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

Published online by Cambridge University Press:  26 February 2014

Jianfang Chang ,
Chi-Shing Tse ,
Grace Tak Yu Leung ,
Ada Wai Tung Fung ,
Kit-Tai Hau ,
Helen Fung Kum Chiu  and
Linda Chiu Wa Lam
Jianfang Chang*
Affiliation:
Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China Department of Psychology, Guangdong University of Education, Guangzhou, China
Chi-Shing Tse
Affiliation:
Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
Grace Tak Yu Leung
Affiliation:
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
Ada Wai Tung Fung
Affiliation:
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
Kit-Tai Hau
Affiliation:
Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China
Helen Fung Kum Chiu
Affiliation:
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
Linda Chiu Wa Lam
Affiliation:
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
*
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.
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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.

Keywords

Alzheimer's diseaseChineseclinical dementia ratingeducationHong Kong
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 6 , June 2014 , pp. 995 - 1010
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

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, 467–476.Google Scholar
Banos, J. H. and Franklin, L. M. (2002). Factor structure of the Mini-Mental State Examination in adult psychiatric inpatients. Psychological Assessment, 14, 397–400.Google Scholar
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, 871–874.Google Scholar
Brucki, S. and Nitrini, R. (2008). Cancellation task in very low educated people. Archives of Clinical Neuropsychology, 23, 139–147.Google Scholar
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, 863–872.Google Scholar
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, 611–617.Google Scholar
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, 25–28.Google Scholar
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, 247–250.Google Scholar
Chiu, H. F. K. et al. (1998). Prevalence of dementia in Chinese elderly in Hong Kong. Neurology, 50, 1002–1009.Google Scholar
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, 474–485.Google Scholar
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, 274–279.Google Scholar
Doraiswamy, P. M. et al. (1997). Memory, language, and praxis in Alzheimer's disease: norms for outpatient clinical trial populations. Psychopharmacology Bulletin, 33, 123–128.Google Scholar
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.Google Scholar
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, 201–206.Google Scholar
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, 645–652.Google Scholar
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.Google Scholar
Jaccard, J. (2001). Interaction Effects in Logistic Regression. Thousand Oaks, CA: Sage.Google Scholar
Jalbert, J. J., Daeillo, L. A. and Lapane, K. L. (2008). Dementia of the Alzheimer type. Epidemiologic Reviews, 30, 15–34.Google Scholar
Jones, R. N. and Gallo, J. J. (2001). Education bias in the Mini-Mental State Examination. International Psychogeriatrics, 13, 299–310.Google Scholar
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, 548–558.Google Scholar
Koepsell, T. D. et al. (2008). Education, cognitive function, and severity of neuropathology in Alzheimer disease. Neurology, 70, 1732–1739.Google Scholar
Kosmidis, M. H., Zafiri, M. and Polytimou, N. (2011). Literacy versus formal schooling: influence on working memory. Archives of Clinical Neuropsychology, 26, 575–582.Google Scholar
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, 353–357.Google Scholar
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, 6–12.Google Scholar
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, 153–157.Google Scholar
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, 135–148.Google Scholar
Lam, L. C. et al. (2009). Modality of physical exercise and cognitive function in Hong Kong older Chinese community. International Psychogeriatrics, 24, 48–53.Google Scholar
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, 176–182.Google Scholar
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, 910–915.Google Scholar
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.Google Scholar
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, 645–655.Google Scholar
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.Google Scholar
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, 299–304.Google Scholar
Proitsi, P. et al. (2011). A Multiple Indicators Multiple Causes (MIMIC) model of Behavioural and Psychological Symptoms in Dementia (BPSD). Neurobiology of Aging, 32, 434–442.Google Scholar
Schmand, B. et al. (1995). What is a significant score change on the Mini-Mental State examination? International Journal of Geriatric Psychiatry, 10, 411–414.Google Scholar
Stern, Y. et al. (1994). Influence of education and occupation on the incidence of Alzheimer's disease. JAMA, 271, 1004–1010.Google Scholar
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, 876–880.Google Scholar
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.Google Scholar
Wechsler, D. (1999). Wechsler Adult Intelligence Scale, 3rd edn. San Antonio, TX: Harcourt Assessment.Google Scholar
Yassuda, M. S. et al. (2009). Neuropsychological profile of Brazilian Older Adults with heterogeneous educational backgrounds. Archives of Clinical Neuropsychology, 24, 71–79.Google Scholar