Paul R. Crisostomo|Katherine Butler|James R. Webster|Maureen Moran
Prevalence of Cognitive Impairment in an Urban Hispanic Community Population
Northwestern University
editor dementia major health problem older persons studies addressed prevalence dementia specifically among hispanics united states purpose study estimate prevalence cognitive impairment communityliving sample older urban hispanics living chicago using minimental state examination mmse convenience sample n 222 selfidentified hispanics aged 55 older administered cognitive testing nine community sites throughout chicago two bilingual medical students full 30point mmse administered subjects preferred language english 166 spanish 833 version uses appletable penny three words recall serial sevens used spelling world backwards phrase ifs ands buts translated ni si ni ni peros1 two hundred twentytwo subjects enrolled predominantly mexican origin 486 mexican ancestry born united states 203 puerto rican origin 194 closely reflects proportions hispanics chicago 38 men 171 184 women 829 mean age standard deviation overall sample 703 76 range 5592 mean education 56 45 years range 018 prevalence cognitive impairment mmse score 24 266 prevalence moderate cognitive impairment mmse score 18 104 adjusting age education 126 sample adjusted mmse score less 242 mean mmse score declined age mean 269 aged 55 64 187 aged 85 older mean mmse scores increased years schooling 209 0 1 years education 278 12 years education mean mmse scores differed significantly english 281 23 spanishspeaking 245 55 subjects p 001 mean mmse scores also differed significantly immigrants 245 54 usborn subjects 273 39 p 001 factors significantly affect mean mmse included gender p 418 diabetes mellitus p 633 hypertension p 8 smoking p 48 prevalence cognitive impairment urban communityliving hispanic population much higher average reported united states cognitive impairment increased age decreased education impairment study may reflect truly higher prevalence dementia may overestimate resulting sampling cultural test biases higher prevalence dementia plausible given relatively high rates related health problems hispanics risk factors vascular dementia selfreported history disorders indeed high study hypertension 533 diabetes mellitus 333 cigarette smoking 225 see appendix 1 however higher prevalence dementia may partially due bias mmse disadvantaged minority populations bird et al escobar et al found education significantly influenced mmse score34 study sample 617 less 7 years education resulting low levels literacy limited experience test taking investigators proposed various corrections educational cultural biases mmse murden et al postulated score less 18 low education indicator mild cognitive impairment5 mungas et al calculated statistical correction bias education age mmse scores population composed hispanics nonhispanics2 escobar et al teresi et al suggested differentially weighing removing five biased questions equal nine points46 recently many authors argued mmse score reflects real cognitive impairment secondary educational cognitive factors7 significant differences mean mmse scores english spanishspeaking subjects immigrants usborn subjects study suggest ethnic language biases may falsely lower mean total mmse score therefore need correction mmse score whether modification cutoff statistical adjustment removal biased items likely appropriate prevent artificially high reported prevalence cognitive impairment groups sample studied limitations study include convenience sampling bias lack unequivocal diagnosis dementia point prevalence cognitive impairment mmse 18 older chicago hispanics probably reflects truly high prevalence dementia despite cultural educational biases mmse test resources need directed toward study dementia rapidly growing underserved hispanic population