A useful and brief cognitive assessment for advanced dementia in a population with low levels of education

Education bias in typical brief cognitive tests used for the detection of dementia in elderly population with low educational level: a critical review

Dementia is a significant decline in cognition that interfere with independent, daily functioning. Dementia is a syndrome caused by a myriad and include primary neurologic, neuropsychiatric, and medical conditions. It has been projected that the prevalence of dementia will triple in the elderly population by the year 2050. Despite the benefits of early diagnosis, there is an effective under-detection of around 62% of people with mild cognitive impairment (MCI) or dementia. One of the factors associated with this problem is that diagnostic techniques are affected by the educational level of those evaluated. This is an important aspect to consider in the use of brief cognitive tests for the detection of dementia. This review presents and critically analyzes the available evidence regarding the effect of educational level on the diagnostic utility of three of the most widely used tools in the clinical setting: the Mini-mental Test Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Addenbrooke's Cognitive Examination (ACE). Previous evidence shows that the tasks that require reading, writing, calculation, phonological fluency, and visuoconstruction are affected by educational level. These results lead to discourage the use of these tests in older people with less than 6 years of schooling. The development of brief cognitive tests appropriate for people with a low educational level is recommended. We posit that adequate cognitive tests should not consider tasks or items that resemble characteristics of academic contexts and should be more analogous to daily activities situations.

Accuracy of two prognostic indexes to predict mortality in older adults with advanced dementia

Dementia is a cause of disability among older adults. Accessing advanced dementia prognosis is a challenge.

Cognitive Screening Instruments for Older Adults with Low Educational and Literacy Levels: A Systematic Review

This study presents a systematic review on existing cognitive screening tools for mild cognitive impairment and dementia in populations with low education and literacy levels. Cochrane Library, PubMed and LILACS databases were examined for studies including adults aged 50 years old or older with low educational level. 61 articles were included. Despite its frequent use, studies on Mini-Mental State Examination (MMSE) revealed that educational level biased the score obtained, regardless of other factors. Separately, the Informant Questionnaire on Cognitive Decline in the Elderly, the Fototest, or the Eurotest, appear to minimize the effect of education and literacy. MMSE is unreliable for individuals with low literacy. Tasks involving reading, writing, arithmetics, drawing, praxis, visuospatial, and visuoconstructive skills have a greater educational bias than naming, orientation, or memory. An adequate determination of educational level and validation of instruments in populations with heterogeneous levels of literacy requires further research.

Dealing with severe dementia in clinical practice: A validity and reliability study of Severe Mini-Mental State Examination in Greek population

Objective

Considering the floor effect problems of many cognitive instruments administered in patients with dementia, we aimed to evaluate the validity and reliability of the Severe Mini‐Mental State Examination (SMMSE) for monitoring patients with moderate to severe dementia in the Greek population.

Methods

We included 210 patients with dementia, mostly diagnosed with Alzheimer's disease, and administered the SMMSE, the Mini‐Mental State Examination (MMSE), the Global Deterioration Scale, and the Katz Activities of Daily Living Scale (ADL). Demographic effects on SMMSE, validity, and reliability properties were initially tested for the total sample; SMMSE diagnostic accuracy was examined between subgroups of patients according to their MMSE performance; longitudinal changes over a 6‐month period were assessed for a subgroup of 100 patients.

Results

None of the demographic variables correlated with SMMSE score. Reliability analysis revealed high indices regarding internal consistency, inter‐rater, and test‐retest reliability. Validity analysis showed high correlation coefficients between SMMSE, MMSE, Global Deterioration Scale, and Katz Activities of Daily Living Scale (concurrent validity) and excellent discriminant validity of SMMSE to correctly categorize patients based on their MMSE score. In the longitudinal analysis, we found significant differences (1) only on SMMSE for patients with an MMSE = 0 to 6 at baseline and (2) both on SMMSE and MMSE for patients with an MMSE = 7 to 16 at baseline. No differences were detected for patients with an MMSE = 17 to 22 at baseline.

Conclusions

We suggest the SMMSE as quick, reliable, valid, and insensitive to demographic effects psychometric instrument to monitor cognitive changes in patients with profoundly severe dementia.

Clinical evaluation of brief cognitive assessment measures for patients with severe dementia

BACKGROUND

Alzheimer's disease has become an important public health burden for older adults. Clinicians face a challenging task to efficiently evaluate cognition in dementia in clinical settings. We sought to assess the validity and inter-correlations of brief cognitive assessments in a cohort of severely demented patients.

METHODS

In total, 49 individual patients (N = 49) ranging in age from 62 to 97 years old were included in this performance improvement project. Over the course of two-three sessions, five cognitive instruments were administered to each patient: Severe Impairment Battery (SIB), Severe Impairment Battery-8 (SIB-8), Mini Mental State Examination (MMSE), Severe Mini Mental State Examination (sMMSE) and Brief Interview of Mental Status (BIMS). We sought to assess patient factors that might have been barriers to optimal performance on cognitive/functional tests. Researchers assessed her impression of the participants' difficulty comprehending instructions, distractibility, apparent fatigue, and frustration, which were the four barriers rated.

RESULTS

Data were analyzed for 49 patients from the inpatient dementia unit with a total of 51 samples. All of the inter-correlations between the five cognitive instruments had Spearman coefficients of (rs) > 0.7 and were statistically significant with p < 0.001. The SIB-8 and sMMSE were positively correlated with the SIB. The perceived barrier scores ranged from 0- no issue to 1-mild issue on all five cognitive instruments.

CONCLUSION

Brief cognitive tests designed for severe dementia such as the SIB-8 and sMMSE have been evaluated in this project to be shorter in administration duration and highly correlated with gold standard instruments: the SIB and MMSE.