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Bias in discriminating very mild dementia for older adults with different levels of education in Hong Kong

  • Jianfang Chang (a1) (a2), Chi-Shing Tse (a1), Grace Tak Yu Leung (a3), Ada Wai Tung Fung (a3), Kit-Tai Hau (a1), Helen Fung Kum Chiu (a3) and Linda Chiu Wa Lam (a3)...

Abstract

Background:

Education has a profound effect on older adults’ cognitive performance. In Hong Kong, some dementia screening tasks were originally designed for developed population with, on average, higher education.

Methods:

We compared the screening power of these tasks for Chinese older adults with different levels of education. Community-dwelling older adults who were healthy (N = 383) and with very mild dementia (N = 405) performed the following tasks: Mini-Mental State Examination, Alzheimer's Disease Assessment Scale-Cognitive subscales, Verbal Fluency, Abstract Thinking, and Visual/Digit Span. Logistic regression was used to examine the power of these tasks to predict Clinical Dementia Rating (CDR 0.5 vs. 0).

Results:

Logistic regression analysis showed that while the screening power of the total scores in all tasks was similar for high and low education groups, there were education biases in some items of these tasks.

Conclusion:

The differential screening power in high and low education groups was not identical across items in some tasks. Thus, in cognitive assessments, we should exercise great caution when using these potentially biased items for older adults with limited education.

Copyright

Corresponding author

Correspondence should be addressed to: Jianfang Chang, PhD, Department of Educational Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong. Phone: +852-39438226; Fax: +852-39433700. Email: ffchangpsy@gmail.com.

References

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Anderson, T., Sachdev, P. S., Brodaty, H., Trollor, J. N. and Andrews, G. (2007). Effects of sociodemographic and health variables on Mini-Mental State Examination (MMSE) scores in older Australians. American Journal of Geriatric Psychiatry, 15, 467476.
Banos, J. H. and Franklin, L. M. (2002). Factor structure of the Mini-Mental State Examination in adult psychiatric inpatients. Psychological Assessment, 14, 397400.
Borson, S., Scanlan, J. M., Watanabe, J., Tu, S. P. and Lessig, M. (2005). Simplifying detection of cognitive impairment: comparison of the Mini-Cog and Mini-Mental State Examination in a multiethnic sample. Journal of the American Geriatrics Society, 53, 871874.
Brucki, S. and Nitrini, R. (2008). Cancellation task in very low educated people. Archives of Clinical Neuropsychology, 23, 139147.
Castro-Costa, E. et al. (2009). Dimensions underlying the mini-mental state examination in a sample with low-education levels: the bambui health and aging study. American Journal of Geriatric Psychiatry, 17, 863872.
Chan, S. S. et al. (2008). Prevalence of clinically significant depressive symptoms in an epidemiologic sample of community-dwelling elders with milder 580 forms of cognitive impairment in Hong Kong SAR. International Journal of Geriatric Psychiatry, 23, 611617.
Chiu, H. F. K., Lee, H. C., Chung, W. S. and Kwong, P. K. (1994). Reliability and validity of the Cantonese version of Mini-Mental State examination-a preliminary study. Journal of College of Psychiatrists, 4, SP2, 2528.
Chiu, H. F. K. et al. (1997). The modified Fuld Verbal Fluency Test: a validation study in Hong Kong. Journals of Gerontology Series B: Psychological Sciences and Social Science, 52, 247250.
Chiu, H. F. K. et al. (1998). Prevalence of dementia in Chinese elderly in Hong Kong. Neurology, 50, 10021009.
Chu, L. W. et al. (2000). The reliability and validity of the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog) among the elderly Chinese in Hong Kong. Annals Academy of Medicine Singapore, 29, 474485.
Chung, J. C. C. and Ho, W. S. (2009). Validation of fuld object memory evaluation for the detection of dementia in nursing home residents. Aging and Mental Health, 13, 274279.
Doraiswamy, P. M. et al. (1997). Memory, language, and praxis in Alzheimer's disease: norms for outpatient clinical trial populations. Psychopharmacology Bulletin, 33, 123128.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Hannesdóttir, K. and Snaedal, J. (2002). A study of the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) in an Icelandic elderly population. Nordic Journal of Psychiatry, 56, 201206.
Hawkins, K. A., Cromer, J. R., Piotrowski, A. S. and Pearlson, G. D. (2011). Mini-Mental State Exam performance of older African Americans: effect of age, gender, education, hypertension, diabetes, and the inclusion of serial 7s subtraction versus “world” backward on score. Archives of Clinical Neuropsychology, 26, 645652.
Hong Kong Census and Statistics Department. (2011). Population Census 2011. Available at: http://www.census2011.gov.hk/en/main-table.html; last accessed 11 February 2014.
Jaccard, J. (2001). Interaction Effects in Logistic Regression. Thousand Oaks, CA: Sage.
Jalbert, J. J., Daeillo, L. A. and Lapane, K. L. (2008). Dementia of the Alzheimer type. Epidemiologic Reviews, 30, 1534.
Jones, R. N. and Gallo, J. J. (2001). Education bias in the Mini-Mental State Examination. International Psychogeriatrics, 13, 299310.
Jones, R. N. and Gallo, J. J. (2002). Education and sex differences in the Mini-mental State Examination: effects of differential item functioning. Journals of Gerontology: B Psychological Sciences and Social Sciences, 57, 548558.
Koepsell, T. D. et al. (2008). Education, cognitive function, and severity of neuropathology in Alzheimer disease. Neurology, 70, 17321739.
Kosmidis, M. H., Zafiri, M. and Polytimou, N. (2011). Literacy versus formal schooling: influence on working memory. Archives of Clinical Neuropsychology, 26, 575582.
Lam, L. C. W. et al. (1998). Clock-face drawing, reading and setting tests in the screening of dementia in Chinese elderly adults. Journal of Gerontology: Psychological Science, 53, 353357.
Lam, L. C. W., Tam, C. W., Lui, V. W. and Chan, W. C. (2008a). Screening of mild cognitive impairment in Chinese older adults–a multi-stage validation of the Chinese abbreviated MCI (CAMCI) test. Neuroepidemiology, 30, 612.
Lam, L. C. W. et al. (2008b). Use of clinical dementia rating in detecting early cognitive deficits in a community-based sample of Chinese older persons in Hong Kong. Alzheimer Disease and Associated Disorders, 22, 153157.
Lam, L. C. W. et al. (2008c). Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong. International Psychogeriatrics, 20, 135148.
Lam, L. C. et al. (2009). Modality of physical exercise and cognitive function in Hong Kong older Chinese community. International Psychogeriatrics, 24, 4853.
Lin, K. N. et al. (2002). Cutoff scores of the cognitive abilities screening instrument, Chinese version in screening of dementia. Dementia and Geriatric Cognitive Disorders, 14, 176182.
Liu, H. C. et al. (1994). Performance on a dementia screening test in relation to demographic variables: a study of 5,297 community residents in Taiwan. Archive of Neurology, 51, 910915.
Marsh, H. W., Hau, K. T., Wen, Z., Nagengast, B. and Morin, A. J. S. (2013). Moderation. In Little, T. D. (ed.), Oxford Handbook of Quantitative Methods. New York: Oxford University Press.
Maurer, K., Ihl, R., Dierks, T. and Frölich, L. (1997). Clinical efficacy of Ginkgo biloba special extract EGb 761 in EGb 761 in dementia of the Alzheimer type. Journal of Psychiatric Research, 31, 645655.
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 24122414.
Pettersson, A. F., Olsson, E. and Wahlund, L. O. (2005). Motor function in subjects with mild cognitive impairment and early Alzheimer's disease. Dementiaand Geriatric Cognitive Disorders, 19, 299304.
Proitsi, P. et al. (2011). A Multiple Indicators Multiple Causes (MIMIC) model of Behavioural and Psychological Symptoms in Dementia (BPSD). Neurobiology of Aging, 32, 434442.
Schmand, B. et al. (1995). What is a significant score change on the Mini-Mental State examination? International Journal of Geriatric Psychiatry, 10, 411414.
Stern, Y. et al. (1994). Influence of education and occupation on the incidence of Alzheimer's disease. JAMA, 271, 10041010.
Uhlmann, R. F. and Larson, E. B. (1991). Effect of education on the Mini-Mental State Examination as a screening test for dementia. Journal of the American Geriatrics Society, 39, 876880.
U.S. Department of Health and Human Services. (2011). A Profile of Older Americans: 2011. Available at: http://www.aoa.gov/aoaroot/aging_statistics/Profile/2011/docs/2011profile.pdf; last accessed 11 February 2014.
Wechsler, D. (1999). Wechsler Adult Intelligence Scale, 3rd edn. San Antonio, TX: Harcourt Assessment.
Yassuda, M. S. et al. (2009). Neuropsychological profile of Brazilian Older Adults with heterogeneous educational backgrounds. Archives of Clinical Neuropsychology, 24, 7179.

Keywords

Bias in discriminating very mild dementia for older adults with different levels of education in Hong Kong

  • Jianfang Chang (a1) (a2), Chi-Shing Tse (a1), Grace Tak Yu Leung (a3), Ada Wai Tung Fung (a3), Kit-Tai Hau (a1), Helen Fung Kum Chiu (a3) and Linda Chiu Wa Lam (a3)...

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