and severities of dementia, who were diagnosed by using the Clinical Dementia Rating (CDR) scale. All the patients completed the MMSE and the simplified CDT. RESULTS This study included 197 patients with an age range of 43-79 years. Fifty-one patients (25.9%) were diagnosed with Alzheimer Dementia (AD), 37 patients (18.8%) with Vascular Dementia (VD), 23 patients (11.7%) with Parkinson's Disease Dementia (PDD) and 86 patients (43.6%) with other variants of dementia. The total MMSE score of the enrolled patients was significantly lower as compared to that of the control subjects, with a non-significant difference between the varied diagnoses. The total CDT scores were significantly lower in the patients as compared to those in the controls, with significantly lower scores in the PDD group as compared to those in the AD group. The patients who had AD showed non-significantly higher CDT scores as compared to the patients who had vascular and other types of dementia. CONCLUSION A combined application of both MMSE and CDT can identify the persons with a cognitive affection and this may be a useful tool for the diagnosis of the non Alzheimer's type of dementia.
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Affiliation(s)
- Khaled Sallam
- Assistant Professor, Department of Neurology, Faculty of Medicine, Benha University , Egypt
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El Tallawy HN, Farghly WMA, Shehata GA, Rageh TA, Hakeem NA, Abo-Elfetoh N, Hegazy AM, Rayan I, El-Moselhy EA. Prevalence of dementia in Al Kharga District, New Valley Governorate, Egypt. Neuroepidemiology 2012; 38:130-7. [PMID: 22433971 DOI: 10.1159/000335655] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 12/05/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With aging, there is a parallel increase in the prevalence of dementia worldwide. The aim of this work is to determine the prevalence of dementia among the population of Al Kharga District, New Valley, Egypt. METHODS Screening of all subjects aged ≥50 years (n = 8,173 out of 62,583 inhabitants) was done through a door-to-door survey by 3 neurologists, using a short standardized Arabic screening test and a modified Mini-Mental State Examination. Suspected cases were subjected to full clinical examination, psychometric assessment using the Cognitive Abilities Screening Instrument, Instrumental Activities of Daily Living Scale, Geriatric Depression Scale, Hachinski Ischemic Score, DSM-IV-TR diagnostic criteria, neuroimaging, and laboratory investigations, when indicated. RESULTS The prevalence rate of dementia was 2.26% for the population aged ≥50 years. It increased steeply with age to a maximum of 18.48% for those aged ≥80 years. Alzheimer's disease (51.2%) was the most common subtype, followed by vascular dementia (28.7%), dementia due to general medical conditions (12.8%), and lastly dementia due to multiple etiologies (7.3%). Mild dementia was the commonest (53.7%). CONCLUSION Dementia is prevalent in Egypt as elsewhere. Detection through a door-to-door survey is the best method in developing countries for early detection of mild cases.
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Affiliation(s)
- Hamdy N El Tallawy
- Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Fuchs A, Wiese B, Altiner A, Wollny A, Pentzek M. Cued recall and other cognitive tasks to facilitate dementia recognition in primary care. J Am Geriatr Soc 2011; 60:130-5. [PMID: 22150245 DOI: 10.1111/j.1532-5415.2011.03765.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the accuracy of commonly used tasks with that of the Visual Association Test (VAT), a conceptually different test involving cued recall of pictorial stimuli, in the recognition of dementia within primary care. DESIGN A cross-sectional diagnostic study of concurrent validity. SETTING Twenty-nine German primary care practices. PARTICIPANTS Four hundred twenty-three individuals in primary care participating in a longitudinal cohort study. MEASUREMENTS Participants underwent a comprehensive neuropsychological interview. The validated clinical dementia diagnosis was used as reference standard. Index tests comprised the VAT, Mini-Cog, clock drawing, verbal fluency, episodic memory, and subjective complaints. Validity parameters were calculated; possible confounders of test performance (age, sex, education, comorbidity, depression, language) were evaluated. RESULTS Twenty-one participants (5%) had dementia according to the reference standard. The VAT distinguished dementia from nondementia with a sensitivity of 95.2% (95% confidence interval (CI) = 86.1-100.0), a specificity of 96.0% (95% CI = 94.1-97.9), a positive predictive value (PPV) of 55.6% (95% CI = 39.3-71.8), and a negative predictive value (NPV) of 99.7% (95% CI = 99.2-100.0). The next-most-accurate tasks were the Mini-Cog and immediate and delayed recall. Their sensitivity and NPV are similar to those of the VAT, but their PPV and specificity were significantly lower than those of the VAT. Age and depression affected all test scores. CONCLUSION The VAT (cued recall of pictorial material) is superior to other tasks for the recognition of dementia in terms of higher specificity and PPV. Age-specific cutoff scores may improve the validity of all tests.
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Affiliation(s)
- Angela Fuchs
- Department of General Practice, Medical Faculty, University of Dusseldorf, Dusseldorf, Germany.
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Manly JJ, Smith C, Crystal HA, Richardson J, Golub ET, Greenblatt R, Robison E, Martin EM, Young M. Relationship of ethnicity, age, education, and reading level to speed and executive function among HIV+ and HIV– women: The Women's Interagency HIV Study (WIHS) Neurocognitive Substudy. J Clin Exp Neuropsychol 2011. [DOI: https:/doi.10.1080/13803395.2010.547662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jennifer J. Manly
- a Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, and the Gertrude H. Sergievsky Center , College of Physicians and Surgeons, Columbia University , New York, NY, USA
| | - Clifford Smith
- b Oscar G. Johnson VA Medical Center , Iron Mountain, MI, USA
| | - Howard A. Crystal
- c Department of Neurology , SUNY Downstate Medical Center , Brooklyn, NY, USA
| | - Jean Richardson
- d Keck School of Medicine, University of Southern California , Los Angeles, CA, USA
| | - Elizabeth T. Golub
- e Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | - Ruth Greenblatt
- f Departments of Clinical Pharmacy, Medicine, Epidemiology, and Biostatistics , University of California San Francisco , San Francisco, CA, USA
| | | | - Eileen M. Martin
- h University of Illinois College of Medicine-Chicago , Chicago, IL, USA
| | - Mary Young
- i Department of Medicine , Georgetown University Medical Center , Washington, DC, USA
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Manly JJ, Smith C, Crystal HA, Richardson J, Golub ET, Greenblatt R, Robison E, Martin EM, Young M. Relationship of ethnicity, age, education, and reading level to speed and executive function among HIV+ and HIV- women: the Women's Interagency HIV Study (WIHS) Neurocognitive Substudy. J Clin Exp Neuropsychol 2011; 33:853-63. [PMID: 21950512 PMCID: PMC3383771 DOI: 10.1080/13803395.2010.547662] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Use of neuropsychological tests to identify HIV-associated neurocognitive dysfunction must involve normative standards that are well suited to the population of interest. Norms should be based on a population of HIV-uninfected individuals as closely matched to the HIV-infected group as possible and must include examination of the potential effects of demographic factors on test performance. This is the first study to determine the normal range of scores on measures of psychomotor speed and executive function among a large group of ethnically and educationally diverse HIV-uninfected, high-risk women, as well as their HIV-infected counterparts. Participants (n = 1,653) were administered the Trail Making Test Parts A and B (Trails A and Trails B), the Symbol Digit Modalities Test (SDMT), and the Wide Range Achievement Test-3 (WRAT-3). Among HIV-uninfected women, race/ethnicity accounted for almost 5% of the variance in cognitive test performance. The proportions ofvariance in cognitive test performance accounted for by age (13.8%), years of school (4.1%), and WRAT-3 score (11.5%) were each significant, but did not completely account for the effect of race (3%). HIV-infected women obtained lower scores than HIV-uninfected women on time to complete Trails A and B, SDMT total correct, and SDMT incidental recall score, but after adjustment for age, years of education, racial/ethnic classification, and reading level, only the difference on SDMT total correct remained significant. Results highlight the need to adjust for demographic variables when diagnosing cognitive impairment in HIV-infected women. Advantages of demographically adjusted regression equations developed using data from HIV-uninfected women are discussed.
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Affiliation(s)
- Jennifer J Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, and the Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, USA.
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Millán-Calenti JC, Tubío J, Pita-Fernández S, Rochette S, Lorenzo T, Maseda A. Cognitive impairment as predictor of functional dependence in an elderly sample. Arch Gerontol Geriatr 2011; 54:197-201. [PMID: 21397345 DOI: 10.1016/j.archger.2011.02.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 02/09/2011] [Accepted: 02/10/2011] [Indexed: 10/18/2022]
Abstract
This retrospective study determines the role of cognitive decline as a predictor of functional dependence. In a representative 600 community-dwellers aged 65 or older, we examined using a logistic regression model, the association between cognitive status (taking into account age and educational level) and dependence on basic and instrumental activities of daily living (ADL and IADL, resp.), controlling for socio-demographic variables and health conditions. The Mini-Mental State Examination (MMSE) scores were compared in participants with functional disability to perform basic and instrumental activities. Cognitive status influenced functional dependence on activities of daily living, basic (OR=4.1, 95%CI=2.7-6.1) and instrumental (OR=5.7, 95%CI=3.5-9.3), independently of gender, age, educational level and health conditions. Besides, cognitive impairment was associated with the dependence on certain basic (e.g., bathing, toileting) and instrumental (e.g., using the telephone, taking medications, and handling finances) activities. This was a gradual relationship, the highest cognitive decline implied the highest loss of ability at carrying out activities, with a larger impact on basic activities. These findings suggest that cognitive decline can be a predictor for functional dependence, independently of other variables, and turn into a very useful tool indicating the need for support.
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Affiliation(s)
- José Carlos Millán-Calenti
- Gerontology Research Group, Faculty of Health Sciences, University of A Coruña, Campus de Oza, E-15006, A Coruña, Spain.
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Effects of race and socioeconomic status on the relative influence of education and literacy on cognitive functioning. J Int Neuropsychol Soc 2009; 15:580-9. [PMID: 19573276 PMCID: PMC2722437 DOI: 10.1017/s1355617709090821] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Previous research has shown that reading ability is a stronger predictor of cognitive functioning than years of education, particularly for African Americans. The current study was designed to determine whether the relative influence of literacy and education on cognitive abilities varies as a function of race or socioeconomic status (SES). We examined the unique influence of education and reading scores on a range of cognitive tests in low- and higher-SES African Americans and Whites. Literacy significantly predicted scores on all but one cognitive measure in both African American groups and low-SES Whites, while education was not significantly associated with any cognitive measure. In contrast, both education and reading scores predicted performance on many cognitive measures in higher-SES Whites. These findings provide further evidence that reading ability better predicts cognitive functioning than years of education and suggest that disadvantages associated with racial minority status and low SES affect the relative influence of literacy and years of education on cognition.
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Federman AD, Sano M, Wolf MS, Siu AL, Halm EA. Health literacy and cognitive performance in older adults. J Am Geriatr Soc 2009; 57:1475-80. [PMID: 19515101 DOI: 10.1111/j.1532-5415.2009.02347.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the relationship between health literacy and memory and verbal fluency in older adults. DESIGN Cross-sectional cohort. SETTING Twenty senior centers and apartment buildings in New York, New York. PARTICIPANTS Independently living, English- and Spanish-speaking adults aged 60 and older (N=414). MEASUREMENTS Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). The associations between S-TOFHLA scores and immediate and delayed recall (Wechsler Memory Scale II), verbal fluency (Animal Naming), and global cognitive function (Mini-Mental State Examination, MMSE) were modeled using multivariable logistic and linear regression. RESULTS Health literacy was inadequate in 24.3% of participants. Impairment of immediate recall occurred in 20.4%; delayed recall, 15.0%; verbal fluency, 9.9%; and MMSE, 17.4%. Abnormal cognitive function was strongly associated with inadequate health literacy: immediate recall (adjusted odds ratio (AOR)=3.44, 95% confidence interval (CI)=1.71-6.94, P<.001), delayed recall (AOR=3.48, 95% CI=1.58-7.67, P=.002), and verbal fluency (AOR=3.47, 95% CI=1.44-8.38, P=.006). These associations persisted in subgroups that excluded individuals with normal age-adjusted MMSE scores. CONCLUSION Memory and verbal fluency are strongly associated with health literacy, independently of education and health status, even in those with subtle cognitive dysfunction. Reducing the cognitive burden of health information might mitigate the detrimental effects of limited health literacy in older adults. Research that examines the effect of materials modified to older adults' cognitive limitations on health literacy and health outcomes is needed.
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Affiliation(s)
- Alex D Federman
- Division of General Internal Medicine Development, Mount Sinai School of Medicine, New York, New York 10029, USA.
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Plitas A, Tucker A, Kritikos A, Walters I, Bardenhagen F. Comparative study of the cognitive performance of Greek Australian and Greek national elderly: Implications for neuropsychological practice. AUSTRALIAN PSYCHOLOGIST 2009. [DOI: 10.1080/00050060802587694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Areti Plitas
- School of Psychology, Victoria University, Melbourne, Victoria, Australia
| | - Alan Tucker
- School of Psychology, Victoria University, Melbourne, Victoria, Australia
| | - Ada Kritikos
- School of Psychology, Victoria University, Melbourne, Victoria, Australia
| | - Izabela Walters
- School of Psychology, Victoria University, Melbourne, Victoria, Australia
| | - Fiona Bardenhagen
- School of Psychology, Victoria University, Melbourne, Victoria, Australia
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Lifecourse Social Conditions and Racial and Ethnic Patterns of Cognitive Aging. Neuropsychol Rev 2008; 18:223-54. [DOI: 10.1007/s11065-008-9064-z] [Citation(s) in RCA: 240] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 11/26/2022]
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Inzelberg R, Schechtman E, Abuful A, Masarwa M, Mazarib A, Strugatsky R, Farrer LA, Green RC, Friedland RP. Education effects on cognitive function in a healthy aged Arab population. Int Psychogeriatr 2007; 19:593-603. [PMID: 17052375 PMCID: PMC3695483 DOI: 10.1017/s1041610206004327] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 06/01/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Mini-mental State Examination (MMSE) has not been validated in Arabic speaking populations. The Brookdale Cognitive Screening Test (BCST) has been developed for use in low schooling populations. We investigated the influence of gender, education and occupation in a cognitively normal community sample which was assessed using an Arabic translation of the MMSE and the BCST. METHODS Cognitively normal subjects (n=266, 59.4% males, mean age (SD): 72.4 (5.5) years) from an Arab community in northern Israel (Wadi Ara) were evaluated. Education was categorized into levels: 1=0-4 years, 2=5-8 years, 3=9-12 years. Effects of gender, education and occupation on MMSE and BCST were analyzed by ANOVA, taking age as a covariate. RESULTS The mean MMSE score of males [26.3 (4.1)] was higher than that of females [23.6 (4.2) points]. Two-way ANOVA showed a significant interaction between gender and education on MMSE (p=0.0017) and BCST scores (p=0.0002). The effect of gender on MMSE and BCST was significant in education level 1 (p<0.0001, both tests) and level 2 (p<0.05, both tests). For education level 1, MMSE and BCST scores were higher for males, while both scores were higher for females in education level 2. The effect of occupation was not significant for both genders. CONCLUSION Education and gender influence performance when using the Arabic translation of the MMSE and BCST in cognitively normal elderly. Cognitively normal females with 0-4 years of education scored lower than males. These results should be taken into consideration in the daily use of these instruments in Arabic.
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Affiliation(s)
- Rivka Inzelberg
- Department of Neurology, Hillel Yaffe Medical Center, Hadera, Israel.
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Wright AM, Holliday RE. Interviewing cognitively impaired older adults: How useful is a Cognitive Interview? Memory 2007; 15:17-33. [PMID: 17479922 DOI: 10.1080/09658210601047351] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This research examined whether an Enhanced Cognitive Interview (ECI) and a Modified Cognitive Interview (MCI) improved 75- to 96-year-old adults' recall for a video-taped event. Specifically, we examined the effectiveness of these interviews in relation to a Structured Interview (control), and compared the performance of older adults who scored high or low on the Mini-Mental State Examination (MMSE), which is a test to assess cognitive functioning. Participants with low MMSE scores recalled fewer correct details, and were less accurate than those with high scores. Nevertheless, both high and low MMSE groups reported substantially more correct information about Action, Person, Object, and Surrounding details with the MCI and ECI than with the SI. No corresponding increase in the amount of incorrect and confabulated information was found. Furthermore, recall accuracy for both groups was greater with the ECI and MCI than with the Structured Interview. Overall, findings suggest that older individuals, including those with reduced cognitive ability can benefit from the use of Cognitive Interview protocols.
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Affiliation(s)
- Allison M Wright
- Department of Psychology, Keynes College, University of Portsmouth, UK.
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Schillinger D, Machtinger EL, Wang F, Palacios J, Rodriguez M, Bindman A. Language, literacy, and communication regarding medication in an anticoagulation clinic: a comparison of verbal vs. visual assessment. JOURNAL OF HEALTH COMMUNICATION 2006; 11:651-64. [PMID: 17074733 DOI: 10.1080/10810730600934500] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Despite the importance of clinician-patient communication, little is known about rates and predictors of medication miscommunication. Measuring rates of miscommunication, as well as differences between verbal and visual modes of assessment, can inform efforts to more effectively communicate about medications. We studied 220 diverse patients in an anticoagulation clinic to assess concordance between patient and clinician reports of warfarin regimens. Bilingual research assistants asked patients to (1) verbalize their prescribed weekly warfarin regimen and (2) identify this regimen from a digitized color menu of warfarin pills. We obtained clinician reports of patient regimens from chart review. Patients were categorized as having regimen concordance if there were no patient-clinician discrepancies in total weekly dosage. We then examined whether verbal and visual concordance rates varied with patient's language and health literacy. Fifty percent of patients achieved verbal concordance and 66% achieved visual concordance with clinicians regarding the weekly warfarin regimen (P < .001). Being a Cantonese speaker and having inadequate health literacy were associated with a lower odds of verbal concordance compared with English speakers and subjects with adequate health literacy (AOR 0.44, 0.21-0.93, AOR 0.50, 0.26-0.99, respectively). Neither language nor health literacy was associated with visual discordance. Shifting from verbal to visual modes was associated with greater patient-provider concordance across all patient subgroups, but especially for those with communication barriers.Clinician-patient discordance regarding patients' warfarin regimen was common but occurred less frequently when patients used a visual aid. Visual aids may improve the accuracy of medication assessment, especially for patients with communication barriers.
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Affiliation(s)
- Dean Schillinger
- University of California-San Francisco, Center for Vulnerable Populations, Division of General Internal Medicine, San Francisco General Hospital, San Francisco, California 94110, USA.
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Schillinger D, Wang F, Rodriguez M, Bindman A, Machtinger EL. The importance of establishing regimen concordance in preventing medication errors in anticoagulant care. JOURNAL OF HEALTH COMMUNICATION 2006; 11:555-67. [PMID: 16950728 DOI: 10.1080/10810730600829874] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Miscommunication between patients and providers can have serious consequences, especially where medications are concerned. We examined whether regimen discordance between patient and provider, a possible result of miscommunication, contributes to unsafe medication management. We studied 220 patients taking warfarin in an anticoagulation clinic to characterize two medication assessment methods. We measured (1) adherence by asking patients to report any missed doses and (2) concordance between patients' and providers' reports of warfarin regimens. We categorized patients as having regimen adherence if they missed no doses, and concordance if there was patient-provider agreement in weekly dosage. We characterized anticoagulant outcomes as unsafe if international normalized ratio (INR) values were <2.0 (at risk for thrombosis) or >4.0 (at risk for hemorrhage), and explored relationships among adherence, concordance, and anticoagulant outcomes. One hundred fifty-five patients (71%) reported no missed doses during the prior 30 days. Poor adherence was associated with underanticoagulation (AOR 2.33, 1.56-3.45), but not overanticoagulation (AOR 1.36, 0.69-2.66). One hundred ten patients (50%) reported regimens discordant with clinicians' report. There was no relationship between patients' reports of adherence and concordance. Among adherent patients, discordance was associated with underanticoagulation (AOR 1.67, 1.00-2.78) and overanticoagulation (AOR 3.44, 1.32-9.09). Discordance regarding warfarin regimens is common and places patients at risk for adverse events. To promote safe and effective care, clinicians should separately determine adherence and regimen concordance during routine medication assessments. Systems need to be developed to ensure concordance in medication regimens.
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Affiliation(s)
- Dean Schillinger
- University of California, San Francisco Division of General Internal Medicine, San Francisco, California 94110, USA.
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Sudore RL, Yaffe K, Satterfield S, Harris TB, Mehta KM, Simonsick EM, Newman AB, Rosano C, Rooks R, Rubin SM, Ayonayon HN, Schillinger D. Limited literacy and mortality in the elderly: the health, aging, and body composition study. J Gen Intern Med 2006; 21:806-12. [PMID: 16881938 PMCID: PMC1831586 DOI: 10.1111/j.1525-1497.2006.00539.x] [Citation(s) in RCA: 304] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND While limited literacy is common and its prevalence increases with age, no prospective study has assessed whether limited literacy is associated with mortality in older adults. OBJECTIVE To assess the association of limited literacy with mortality. DESIGN AND SETTING Five-year prospective study from 1999 to 2004 of community-dwelling elders from Memphis, TN, and Pittsburgh, PA, who were from the Health, Aging, and Body Composition study. Subjects' literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine. Scores were categorized into limited (0 to 8th grade reading level) or adequate literacy (> or = 9th grade reading level). PARTICIPANTS Two thousand five hundred and twelve black and white elders without baseline functional difficulties or dementia. MEASUREMENTS Time to death. RESULTS Participants' mean age was 75.6 years, 48% were male, 38% were black, and 24% had limited literacy; the median follow-up time was 4.2 years. Compared with those with adequate literacy, those with limited literacy had a higher risk of death (19.7% vs 10.6%) with a hazard ratio (HR) of 2.03 (95% confidence intervals [CI], 1.62 to 2.55). After adjusting for demographics and socioeconomic status, co-morbid conditions, self-rated health status, health-related behaviors, health care access measures, and psychosocial status, limited literacy remained independently associated with mortality (HR 1.75; 95% CI, 1.27 to 2.41). CONCLUSIONS Limited literacy is independently associated with a nearly 2-fold increase in mortality in the elderly. Given the growth of the aging population and the prevalence of chronic diseases, the mechanisms by which limited literacy is associated with mortality in the elderly warrant further investigation.
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Sudore RL, Mehta KM, Simonsick EM, Harris TB, Newman AB, Satterfield S, Rosano C, Rooks RN, Rubin SM, Ayonayon HN, Yaffe K. Limited literacy in older people and disparities in health and healthcare access. J Am Geriatr Soc 2006; 54:770-6. [PMID: 16696742 DOI: 10.1111/j.1532-5415.2006.00691.x] [Citation(s) in RCA: 252] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the relationship between health literacy, demographics, and access to health care. DESIGN Cross-sectional study, Health, Aging and Body Composition data (1999/2000). SETTING Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS Two thousand five hundred twelve black and white community-dwelling older people who were well functioning at baseline (without functional difficulties or dementia). MEASUREMENTS Participants' health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine. Scores were categorized into 0 to sixth-, seventh- to eighth-, and ninth-grade and higher reading levels (limited health literacy defined as <9th grade). Participants' demographics, socioeconomic status, comorbidities, and three indicators of healthcare access (whether they had a doctor/regular place of medical care, an influenza vaccination within the year, or insurance for medications) were also assessed. RESULTS Participants' mean age was 75.6, 52% were female, 38% were black, and 24% had limited health literacy. After adjusting for sociodemographics, associations remained between limited health literacy and being male, being black, and having low income and education, diabetes mellitus, depressive symptoms, and fair/poor self-rated health (P<.02). After adjusting for sociodemographics, health status, and comorbidities, older people with a sixth-grade reading level or lower were twice as likely to have any of the three indicators of poor healthcare access (odds ratio=1.96, 95% confidence interval=1.34-2.88). CONCLUSION Limited health literacy was prevalent and was associated with low socioeconomic status, comorbidities, and poor access to health care, suggesting that it may be an independent risk factor for health disparities in older people.
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Affiliation(s)
- Rebecca L Sudore
- Department of Medicine, Division of Geriatrics, University of California-San Francisco, San Francisco, CA, USA.
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Greenfield SF, Sugarman DE, Nargiso J, Weiss RD. Readability of patient handout materials in a nationwide sample of alcohol and drug abuse treatment programs. Am J Addict 2005; 14:339-45. [PMID: 16188714 DOI: 10.1080/10550490591003666] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The objective of this study was to assess the readability of a nationwide sample of alcohol and drug abuse treatment programs' materials. Of 646 programs that were randomly selected from the National Clearinghouse for Alcohol and Drug Information directory, 52 programs returned completed materials. The average readability grade level of materials was 11.84 (SD = 0.94). The program staff estimations were significantly lower than actual reading levels of materials, and no program characteristics correlated with readability levels. Thus, it was concluded that materials written at high readability levels may not be effective tools for all patients. Integrating knowledge regarding program materials' readability level and literacy levels of different populations could be successful aides to substance abuse treatment.
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Affiliation(s)
- Shelly F Greenfield
- The Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, MA 02478, USA.
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Abstract
Neuropsychological testing is important for the diagnosis and follow-up of dementia; it can also help provide consultation on patient care. However, lengthy testing is costly and can be stressful to the subjects. Tests developed for members of the majority culture often are inappropriate for ethnic minorities, especially those who speak a different language, have little or no formal education, and grew up in vastly different circumstances. Variables that directly affect test performance, such as education and acculturation instead of race or ethnicity, should be considered as explanatory variables for test performance. Reading level may be a better index for educational attainment than the number of years in school. Neuropsychological testing can be improved in several directions: (1) Use tests that are appropriate for the subject's background. (2) Use detailed scoring of a smaller number of test items to reduce test time, and establish discontinuation rules to limit the subject's experience of failure. (3) Develop parallel test forms for repeated assessment of the same individuals. (4) Strive for large and representative standardization samples. (5) Use computerized test norms based on findings of statistical analysis to better adjust for confounding variables.
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Affiliation(s)
- Evelyn L Teng
- Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
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Staffen W, Schönauer U, Zauner H, Spindler I, Mair A, Iglseder B, Bernroider G, Ladurner G. Brain perfusion SPECT in patients with mild cognitive impairment and Alzheimer's disease: comparison of a semiquantitative and a visual evaluation. J Neural Transm (Vienna) 2005; 113:195-203. [PMID: 15959843 DOI: 10.1007/s00702-005-0321-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 04/17/2005] [Indexed: 11/30/2022]
Abstract
Due to the increasing importance of early recognition and differential diagnosis of dementias, cerebral perfusion scans using "single photon emission computed tomography" (SPECT) are increasingly integrated into the examination routine. The goal of this study was to check the diagnostic validity of SPECT scans of MCI- and DAT-patients, two subgroups out of 369 persons with etiologically unclear cognitive dysfunction, which underwent an assessment program for probable dementia including cognitive testing, cranial computed tomography, ultrasound, routine laboratory testing including vascular risk factors. After exclusion of patients with no or other forms of dementia we analyzed SPECT data of patients with mild cognitive impairment (MCI; n = 85) and dementia of the Alzheimer type (DAT; n = 78) in comparison with a healthy control group (n = 34).Visual assessment as well as a manual "regions of interest" (ROI) regionalization of the cortex were performed, whereby a ROI/cerebellum ratio was calculated as a semi-quantitative value. Association cortex areas were assessed regarding frontal, temporal, and parietal lobes of both hemispheres. When comparing the ratios of patients with DAT and controls, we found a statistically significant reduction of the cerebral perfusion in all measured cortex areas (p < 0.001). The comparison of patients with MCI with the selected control group also established a statistically significant difference in the cerebral perfusion for the evaluated cortex areas with the exception of the left hemispheric frontal and parietal cortex.A considerable number of the MCI patients showed an MMSE-score within the normal range, but with regard to the perfusion in the right hemispheric association cortex these patients also could be distinguished unambiguously from controls. Sensitivity levels found by visual assessment were at least as high as those found by the ROI method (pathological assessment: visual 49.4% vs. ROI 47.1% for MCI; visual 75.6% vs. ROI 73.1% for DAT). High experienced visual assessment of cerebral perfusion scans using SPECT provides an useful additional tool in diagnosis of cognitive impairment. The used semiquantitative ROI-method is nearly equivalent and does not depend on the experience of the investigator.
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Affiliation(s)
- W Staffen
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus University, Salzburg, Austria.
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Borson S, Scanlan JM, Watanabe J, Tu SP, Lessig M. Simplifying Detection of Cognitive Impairment: Comparison of the Mini-Cog and Mini-Mental State Examination in a Multiethnic Sample. J Am Geriatr Soc 2005; 53:871-4. [PMID: 15877567 DOI: 10.1111/j.1532-5415.2005.53269.x] [Citation(s) in RCA: 207] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare detection of cognitive impairment using the Mini-Cog and Mini-Mental State Examination (MMSE) and to identify sociodemographic variables that influence detection in an ethnoculturally diverse sample. DESIGN Cross-sectional. SETTING A registry of the University of Washington Alzheimer's Disease Research Center Satellite. PARTICIPANTS A heterogeneous community sample (n=371) of predominantly ethnic minority elderly assessed using a standardized research protocol, 231 of whom met criteria for dementia or mild cognitive impairment (MCI). MEASUREMENTS Demographic data, a standardized research protocol for cognitive assessment and dementia diagnosis, MMSE, and Mini-Cog. RESULTS Both screens effectively detected cognitive impairment, the Mini-Cog slightly better than the MMSE (P<.01). Overall accuracy of classification was 83% for the Mini-Cog and 81% for the MMSE. The Mini-Cog was superior in recognizing patients with Alzheimer-type dementias (P=.05). Low education negatively affected detection using the MMSE (P<.001), whereas education did not affect the Mini-Cog, and low literacy minimally affected it. CONCLUSION The Mini-Cog detects clinically significant cognitive impairment as well as or better than the MMSE in multiethnic elderly individuals, is easier to administer to non-English speakers, and is less biased by low education and literacy.
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Affiliation(s)
- Soo Borson
- Alzheimer's Disease Research Center, University of Washington, Seattle, Washington, USA.
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Nilsson LG, Söderlund H, Berger K, Breteler M, de Ridder M, Dufouil C, Fuhrer R, Giampaoli S, Hofman A, Pajak A, Sans S, Schmidt R, Launer LJ. Cognitive Test Battery of Cascade: Tasks and Data. AGING NEUROPSYCHOLOGY AND COGNITION 2005. [DOI: 10.1080/13825580590925099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Barnes DE, Tager IB, Satariano WA, Yaffe K. The Relationship Between Literacy and Cognition in Well-Educated Elders. J Gerontol A Biol Sci Med Sci 2004; 59:390-5. [PMID: 15071084 DOI: 10.1093/gerona/59.4.m390] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Literacy is correlated with general intelligence and is often used to estimate premorbid intelligence in persons with dementia. However, little is known about the relationship between literacy and specific cognitive domains. METHODS Study participants were 664 community-living adults aged 65 years or older who were participating in a community-based study of health and function in Sonoma, California. Literacy was measured using the North American Adult Reading Test, which evaluates the ability to pronounce words with irregular spellings (such as indict). Cognitive function was assessed using a neuropsychological test battery that included the Mini-Mental State Examination and measures of attention and executive function (Trails B, Stroop, Digit Symbol), verbal learning and memory (California Verbal Learning Test), and verbal fluency (letter "s," animals). RESULTS The mean age of the participants was 76 years, 50% were women, 97% were white, and 92% had 12 or more years of education. A strong, linear association was observed between literacy and all cognitive measures (all p <.001). Results were similar after adjustment for age, sex, education, and health-related covariates and were consistent in subgroups of the study population (e.g., women vs men; English vs other native languages). Education was not associated with most cognitive measures after adjustment for literacy. CONCLUSIONS Literacy is strongly associated with cognitive function across all cognitive domains in well-educated, elderly white persons. Future studies should determine whether interventions to improve lifetime literacy may help prevent cognitive deterioration with age.
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Affiliation(s)
- Deborah E Barnes
- Department of Medicine, University of California, San Francisco, CA, USA.
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Affiliation(s)
- Jennifer J Manly
- Cognitive Neuroscience Division, GH Sergievsky Center and Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University Health Science Center, 630 West 168th Street, P&S Box 16, New York, NY 10032, USA
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Nguyen HT, Black SA, Ray LA, Espino DV, Markides KS. Cognitive impairment and mortality in older mexican americans. J Am Geriatr Soc 2003; 51:178-83. [PMID: 12558713 DOI: 10.1046/j.1532-5415.2003.51055.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the extent to which cognitive status and decline in cognitive status predict mortality in older Mexican Americans. DESIGN Longitudinal cohort. SETTING Older Mexican Americans residing in five southwestern states in the United States. PARTICIPANTS Two thousand six hundred twenty-five persons aged 65 and older living in Texas, New Mexico, Colorado, Arizona, and California. MEASUREMENTS The cognitive function of participants was assessed using the Mini-Mental State Examination (MMSE) in 1993-94 and again in 1995-96. Cognitive decline was defined using two sets of criteria: a drop to 17 or less (moderate-severe cognitive impairment) on the MMSE at 2-year follow-up and a decrease of at least four points, a threshold change in scores that was used to predict mortality in this sample. Cox proportional hazards models were conducted to examine the association between the MMSE and increased risk for mortality, after controlling for sociodemographic characteristics, medical conditions, and depressive symptoms. RESULTS Five-year mortality risk was significantly associated with persons in the moderately-severely cognitively impaired category (hazard ratio (HR) = 2.35, P <.001). Moreover, mild cognitive impairment was also predictive of mortality in older Mexicans (HR = 1.45, P <.001). Two-year declines in cognitive functioning, particularly in persons who had declined to the moderate-severe impairment category (HR = 2.23, P <.001) and those who dropped at least four points on the MMSE (HR = 1.30, P <.001), were predictive of mortality 3 years later, after controlling for important variables. CONCLUSIONS Baseline moderate-severe and mild cognitive status and 2-year decline in cognitive functioning independently predict mortality in older Mexican Americans. Although age and selected medical conditions have been reported as the more salient predictors of mortality, cognitive functioning should be considered part of identifying older persons at high risk for underlying medical conditions and mortality.
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Affiliation(s)
- Ha T Nguyen
- Center on Aging, University of Texas Medical Branch, Galveston, Texas 77555, USA
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Valle R, Lee B. Research priorities in the evolving demographic landscape of Alzheimer disease and associated dementias. Alzheimer Dis Assoc Disord 2002; 16 Suppl 2:S64-76. [PMID: 12351917 DOI: 10.1097/00002093-200200002-00006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The rapid increase of ethnically diverse late onset dementia-affected persons is bringing a special urgency to Alzheimer disease and associated disorders research. By this decade's end, non-European heritage ethnically diverse persons will account for 25% of the dementia-affected cohort and 33% by mid-century. These populations have received some attention in both dementia-focused basic biomedical and social-behavioral research. However, studies differ greatly with regard to the constructs of culture used, the methodologies used, and representativeness of the populations sampled. Moreover, social status factors are often confounded with cultural variables. Therefore, several clarifying research approaches are suggested. In biomedical research, categorically ascribed (US census type) definitions, or assumed (self-reported) ethnic group designators will not suffice where actual biophysiological sampling precision is needed. A strategy for the phenotypic sampling of cohorts is therefore suggested for this research domain. In social-behavioral research, the acceptance of a common operational definition of culture is urged. And, with reference to a specific social status confound, namely literacy, a neuroimaging research strategy is proposed to determine whether non-literates might not be misclassified relative to the determination of their actual cognitive functioning status. Additionally, two conceptual models for addressing and are briefly presented.
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Affiliation(s)
- Ramón Valle
- San Diego State University, Director, ACCORD, San Diego, California 92119-2823, USA
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Lorentz WJ, Scanlan JM, Borson S. Brief screening tests for dementia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2002; 47:723-33. [PMID: 12420650 DOI: 10.1177/070674370204700803] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare brief dementia screening tests as candidates for routine use in primary care practice. METHOD We selected screening tests that met 2 criteria: 1) administration time of 10 minutes or less in studies including individuals with, and without, dementia; and 2) performance characteristics evaluated in at least 1 community or clinical sample of older adults. We compared tests for face validity, sensitivity, and specificity in a clearly defined subject sample; for vulnerability to sociodemographic biases unrelated to dementia; for direct comparison with an accepted standard; for acceptability to patients and doctors; and for brevity and ease of administration, scoring, and interpretation by nonspecialists. RESULTS Thirteen instruments met our inclusion criteria. Very short tests (1 minute or less) proved unacceptable by several criteria. Standard instruments requiring more than 5 minutes to complete, including the best-studied Mini-Mental State Examination (MMSE), were found to be too long for routine application. Several failed other performance tests or could not be adequately assessed. Short tests taking between 2 and 5 minutes that can be administered by nonspecialists with little or no training and are relatively unbiased by language and education level appear to be superior to both shorter and longer instruments. CONCLUSIONS Three tests showed the most promise for broad application in primary care settings: the Mini-Cog, the Memory Impairment Screen, and the General Practitioner Assessment of Cognition (GPCOG). Formal practice intervention trials are now needed to validate the utility of short screens with regard to implementation, effect on rates of diagnosis and treatment of dementia patients, and outcomes for patients, families, and health care systems.
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Affiliation(s)
- Wendy J Lorentz
- University of Washington School of Medicine, Seattle, Washington, USA
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Cognitive Function: Its Relationship with Functional Status, Fitness, and Vascular and Cerebral Blood Flow. TOPICS IN GERIATRIC REHABILITATION 2002. [DOI: 10.1097/00013614-200206000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tsolaki M, Iakovidou V, Papadopoulou E, Aminta M, Nakopoulou E, Pantazi T, Kazis A. Greek validation of the seven-minute screening battery for Alzheimer's disease in the elderly. Am J Alzheimers Dis Other Demen 2002; 17:139-48. [PMID: 12083343 PMCID: PMC10833790 DOI: 10.1177/153331750201700311] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The increasing prevalence ofAlzheimer's disease (AD) suggests that there is an increasing need for accurate and easily administered screening instruments. The Seven-Minute Screen is a neurocognitive screening battery consisting of four brief tests (enhanced cued recall, temporal orientation, verbal fluency, and clock drawing). We studied 55 outpatients with probable AD, 40 healthy volunteers of comparable age, sex, and education and 31 elderly patients with other neuropsychological disorders. The aim of our study was to determine the validity and reliability of this test. Differences on individual tests were evaluated using the Student t test. (Recall: 6.4 +/- 5.02/15.38 +/- 0.95; Orientation: 48.76 +/- 42.74/0.2 +/- 0.52; Verbal: 8.2 +/- 4.94/18.05 +/- 4.63; Clock drawing: 2.07 +/- 2.56/6.03 +/- 11.25 for AD patients and control subjects, respectively). Mean scores for patients with AD and control subjects on allfour individual tests were significantly different (for each, p < 0.001). The mean time to complete the test for healthy control subjects was nine minutes and 18 seconds, for neuropsychological disorders nine minutes and six seconds, and for AD patients 13 minutes and 32 seconds (p < 0,001). Logistic regression analysis was used to determine the degree to which the battery discriminated between control subjects and patients with AD (sensitivity 92.73 percent and specificity 97.50 percent). We then separated the patients with MMSE > 20 and the same model of regression analysis was used. Sensitivity was 81.25 percent and specificity was 96.55 percent using 0.7 as the cutoff probability, and 93.75 and 96.55 percent, respectively, using 0.5 as the cutoffprobability. Neither age nor education and gender had an effect on the results. The Seven-Minute Screen appears highly sensitive to AD patients and may be useful in helping to make initial distinctions between patients with early dementia and normal elderly.
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Affiliation(s)
- Magda Tsolaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, General Hospital G. Papanicolaou, Greece
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Abstract
BACKGROUND The number of older adult drivers with dementia is expected to increase over the next few decades. This increase raises public and personal safety concerns given the higher crash rates of drivers with a dementing illness. However, the identification of drivers with a dementia who may be at risk for a crash is difficult, particularly for those in the early stages of dementia. REVIEW SUMMARY Studies examining the correlation of dementia with driving outcomes such as motor vehicle crashes are reviewed. The strengths and weaknesses of recent consensus statements, published to assist clinicians in evaluating drivers with a dementia, are discussed. The authors also review common practices currently in use by physicians to identify at-risk drivers, including mental status examinations, global dementia rating scales, specialist referral, medical evaluations, and the use of caregiver reports and other proxy measures. Legal issues, based on the role of the physician, are reviewed along with suggestions for driving cessation and education for the caregiver and family. CONCLUSIONS In patients with mild to moderate dementia, the literature indicates that physicians would have difficulty in identifying which individuals should not drive. Performance-based measures of driving skills, such as on-road driving tests, are recommended as a means of assessing driving competency.
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Affiliation(s)
- Bonnie M Dobbs
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada.
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de Silva HA, Gunatilake SB. Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka. Int J Geriatr Psychiatry 2002; 17:134-9. [PMID: 11813275 DOI: 10.1002/gps.541] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although the Sri Lankan population is ageing rapidly, dementia has not been systematically investigated here. The Mini Mental State Examination (MMSE) is a brief global instrument used to assess cognitive abilities in the elderly. OBJECTIVE This study aimed to develop and validate a Sinhalese translation of the MMSE, which could be used as a screening instrument to detect impaired cognition in an epidemiological investigation of dementia in Sri Lanka. METHODS Due to the high literacy rate in the country, the MMSE was translated and modified slightly without having to make major changes to the original version. 380 randomly selected subjects over 65 years in a semi-urban area were screened with the translated version of the MMSE. The cut-off score for cognitive impairment was taken as 17. Of the 380 subjects screened, 33 scored < or = 17, and were thus considered cases of suspected dementia. All 33 who scored < or = 17 and 24 randomly selected subjects who scored>17 on the MMSE, thus considered cognitively normal, underwent a brief clinical examination and neuropsychological assessment with the more comprehensive neuropsychiatric test battery, Cambridge Cognitive Score (CAMCOG), to determine the presence of dementia. RESULTS Evaluated against the performance at the CAMCOG, the sensitivity and specificity of the translated MMSE were 93.5% and 84.6% respectively. CONCLUSION Therefore, the Sinhalese translation of the MMSE described here is a sensitive instrument to screen for dementia in Sri Lanka.
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Affiliation(s)
- H A de Silva
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Sri Lanka.
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Baker DW, Gazmararian JA, Sudano J, Patterson M, Parker RM, Williams MV. Health literacy and performance on the Mini-Mental State Examination. Aging Ment Health 2002; 6:22-9. [PMID: 11827619 DOI: 10.1080/13607860120101121] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The objectives of the study were to determine the relationship between functional health literacy and performance on the Mini-Mental State Examination (MMSE). New Medicare managed-care enrollees aged 65 years and older, living independently in the community in four US cities (Cleveland, Houston, Tampa, and Fort Lauderdale/Miami), were eligible to participate. In-home interviews were conducted to determine demographics and health status, and interviewers then administered the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the MMSE. We then determined the relationship between functional health literacy and the MMSE, including total scores, subscale scores (orientation to time, orientation to place, registration, attention and calculation, recall, language, and visual construction), and individual items. Functional health literacy was linearly related to the total MMSE score across the entire range of S-TOFHLA scores (R(2) = 0.39, p < 0.001). This relationship between health literacy and MMSE was consistent across all MMSE subscales and individual items. Adjustment for chronic conditions and self-reported overall health did not change the relationship between health literacy and MMSE score. Health literacy was related to MMSE performance even for subscales of the MMSE that were not postulated to be directly dependent on reading ability or education (e.g. delayed recall). These results suggest that the lower MMSE scores for patients with low health literacy are only partly due to 'test bias' and also result from true differences in cognitive functioning. 'Adjusting' MMSE scores for an individual's functional health literacy may be inappropriate because it may mask true differences in cognitive functioning.
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Affiliation(s)
- D W Baker
- Center for Health Care Research and Policy and the Department of Medicine, Case Western Reserve University at MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, USA.
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Affiliation(s)
- S Vanderberg-Dent
- Rush Medical College, Rush-Illinois Masonic Family Practice Residency, Chicago, USA
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Tsolaki M, Iakovidou V, Navrozidou H, Aminta M, Pantazi T, Kazis A. Hindi Mental State Examination (HMSE) as a screening test for illiterate demented patients. Int J Geriatr Psychiatry 2000; 15:662-4. [PMID: 10918349 DOI: 10.1002/1099-1166(200007)15:7<662::aid-gps171>3.0.co;2-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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