Skip to main content Accessibility help
×
Home

Screening Older Latinos for Dementia in the Primary Care Setting

  • Ellen Grober (a1), Amy R. Ehrlich (a2), Yaritza Troche (a1), Steven Hahn (a3) and Richard B. Lipton (a1) (a4)...

Abstract

The purpose was to compare the Spanish language picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR) and the Mini Mental State Exam (MMSE) in identifying very mild dementia among Spanish speaking Latino patients. The tests and an independent diagnostic assessment were administered to 112 Latino patients free of medically diagnosed dementia from an urban primary care clinic. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to examine differences in the operating characteristics of the pFCSRT+IR and the MMSE. Cut scores were manipulated to equate sensitivities (specificities) at clinically relevant values to compare differences in specificities (sensitivities) using the Pearson Chi Square test. Youden’s index was used to select the optimal cut scores. Twenty-four of the 112 primary care patients (21%) received a research dementia diagnosis, indicating a substantial burden of unrecognized dementia. MMSE scores but not free recall scores were associated with years of education in patients free of dementia. AUC was significantly higher for free recall than for MMSE. Free recall performed significantly better than the MMSE in sensitivity and in specificity. Using optimal cut scores, patients with impaired free recall were 10 times more likely to have dementia than patients with intact recall, and patients with impaired MMSE scores were 4.5 times more likely to have dementia than patients with intact scores. These results suggest that the Spanish language pFCSRT+IR may be an effective tool for dementia screening in educationally diverse Latino primary care populations. (JINS, 2014, 20, 1–8)

Copyright

Corresponding author

Correspondence and reprint requests to: Ellen Grober, Kennedy Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461. E-mail: egrober@montefiore.org

References

Hide All
Alzheimer’s Association (2004). Hispanic/Latinos and Alzheimer’s Disease. Retrieved from http://www.alz.org/national/documents/report_sp_hispanic.pdf.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association Press.
Auriacombe, S., Helmer, C., Amieva, H., Berr, C., Dubois, B., & Dartigues, J.F. (2010). Validity of the free and cued selective reminding test in predicting dementia: The 3C Study. Neurology, 74(22), 17601767.
Blessed, G., Tomlinson, B.E., & Roth, M. (1968). The association between quantitative measures and senile changes in the cerebral gray matter of elderly subjects. British Journal of Psychiatry, 114, 797811.
Boustani, M., Peterson, B., Hanson, L., Harris, R., & Lohr, K.N. (2003). Screening for dementia in primary care: A summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 138(11), 927937.
Brayne, C., Fox, C., & Boustani, M. (2007). Dementia screening in primary care: Is it time? Journal of the American Medical Association, 298(20), 24092411. doi: 10.1001/jama.298.20.2409
Callahan, C.M., Hendrie, H.C., & Tierney, W.M. (1995). Documentation and evaluation of cognitive impairment in elderly primary care patients. Annals of Internal Medicine, 122(6), 422429.
Clark, C.M., DeCarli, C., Mungas, D., Chui, H.I., Higdon, R., Nunez, J., & van Belle, G. (2005). Earlier onset of Alzheimer disease symptoms in Latino individuals compared with anglo individuals. Archives of Neurology, 62(5), 774778. doi: 10.1001/archneur.62.5.774
Dartigues, J.F., Commenges, D., Letenneur, D., Barberger-Gateau, P., Gilleron, V., Fabrigoule, C., & Salamon, R. (1997). Cognitive predictors of dementia in elderly community residents. Neuroepidemiology, 16(1), 2939.
de Souza, L.C., Chupin, M., Lamari, F., Jardel, C., Leclercq, D., Colliot, O., & Sarazin, M. (2012). CSF tau markers are correlated with hippocampal volume in Alzheimer’s disease. Neurobiology of Aging, 33(7), 12531257. doi: 10.1016/j.neurobiolaging.2011.02.022
Derby, C.A., Burns, L.C., Wang, C., Katz, M.J., Zimmerman, M.E., L’Italien, G., & Lipton, R.B. (2013). Screening for predementia AD: Time-dependent operating characteristics of episodic memory tests. Neurology, 80(14), 13071314.
Diamond, E.L., Miller, S., Dickerson, B.C., Atri, A., DePeau, K., Fenstermacher, E., & Sperling, R.A. (2007). Relationship of fMRI activation to clinical trial memory measures in Alzheimer disease. Neurology, 69(13), 13311341. doi: 10.1212/01.wnl.0000277292.37292.69
Dubois, B., Feldman, H.H., Jacova, C., Cummings, J.L., Dekosky, S.T., Barberger-Gateau, P., & Scheltens, P. (2010). Revising the definition of Alzheimer’s disease: A new lexicon. The Lancet Neurology, 9(11), 11181127.
Dubois, B., Feldman, H.H., Jacova, C., DeKosky, S.T., Barberger-Gateau, P., Cummings, J., & Scheltens, P. (2007). Research criteria for the diagnosis of Alzheimer’s disease: Revising the NINCDS-ADRDA criteria. The Lancet Neurology, 6(8), 734.
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). The Mini-Mental State: A practical method for grading cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Freeman, M., Leach, L., Kaplan, E., Winocur, G., Schulman, K., & Delis, D. (1994). Clock drawing: A neuropsychological analysis. New York: Oxford University Press.
Galasko, D., Bennett, D. A., Sano, M., Marson, D., Kaye, J., & Edland, S. D. (2006). ADCS Prevention Instrument Project: assessment of instrumental activities of daily living for community-dwelling elderly individuals in dementia prevention clinical trials. Alzheimer Dis Assoc Disord, 20(4 Suppl. 3), S152169.
González, H.M., Tarraf, W., Gouskova, N., & Mosley, T.H. (2014). Neurocognitive function among middle-aged and older Hispanic/Latinos: Results from the Hispanic Community Health Study/Study of Latinos (unpublished manuscript).
Grober, E. (1984). Nonlinguistic memory in aphasia. Cortex, 20, 6773.
Grober, E., & Buschke, H. (1987). Genuine memory deficits in dementia. Developmental Neuropsychology. 3, 1336.
Grober, E., Buschke, H., Crystal, H., Bang, S., & Dresner, R. (1988). Screening for dementia by memory testing. Neurology, 38(6), 900903.
Grober, E., Dickson, D., Sliwinski, M.J., Buschke, H., Katz, M., Crystal, H., & Lipton, R.B. (1999). Memory and mental status correlates of modified Braak staging. Neurobiology of Aging, 20(6), 573.
Grober, E., Hall, C., Lipton, R.B., & Teresi, J. (2008). Primary care screen for early dementia. Journal of the American Geriatrics Society, 56, 206213.
Grober, E., Hall, C., McGinn, M., Nicholls, T., Stanford, S., Ehrilich, A., & Lipton, R.B. (2008). Neuropsychological strategies for detecting early dementia. Journal of the International Neuropsychological Society, 14, 130142.
Grober, E., Hall, C., Sanders, A., & Lipton, R.B. (2008). Free and cued selective reminding distinguishes Alzherimer’s disease from vascular dementia. Journal of the American Geriatrics Society, 56(5), 944946.
Grober, E., Lipton, R.B., Hall, C., & Crystal, H. (2000). Memory impairment on free and cued selective reminding predicts dementia. Neurology, 54(4), 827832.
Grober, E., Lipton, R.B., Katz, M., & Sliwinski, M. (1998). Demographic influences on free and cued selective reminding performance in older persons. Journal of Clinical and Experimental Neuropsychology, 20, 221226.
Grober, E., Sanders, A., Hall, C., & Lipton, R.B. (2010). Free and cued selective reminding identifies very mild dementia in primary care. Alzheimer Disease and Associated Disorders, 24, 284290.
Gurland, B.J., Wilder, D.E., Cross, P., Teresi, J., & Barrett, V.W. (1992). Screening scales for dementia: Toward reconciliation of conflicting cross-cultural findings. International Journal of Geriatric Psychiatry, 7(2), 105113. doi: 10.1002/gps.930070207
Haan, M.N., Mungas, D.M., Gonzalez, H.M., Ortiz, T.A., Acharya, A., & Jagust, W.J. (2003). Prevalence of dementia in older Latinos: The influence of type 2 diabetes mellitus, stroke and genetic factors. Journal of the American Geriatrics Society, 51(2), 169177. doi: doi:10.1046/j.1532-5415.2003.51054.x
Harris, D.P., Ortiz, F., Adler, F.M., Yu, K., Maines, M.L., Barba, D., & Vickrey, B.G. (2011). Challenges to screening and evaluation of memory impairment among Hispanic elders in a primary care safety net facility. [Research Support, U.S. Gov’t, Non-P.H.S.]. International Journal of Geriatric Psychiatry, 26(3), 268276.
Ivnik, R.J., Smith, G.E., & Lucas, J.A. (1997). Free and cued selective reminding test: MOANS norms. Journal of Clinical and Experimental Neuropsychology, 19, 676691.
Katz, M.J., Lipton, R.B., Hall, C.B., Zimmerman, M.E., Sanders, A.E., Verghese, J., & Derby, C.A. (2012). Age-specific and sex-specific prevalence and incidence of mild cognitive impairment, dementia, and Alzheimer dementia in blacks and whites: A report from the Einstein Aging Study. Alzheimer Disease and Associated Disorders, 26(4), 335343.
Knopman, D.S., Donohue, J.A., & Gutterman, E.M. (2000). Patterns of care in the early stages of Alzheimer’s disease: Impediments to timely diagnosis. Journal of the American Geriatrics Society, 48, 300304.
Koric, L., Ranjeva, J.P., Felician, O., Guye, M., de Anna, F., Soulier, E., & Ceccaldi, M. (2013). Cued recall measure predicts the progression of gray matter atrophy in patients with amnesic mild cognitive impairment. Dementia and Geriatric Cognitive Disorders, 36(3-4), 197210.
Lekeu, F., Van der Linden, M., Chicherio, C., Collette, F., Degueldre, C., Franck, G., & Salmon, E. (2003). Brain correlates of performance in a free/cued recall task with semantic encoding in Alzheimer disease. Alzheimer Disease and Associated Disorders, 17(1), 3545.
Lin, J.S., O’Connor, E., Rossom, R.C., Perdue, L.A., & Eckstrom, E. (2013). Screening for cognitive impairment in older adults: A systematic review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 159(9), 601612.
Lemos, R., Simoes, M.R., Santiago, B., & Santana, I. (2014). The free and cued selective reminding test: Validation for mild cognitive impairment and Alzheimer’s disease. J Neuropsychol, 3(10), 12048.
Lindenberger, U., & Reischies, F.M. (1999). Limits and potentials of intellectual functioning in old age. New York: Cambridge University Press.
Luchsinger, J.A., Reitz, C., Honig, L.S., Tang, M.X., Shea, S., & Mayeux, R. (2005). Aggregation of vascular risk factors and risk of incident Alzheimer disease. Neurology, 65(4), 545551. doi: 10.1212/01.wnl.0000172914.08967.dc
Mahieux, F., Onen, F., Berr, C., Volteau, M., Habert, M., & Legrain, S., … Pre-Al Study Group. (2009). Early detection of patients in the pre demented stage of Alzheimer’s disease: The Pre-Al study. The Journal of Nutrition, Health & Aging, 13(1), 2126. doi: 10.1007/s12603-009-0004-2
Manly, J. (2006). Deconstructing race and ethnicity: Implications for measurement and health outcomes. Medical Care, 44(11, Suppl. 3), S10S16.
Marin, G., Sabogal, F., & Vanoss, M.B. (1987). Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Science, 9, 183205.
McLaren, D.G., Sreenivasan, A., Diamond, E.L., Mitchell, M.B., Van Dijk, K.R., Deluca, A.N.,& Atri, A. (2012). Tracking cognitive change over 24 weeks with longitudinal functional magnetic resonance imaging in Alzheimer’s disease. Neuro-degenerative Diseases, 9(4), 176186. doi: 10.1159/000335876
Mejia, S., Gutierrez, L.M., Villa, A.R., & Ostrosky-Solis, F. (2004). Cognition, functional status, education, and the diagnosis of dementia and mild cognitive impairment in Spanish-speaking elderly. Applied Neuropsychology, 11(4), 194201.
Morris, J.C. (1993). Clinical dementia rating: Current version and scoring rules. Neurology, 43, 24122414.
Mungas, D. (2006). Neuropsychological assessment of Hispanic elders: Challenges and psychometric approaches. In G. Yeo & D. Gallagher-thompson (Eds.), Ethnicity and the dementias (2nd ed.), Washington, DC: Routledge.
Ortiz, F., & Fitten, L.J. (2000). Barriers to healthcare access for cognitively impaired older Hispanics. [Article]. Alzheimer Disease & Associated Disorders, 14(3), 141150.
Ostrosky-Solis, F., Lopez-Arango, G., & Ardila, A. (2000). Sensitivity and specificity of the Mini-Mental State Examination in a Spanish-speaking population. Applied Neuropsychology, 7(1), 2531.
Pena-Casanova, J., Gramunt-Fombuena, N., Quinones-Ubeda, S., Sanchez-Benavides, G., Aguilar, M., & Badenes, D., … for the NEUROORMA Study Team (2009). Spanish Multicenter Normative Studies (NEURONORMA Project): Norms for the Rey-Osterrieth complex figure (copy and memory), and free and cued selective reminding test. Archives of Clinical Neuropsychology, 24(4), 371393. doi: 10.1093/arclin/acp041
Petersen, R.C., Jack, C.R., Xu, Y.C., Waring, S.C., O’Brien, P.C., Smith, G.E., & Kokmen, E. (2000). Memory and MRI-based hippocampal volumes in aging and AD. Neurology, 54(3), 581.
Petersen, R.C., Smith, G.E., Ivnik, R.J., Kokmen, E., & Tangalos, E.G. (1994). Memory function in very early Alzheimer’s disease. Neurology, 44(5), 867872.
Petersen, R.C., Stevens, J.C., Ganguli, M., Tangalos, E.G., Cummings, J.L., & DeKosky, S.T. (2001). Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review). Neurology, 56, 11331142.
Pillon, B., Deweer, B., Agid, Y., & Dubois, B. (1993). Explicit memory in Alzheimer’s, Huntington’s, and Parkinson’s diseases. Archives of Neurology, 50(4), 374379. doi: 10.1001/archneur.50.4.374
Rami, L., Fortea, J., Bosch, B., Sole-Padulles, C., Llado, A., Iranzo, A.,& Molinuevo, J.L. (2011). Cerebrospinal fluid biomarkers and memory present distinct associations along the continuum from healthy subjects to AD patients. Journal of Alzheimers Disease, 23(2), 319326. doi: 10.3233/jad-2010-101422
Rosen, W. (1980). Verbal fluency in aging and dementia. Journal of Clinical Neuropsychology, 2, 135146.
Sano, M., Egelko, S., Jin, S., Cummings, J., Clark, C.M., & Pawluczyk, S., … the members of the Alzheimer’s Disease Cooperative Study Group. (2006). Spanish Instrument Protocol: New Treatment Efficacy Instruments for Spanish-speaking Patients in Alzheimer Disease Clinical Trials. Alzheimer Disease & Associated Disorders, 20(4), 232241.
Sarazin, M., Berr, C., De Rotrou, J., Fabrigoule, C., Pasquier, F., Legrain, S., & Dubois, B. (2007). Amnestic syndrome of the medial temporal type identifies prodromal AD: A longitudinal study. Neurology, 69(19), 18591867. doi: 10.1212/01.wnl.0000279336.36610.f7
Sarazin, M., Chauvire, V., Gerardin, E., Colliot, O., Kinkingnehun, S., De Souza, L., & Dubois, B. (2010). The amnestic syndrome of hippocampal type in Alzheimer’s disease: An MRI study. Journal of Alzheimer’s Disease, 22, 285294.
Skoog, I., Nilsson, L., Persson, G., Lernfelt, B., Landahl, S., Palmertz, B., & Svanborg, A. (1996). 15-year longitudinal study of blood pressure and dementia. The Lancet, 347(9009), 11411145.
Teresi, J.A., Golden, R.R., Cross, P., Gurland, B., Kleinman, M., & Wilder, D. (1995). Item bias in cognitive screening measures: Comparisons of elderly white, Afro-American, Hispanic and high and low education subgroups. Journal of Clinical Epidemiology, 48(4), 473.
Teresi, J.A., Stewart, A.L., Morales, L.S., & Stahl, S.M. (2006). Measurement in a multi-ethnic society: Overview to the special issue. [Editorial]. Medical Care, 44(Suppl. 3), S3S4.
Tounsi, H., Deweer, B., Ergis, A., Van der Linden, M., Pillon, B., Michon, A., &Dubois, B. (1999). Sensitivity to semantic cuing: An index of episodic memory dysfunction in early Alzheimer disease. Alzheimer Disease and Associated Disorders, 13(1), 3846.
Traykov, L., Baudic, S., Raoux, N., Latour, F., Rieu, D., Smagghe, A., & Rigaud, A.-S. (2005). Patterns of memory impairment and perseverative behavior discriminate early Alzheimer’s disease from subcortical vascular dementia. Journal of the Neurological Sciences, 75, 229230.
Wagner, M., Wolf, S., Reischies, F.M., Daerr, M., Wolfsgruber, S., Jessen, F., & Wiltfang, J. (2012). Biomarker validation of a cued recall memory deficit in prodromal Alzheimer disease. Neurology, 78(6), 379386. doi: 10.1212/WNL.0b013e318245f447
Welsh, K.A., Butters, N., Mohs, R.C., Beekly, D., Edland, S., Fillenbaum, G., & Heyman, A. (1994). The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part V. A normative study of the neuropsychological battery. Neurology, 44(4), 609614.
Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M., & Leirer, V.O. (1982–1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 3749.
Youden, W.J. (1950). Index for rating diagnostic tests. Cancer, 3(1), 3235.
Zimmerman, M.E., Pan, J.W., Hetherington, H.P., Katz, M.J., Verghese, J., Buschke, H., & Lipton, R.B. (2008). Hippocampal neurochemistry, neuromorphometry, and verbal memory in nondemented older adults. Neurology, 70(18), 15941600. doi: 10.1212/01.wnl.0000306314.77311.be

Keywords

Type Description Title
WORD
Supplementary materials

Grober Supplementary Material
Figure S1

 Word (35 KB)
35 KB
WORD
Supplementary materials

Grober Supplementary Material
Table S1

 Word (58 KB)
58 KB
WORD
Supplementary materials

Grober Supplementary Material
Table S2

 Word (19 KB)
19 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed