Previous research has shown that the Mini-Mental State Examination (MMS) is biased as a measure of cognitive impairment in minority and low-education patients. The purpose of this study was to (1) develop a statistical correction for effects of age and education and (2) test the efficacy of the statistically adjusted MMS (MMSAdj) as a screening test for dementia using different ethnic groups and education levels. We used a population-base community survey sample (n=590) composed of 46.6% Hispanics and 53.4% non-Hispanics to derive the statistical correction, defined as:MMSAdj = Raw MMS - (0.471 X [Education-12]) + (0.131 X [Age-70]). Ethnicity and language of test administration were not significantly related to MMSAdj in the community survey sample, but the raw MMS was strongly influenced by these factors. We used an independent sample (n=2,983) of patients evaluated through the California Alzheimer's Disease Diagnostic and Treatment Centers to test the diagnostic accuracy of the MMS and the MMSAdj across low- and high-education groups and across whites, Hispanics, and blacks. Results showed greater stability of sensitivity and specificity across education levels and ethnic groups for the MMSAdj than for the raw MMS and suggest that the MMSAdj is a preferable measure of cognitive impairment for low- education and minority individuals.

Item response theory (IRT) methods were used to develop a neuropsychological test battery with matched English and Spanish language forms. Candidate items for 12 scales measuring core neuropsychological abilities were generated and administered to 200 community-dwelling elderly participants tested in Spanish and 208 tested in English. IRT methods were used to eliminate linguistically biased items and refine scales to assess broad ability ranges. Reasonably good psychometric matching of scales was achieved within and across English and Spanish language forms. All scales were sensitive to cognitive impairment as measured by the Mini-Mental State Examination (MMSE), with highly similar relationships between scale scores and MMSE across English and Spanish groups. The outcome supports the use of IRT methods in cross-cultural and multilingual test development and indicates that this strategy has potential for future neuropsychological test development.

Word-list verbal learning and memory tests with appropriate normative data can be highly sensitive to cognitive decline, but there are significant limitations of such tests available for use with older Hispanic and non-Hispanic people living in the US. The purpose of this study was to (1) create a new word-list learning and memory test in both English and Spanish and, (2) validate it with respect to sensitivity to cognitive impairment, and (3) develop statistical corrections for the effects of significant demographic variables, including ethnicity, language of administration, age, education, and gender. A community dwelling sample of 801 English-and Spanish-speaking older people was employed. Recall on learning trials and the delayed recall trial of the word-list learning test were strongly related to the Mini-Mental State Examination (MMSE), moderately related to age, and weakly related to gender and education. The relationship of word-list variables and the MMSE did not significantly differ across ethnicity0language groups. Regression coefficients for demographic variables were used in a statistical correction formula to adjust raw word-list scores, and then to develop specific percentile cut-off values. (JINS, 2001, 7, 544-555.)

The purpose of this study was to determine if the Mini-Mental State Examination (MMS; M. F. Folstein, S. E. Folstein, & P. R. McHugh, 1975) demonstrates item bias with respect to measuring cognitive functioning of older Hispanics and non-Hispanics. Assessment of differential item functioning (DIF) of individual MMS items across 3 language/ethnicity groups (English test administration/non-Hispanic ethnicity, English test administration/Hispanic ethnicity, and Spanish test administration/Hispanic ethnicity) was performed by using a logistic regression procedure. Fifteen of the 26 MMS items were significantly related to total score and were shown to provide unbiased measurement across the 3 groups. Normative data are presented for older Hispanics (n = 365) and non-Hispanics (n = 388) on the raw MMS, a 15-item version in which items with significant DIF were eliminated, and a total score statistically adjusted for effects of education and age.

This collaborative autoethnography explores how a doctoral peer writing group (PWG) has become an important means of fostering well-being among the authors, who are four doctoral scholars. Focusing on how writing in doctoral education can act as a barrier to well-being, defined as feeling part of a community, feeling balanced, and feeling motivated by forward momentum, each author shares her particular experiences with writing and how the PWG has contributed to her well-being. Based on the authors' narratives, the article also suggests how PWGs may be useful in promoting well-being across several levels of education.