Little is known about factors that predict older American Indians' performance on cognitive tests. This study examined 137 American Indian elders' performance on the MMSE and the Dementia Rating Scale-Second Edition (DRS-2). Multivariate regression identified younger age, more education, not receiving Supplemental Security Income, and frequent receipt of needed health care as predictors of better performance on the MMSE. Better performance on the DRS-2 was predicted by more education, boarding school attendance, not receiving Supplemental Security Income, and frequent receipt of needed health care. This study points to the importance of economic and educational factors on cognitive test performance among American Indian elders.Despite a dramatic increase in American Indian life expectancy in recent years, 1 remarkably little is known about the nature and frequency of cognitive impairment among older American Indians. 2 Although a few studies have examined the utility of standard neuropsychological testing in this population, [3][4][5] little is known about the performance on common neurocognitive screening measures among American Indian elders. This gap is especially noteworthy since American Indians have high rates of several conditions that increase risk for poor cognitive functioning, such as alcohol abuse and addiction, 6-8 diabetes, 9,10 traumatic brain injury, 11,12 and overweight/obesity and cardiovascular disease. 13,14 Further, American Indians are disproportionately poor (28.4% compared with 12.4% of the U.S. general population), 15 and low socioeconomic status has been linked to several factors that might affect cognitive ability. These include pre-and postnatal Address correspondence to Lori L. Jervis, 2 Partners Place, 3100 Monitor Ave., Room 100, Norman, OK 73072-7805; lori.jervis@ou.edu. This constellation of factors suggests that American Indians may be at considerable risk for the development of cognitive disorders associated with aging. As the population of older American Indians continues to increase, so does the need to develop methods by which to identify cognitive impairment and its optimal assessment in this population.
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American Indians, Dementia Prevalence, and Cognitive TestingA handful of small, non-population-based, empirical studies have examined dementia among American Indian and Canadian First Nations people. [3][4][5][18][19][20][21][22][23][24] Overall, most studies of cognitive test performance to date typically have shown little difference between Native and non-Native samples, although most of these investigations have been conducted with relatively acculturated tribes, [3][4][5]22,25 With this in mind, our work examines performance on the MMSE and the DRS-2 in a community-dwelling American Indian sample. The goal was to investigate the predictors of differential performance on these assessment instruments in this culturally unique population, since it is likely that performance reflects factors other than neurocognitive disease alone. It was hypothes...