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The influence of education and social class on the diagnosis of dementia in a community population

Published online by Cambridge University Press:  09 July 2009

D. W. O'Connor*
Affiliation:
Hughes Hall and Department of Community Medicine, University of Cambridge
P. A. Pollitt
Affiliation:
Hughes Hall and Department of Community Medicine, University of Cambridge
F. P. Treasure
Affiliation:
Hughes Hall and Department of Community Medicine, University of Cambridge
*
1Address for correspondence: Professor D. W. O'Connor, Monash University Heatherton Hospital, Private Bag 8, Cheltenham, Victoria 3192, Australia.

Synopsis

We have reported previously that poorly educated elderly people and those of low social class were at much increased risk of scoring below the customary cut-point on the Mini-Mental State Examination, a widely-used, brief cognitive screening test. As part of the same study, subjects who scored 23 or less on the MMSE out of a maximum of 30 points, and a sample of those who scored 24 or 25 points, were assessed by psychiatrists using a structured, diagnostic interview. Assuming that persons who scored 26 points or above were cognitively intact (our data suggest that 2% or less were not), neither educational attainment nor social class had any influence on the likelihood that subjects would be diagnosed as demented. Our data suggest that social and psychological factors contribute substantially to cognitive test scores and serve to emphasize the importance of detailed assessment procedures in epidemiological surveys of dementia.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1991

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References

American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd ed.APA: Washington, D.C.Google Scholar
Anthony, J. C., LeResche, L., Niaz, U., Von Korff, M. R. & Folstein, M. F. (1982). Limits of the ‘Mini-Mental State’ as a screening test for dementia and delirium among hospital patients. Psychological Medicine 12, 397408.CrossRefGoogle ScholarPubMed
Arendt, T. & Bigl, V. (1987). Alzheimer's disease as a presumptive threshold phenomenon. Neurobiology of Aging 8, 552554.CrossRefGoogle ScholarPubMed
Escobar, J. I., Burnam, A., Karno, M., Forsythe, A., Landsverk, J. & Golding, J. M. (1986). Use of the Mini-Mental State Examination (MMSE) in a community population of mixed ethnicity. Journal of Nervous and Mental Disease 174, 607614.CrossRefGoogle Scholar
Fillenbaum, G. G., Hughes, D. C., Heyman, A., George, L. K. & Blazer, D. G. (1988). Relationship of health and demographic characteristics to Mini-Mental State Examination among community residents. Psychological Medicine 18, 719726.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. & 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.CrossRefGoogle Scholar
Folstein, M. F., Anthony, J. C., Parhad, I., Duffy, B. & Gruenberg, E. M. (1985). The meaning of cognitive impairment in the elderly. Journal of the American Geriatrics Society 33, 228235.CrossRefGoogle ScholarPubMed
Gurland, B. J. (1981). The borderlands of dementia: the influence of sociocultural characteristics on rates of dementia occurring in the senium. In Clinical Aspects of Alzheimer's Disease and Senile Dementia (ed. Miller, N. E. and Cohen, G. D.), pp. 6184. Raven Press: New York.Google Scholar
Holzer, C. E., Tischler, G. L., Leaf, P. J. & Myers, J. K. (1984). An epidemiologic assessment of cognitive impairment in a community population. Research in Community and Mental Health 4, 332.Google Scholar
Jorm, A. F., Scott, R., Henderson, A. S. & Kay, D. W. K. (1988). Educational level differences on the Mini-Mental State: the role of test bias. Psychological Medicine 18, 727731.CrossRefGoogle ScholarPubMed
Kay, D. W. K., Beamish, P. & Roth, M. (1964). Old age mental disorders in Newcastle Upon Tyne. II. A study of possible social and medical causes. British Journal of Psychiatry 110, 668682.CrossRefGoogle Scholar
Kittner, S. J., White, L. R., Farmer, M. E., Wolz, M., Kaplan, E., Moes, E., Brody, J. A. & Feinleib, M. (1986). Methodological issues in screening for dementia: the problem of education adjustment. Journal of Chronic Diseases 39, 163170.CrossRefGoogle ScholarPubMed
Matsuyama, H. (1983). Incidence of neurofibrillary change, senile plaques, and granulovacuolar degeneration in aged individuals. In Alzheimer's Disease: the Standard Reference (ed. Reisberg, B.), pp. 149154. Free Press: New York.Google Scholar
Natelson, B. H., Haupt, E. J., Fleischer, E. J. & Grey, L. (1979). Temporal orientation and education: a direct relationship in normal people. Archives of Neurology 36, 444446.CrossRefGoogle ScholarPubMed
O'Connor, D. W., Pollitt, P. A., Treasure, F. P., Brook, C. P. B. & Reiss, B. B. (1989 a). The influence of education, social class and sex on Mini-Mental State scores. Psychological Medicine 19, 771776.CrossRefGoogle ScholarPubMed
O'Connor, D. W., Pollitt, P. A., Hyde, J. B., Fellowes, J. L., Miller, N. D., Brook, C. P. B., Reiss, B. B. & Roth, M. (1989 b). The prevalence of dementia as measured by the Cambridge Mental Disorders of the Elderly Examination. Acta Psychiatrica Scandinavica 79, 190198.CrossRefGoogle ScholarPubMed
O'Connor, D. W., Pollitt, P. A., Brook, C. P. B. & Reiss, B. B. (1989 c). The validity of informant histories in a community study of dementia. International Journal of Geriatric Psychiatry 4, 203208.CrossRefGoogle Scholar
O'Connor, D. W., Pollitt, P. A., Hyde, J. B., Fellowes, J. L., Miller, N. D., Brook, C. P. B. & Reiss, B. B. (1989 d). The reliability and validity of the Mini-Mental State in a British community survey. Journal of Psychiatric Research 23, 8796.CrossRefGoogle Scholar
O'Connor, D. W., Pollitt, P. A., Hyde, J. B., Fellowes, J. L., Miller, N. D. & Roth, M. (1990). A follow-up study of dementia diagnosed in the community using the Cambridge Mental Disorders of the Elderly Examination. Acta Psychiatrica Scandinavica 81, 7882.CrossRefGoogle ScholarPubMed
Office of Population Censuses and Surveys (1980). Classification of Occupations. HMSO: London.Google Scholar
Parsons, P. L. (1965). Mental health of Swansea's old folk. British Journal of Preventative and Social Medicine 19, 4347.Google Scholar
Roth, M., Tym, E., Mountjoy, C. Q., Huppert, F. A., Hendrie, H., Verma, S. & Goddard, R. (1986). CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry 149, 698709.CrossRefGoogle Scholar
Sokal, R. R. & Rohlf, F. J. (1981). Biometry, 2nd ed.W. H. Freeman: San Francisco.Google Scholar
Tomlinson, B. E., Blessed, G. & Roth, M. (1970). Observations on the brains of demented people. Journal of the Neurological Sciences 11, 205242.CrossRefGoogle Scholar
Wilson, B. A., Cockburn, J. & Baddeley, A. D. (1985). The Rivermead Behavioural Memory Test. Thames Valley Test Company: Reading.Google Scholar