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Study of 5297 Community Residents in Taiwan

Hsiu-Chih Liu, MD; Evelyn Lee Teng, PhD; Ker-Neng Lin, MS; Tao-Chang Hsu, MD; Nai-Wen Guo, MS; Pesus Chou, DrPH; Han-Hwa Hu, MD; Wen-Nuan Cheng, MS; Benjamin N. Chiang, MD

Arch Neurol. 1994;51(9):910-915.

Abstract
Objective
To examine the relation between performance on a dementia screening test and the demographic variables of age, education, gender, and urban vs rural residency.

Design
Community survey with cluster sampling.

Setting
One urban and one rural community from each of four geographic regions in Taiwan, Republic of China.

Participants
A total of 5265 nondemented individuals approximately equally divided between men and women and between urban and rural residency with a range in age from 41 to 88 years and in education from 0 to 20 years.

Main Outcome Measure
Score on a Chinese adaptation of the Mini-Mental State Examination.

Results:

Lower test scores were associated with older age and less education. The decrease in score with age was faster among participants who had never attended school. Better performance by men and by urban residents was found only among participants with fewer than 6 years of schooling. In this group, the magnitudes of sex and residency differences were comparable among those subjects aged 41 to 64 years and those aged 65 to 88 years. Women who had never worked outside of the home performed poorer than those who had worked outside of the home.

Conclusions
The influence of educational background on test performance is most evident in individuals with less education. Commonly used dementia screening tests may be unfair to poorly educated individuals, especially women and rural residents. Efforts should be made to develop ecologically relevant cognitive tests for the intended study populations. To help distinguish test bias from different rates of cognitive decline, the study populations should include individuals in predementia age ranges.

Author Affiliations
From The Neurological Institute (Drs Liu and Hu and Mr Lin and Ms Cheng), Department of Rehabilitation (Dr Hsu and Ms Guo), and the Clinical Research Center (Dr Chiang), Veterans General Hospital—Taipei (Taiwan, Republic of China) and National Yang-Ming Medical College, Taipei; the Institute of Public Health, National Yang-Ming Medical College (Dr Chou); and the Department of Neurology, University of Southern California School of Medicine, Los Angeles (Dr Teng).

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