Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-11T03:43:32.345Z Has data issue: false hasContentIssue false
  • English
  • Français

Differentiating illiteracy from Alzheimer's disease by using neuropsychological assessments

Published online by Cambridge University Press:  22 July 2011

Jung-Hae Youn ,
Maryse Siksou ,
R. Scott Mackin ,
Jung-Seok Choi ,
Jeanyung Chey  and
Jun-Young Lee
Jung-Hae Youn
Affiliation:
Department of Psychiatry, Seoul National University Boramae Hospital, Seoul, Korea
Maryse Siksou
Affiliation:
Department of Psychology, University of Paris – Paris 7, Paris, France
R. Scott Mackin
Affiliation:
Department of Psychiatry, University of California, San Francisco, California, USA
Jung-Seok Choi
Affiliation:
Department of Psychiatry, Seoul National University Boramae Hospital, Seoul, Korea
Jeanyung Chey
Affiliation:
Department of Psychology, Seoul National University, Seoul, Korea
Jun-Young Lee*
Affiliation:
Department of Psychiatry, Seoul National University Boramae Hospital, Seoul, Korea
*
Correspondence should be addressed to: JY Lee, Department of Psychiatry, Seoul National University Boramae Hospital, 395 Sindaebang-2-dong, Dongjak-ku, Seoul 156-707, Korea. Phone: +82-2870-2462; Fax: +82-2870-3866. Email: benji@snu.ac.kr.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: In Asia, where illiteracy rates are high, determining the degree to which neuropsychological measures can be used to identify cognitive impairment in illiterate elders is important. The aim of this study was to evaluate the effectiveness of using formal neuropsychological assessments to distinguish healthy illiterate elders from dementia patients.

Methods: We compared the cognitive performance of healthy elders who were illiterate (illiterate NC, n = 25) with those who were literate (literate NC, n = 25), literate patients with mild Alzheimer's disease (literate AD, n = 25), and illiterate patients with mild AD (illiterate AD, n = 25). Neuropsychological measures included the Mini-Mental State Examination (MMSE), the verbal fluency test, the Boston naming test, the Rosen drawing test, and the verbal learning test.

Results: In the between-group analyses, the scores on all tests, except verbal fluency and recognition memory, were lower for illiterate NC compared to the literate NC. The scores on the MMSE, Boston naming test, Rosen drawing test, and immediate free recall could not distinguish the illiterate NC from literate AD. However, the scores on all tests, except the Rosen drawing test, could distinguish illiterate NC from illiterate AD. ROC analyses showed the same pattern of results. In addition, age-, sex-, and education-matched cut-off scores of all tests, except immediate recall and delayed recall trials of the verbal learning test, showed good specificities in participants who were illiterate compared to those in participants who were literate.

Conclusion: These findings suggest that the impact of literacy on neuropsychological test performance is an important aspect of cognitive evaluations for elders who are illiterate.

Keywords

illiteracycognitionAlzheimer's diseaseneuropsychological testeducation
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 10 , December 2011 , pp. 1560 - 1568
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adrian, J. A., Alegria, , Morais, J., , J. (1995). Metaphonological abilities of spanish illiterate adults. International Journal of Psychology, 30, 329–353.CrossRefGoogle Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Press.Google Scholar
Ardila, A., Rosselli, M. and Rosas, P. (1989). Neuropsychological assessment in illiterates: visuospatial and memory abilities. Brain and Cognition, 11, 147–166.CrossRefGoogle ScholarPubMed
Ardila, A., Ostrosky-Solis, F., Rosselli, M. and Gomez, C. (2000). Age-related cognitive decline during normal aging: the complex effect of education. Archives of Clinical Neuropsychology, 15, 495–513.Google ScholarPubMed
Baiyewu, O. et al. (2005). The Stick Design test: a new measure of visuoconstructional ability. Journal of the International Neuropsychological Society, 11, 598–605.CrossRefGoogle Scholar
Carreiras, M. et al. (2009). An anatomical signature for literacy. Nature, 461, 983–986.CrossRefGoogle ScholarPubMed
Castro-Caldas, A., Petersson, K. M., Reis, A., Stone-Elander, S. and Ingvar, M. (1998). The illiterate brain: learning to read and write during childhood influences the functional organization of the adult brain. Brain, 121, 1053–1063.CrossRefGoogle ScholarPubMed
Chandler, M. J. et al. (2005). A total score for the CERAD neuropsychological battery. Neurology, 65, 102–106.CrossRefGoogle ScholarPubMed
Chaves, M. L. et al. (2007). Validity of the clinical dementia rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Disease and Associated Disorders, 21, 210–217.CrossRefGoogle ScholarPubMed
Choi, S. H. et al. (2011). Validation of the Literacy Independent Cognitive Assessment. International Psychogeriatrics, 23, 593–601.CrossRefGoogle ScholarPubMed
Collin, C., Wade, D. T., Davies, S. and Horne, V. (1988). The Barthel Index: a reliability study. International Disability Studies, 10, 61–63.CrossRefGoogle ScholarPubMed
da Silva, C. G., Petersson, K. M., Faisca, L., Ingvar, M. and Reis, A. (2004). The effects of literacy and education on the quantitative and qualitative aspects of semantic verbal fluency. Journal of Clinical and Experimental Neuropsychology, 26, 266–277.CrossRefGoogle ScholarPubMed
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, 189–198.CrossRefGoogle ScholarPubMed
Gladsjo, J. A., Schuman, C. C., Evans, J. D., Peavy, G. M., Miller, S. W. and Heaton, R. K. (1999). Norms for letter and category fluency: demographic corrections for age, education, and ethnicity. Assessment, 6, 147–178.CrossRefGoogle ScholarPubMed
Lee, D. Y. et al. (2002). A normative study of Mini-mental state examination in the Korean elderly. Journal of Korean Neuropsychiatric Association, 41, 508–525.Google Scholar
Lee, D. Y. et al. (2004). A normative study of the CERAD neuropsychological assessment battery in the Korean elderly. Journal of the International Neuropsychological Society, 10, 72–81.CrossRefGoogle ScholarPubMed
Lee, J. H. et al. (2002). Development of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K): clinical and neuropsychological assessment batteries. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 57, 47–53.CrossRefGoogle Scholar
Lee, J. Y. et al. (2008). Illiteracy and the incidence of Alzheimer's disease in the Yonchon County survey, Korea. International Psychogeriatrics, 20, 976–985.CrossRefGoogle ScholarPubMed
Lukatela, K., Malloy, P., Jenkins, M. and Cohen, R. (1998). The naming deficit in early Alzheimer's and vascular dementia. Neuropsychology, 12, 565–572.CrossRefGoogle ScholarPubMed
Mack, W. J., Freed, D. M., Williams, B. W. and Henderson, V. W. (1992). Boston Naming Test: shortened versions for use in Alzheimer's disease. Journal of Gerontology, 47, 154–158.CrossRefGoogle ScholarPubMed
Manly, J. J. et al. (1999). Effect of literacy on neuropsychological test performance in nondemented, education-matched elders. Journal of the International Neuropsychological Society, 5, 191–202.CrossRefGoogle ScholarPubMed
Moon, H. S. and Chey, J. Y. (2004). Literacy and neuropsychological functions in the older Korean adults. Journal of Korean Geriatr Psychiatry, 8, 113–120.Google Scholar
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.CrossRefGoogle ScholarPubMed
Ostrosky-Solis, F., Ardila, A., Rosselli, M., Lopez-Arango, G. and Uriel-Mendoza, V. (1998). Neuropsychological test performance in illiterate subjects. Archives of Clinical Neuropsychology, 13, 645–660.CrossRefGoogle ScholarPubMed
Pantoni, L. et al. (2005). Impact of age-related cerebral white matter changes on the transition to disability: the LADIS study: rationale, design and methodology. Neuroepidemiology, 24, 51–62.CrossRefGoogle ScholarPubMed
Petersson, K. M., Reis, A., Askelof, S., Castro-Caldas, A. and Ingvar, M. (2000). Language processing modulated by literacy: a network analysis of verbal repetition in literate and illiterate subjects. Journal of Cognitive Neuroscience, 12, 364–382.CrossRefGoogle ScholarPubMed
Petersson, K. M., Silva, C., Castro-Caldas, A., Ingvar, M. and Reis, A. (2007). Literacy: a cultural influence on functional left-right differences in the inferior parietal cortex. European Journal of Neuroscience, 26, 791–799.CrossRefGoogle ScholarPubMed
Prince, M., Acosta, D., Chiu, H., Scazufca, M. and Varghese, M. (2003). Dementia diagnosis in developing countries: a cross-cultural validation study. Lancet, 361, 909–917.CrossRefGoogle ScholarPubMed
Reis, A., Petersson, K. M., Castro-Caldas, A. and Ingvar, M. (2001). Formal schooling influences two- but not three-dimensional naming skills. Brain and Cognition, 47, 397–411.CrossRefGoogle Scholar
Reis, A., Guerreiro, M. and Petersson, K. M. (2003). A sociodemographic and neuropsychological characterization of an illiterate population. Applied Neuropsychology, 10, 191–204.CrossRefGoogle ScholarPubMed
Reis, A., Faisca, L., Ingvar, M. and Petersson, K. M. (2006). Color makes a difference: two-dimensional object naming in literate and illiterate subjects. Brain and Cognition, 60, 49–54.CrossRefGoogle ScholarPubMed
Rosen, W. (1981). The Rosen Drawing Test. Bronx, NY: Veterans Administration Medical Center.Google Scholar
Scazufca, M., Almeida, O. P., Vallada, H. P., Tasse, W. A. and Menezes, P. R. (2009). Limitations of the Mini-Mental State Examination for screening dementia in a community with low socioeconomic status: results from the Sao Paulo Ageing and Health Study. European Archives of Psychiatry and Clinical Neuroscience, 259, 8–15.CrossRefGoogle Scholar
Scheltens, P. et al. (1993). A semiquantative rating scale for the assessment of signal hyperintensities on magnetic resonance imaging. Journal of the Neurological Sciences, 114, 7–12.CrossRefGoogle ScholarPubMed
Snowdon, D. A., Greiner, L. H. and Markesbery, W. R. (2000). Linguistic ability in early life and the neuropathology of Alzheimer's disease and cerebrovascular disease: findings from the Nun Study. Annals of the New York Academy of Sciences, 903, 34–38.CrossRefGoogle ScholarPubMed
Swets, J. A. (1988). Measuring the accuracy of diagnostic systems. Science, 240, 1285–1293.CrossRefGoogle ScholarPubMed
UNESCO (2005). Global Monitoring Report on Education for All. Paris: United Nations Educational, Scientific and Cultural Organization.Google Scholar
Welsh, K. A. et al. (1994). The Consortium to Establish a Registry for Alzheimer's Disease (CERAD): Part V. A normative study of the neuropsychological battery. Neurology, 44, 609–614.CrossRefGoogle Scholar
Xu, G., Meyer, J. S., Huang, Y., Du, F., Chowdhury, M. and Quach, M. (2003). Adapting Mini-Mental State Examination for dementia screening among illiterate or minimally educated elderly Chinese. International Journal of Geriatric Psychiatry, 18, 609–616.CrossRefGoogle ScholarPubMed