Performance on a dementia screening test in relation to demographic variables. Study of 5297 community residents in Taiwan
H. C. Liu, E. L. Teng, K. N. Lin, T. C. Hsu, N. W. Guo, P. Chou, H. H. Hu, W. N. Cheng and B. N. Chiang
Neurological Institute, Veterans General Hospital-Taipei, Taiwan, Republic of China.
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.
