Are our Norms “Normal”? A 4-Year Follow-Up Study of a Biracial Sample of Rural Elders With Low Education

Abstract

Conventional norms that test presumably normal elderly individuals at one point in time may include preclinical cases of dementia and therefore may be less sensitive to the presence of dementia (Sliwinski, Lipton, Buschke, & Stewart, 1996). A sample of presumably normal African American and White rural community older adults (first reported in Marcopulos, McLain, & Giuliano, 1997) were retested after approximately 4 years to develop "robust" norms for the Mini Mental State Examination, Mattis Dementia Rating Scale Fuld Object Memory Evaluation, WAIS-R Vocabulary and Block Design, Wechsler Memory Scale - Revised Logical Memory and Visual Reproduction, Raven's Colored Progressive Matrices, and Clock Drawing Test. Ninety-four out of the original 133 participants were located and agreed to be retested. Twelve of the participants retested at Time 2 showed significant decline on testing relative to their own baseline and were dropped from the recalculated norms. Participants who declined on testing tended to be older, less educated, had lower WAIS-R scores on Vocabulary and Block Design combined, had poorer IADLs and were less socially active. There was no difference in physical health status or level of depression. Recalculated group means showed little change when the participants who declined had been removed, but this left very few participants at the extremes of age (>85 years) and education (<4 years). It appears that the incidence of cognitive decline in this sample is comparable to other community samples of cognitive decline and dementia. Results are discussed in light of the practical difficulties of identifying preclinical dementia for deriving robust norms, implications for the theory of cognitive reserve, risk of cognitive decline in persons with low education and/or low premorbid mental ability and the clinical utility of utilizing education-corrected norms.

Octogenarian and centenarian performance on the Fuld Object Memory Evaluation

“…Several studies have evidenced the validity and utility of the FOME to detect memory impairment in racially diverse, urban older adults (Marcopulos & McLain, 2003;Marcopulos et al, 1997;Mast et al, 2001;Summers et al, 1995), as well as older adults with low education (Avila et al 2009;Chung & Ho, 2009), and those living in residential care facilities or independently in the community (Marcopulos & McLain, 2003;Marcopulos et al, 1997). This study confirms previous findings that the FOME is an important tool for memory assessment in African-American as well as Caucasian older adults with differing levels of education and with different residential situations.…”

“…Among individuals with low education, the test can distinguish between cognitively normal versus cognitively impaired patients and between individuals with memory deficits derived from dementia versus psychiatric illness (Marcopulos, Gripshover, Broshek, McLain, & McLain, 1999). Finally, the FOME has been established as an appropriate tool for detection of dementia, mild cognitive impairment, and other memory deficits in urban and rural communities, rehabilitation centers, and residential care facilities (Marcopulos & McLain, 2003;Marcopulos et al, 1997), and for African-American and Caucasian individuals (Marcopulos & McLain, 2003;Marcopulos et al, 1997;Mast, Fitzgerald, Steinberg, MacNeill & Lichtenberg, 2001). The test has been validated and used to detect dementia in samples of older adults from Brazil (Lopes, Ferrioli, Nakano, Litvoc, & Bottino, 2012), Latin America (Loewnstein, Duara, Argulles, & Arguelles, 1995), and China (Chung, 2009).…”

Financial decision-making abilities and financial exploitation in older African Americans: Preliminary validity evidence for the Lichtenberg Financial Decision Rating Scale (LFDRS)

“…The study also demonstrated that the MMSE is more specific for the older adult population than the modified MMSE, because the former also assesses verbal fluency. Furthermore, normative data for the MMSE are available for both urban and rural older adults from Caucasian and African American backgrounds (Marcopulos & McLain, 2003; Marcopulos, McLain, & Giuliano, 1997). These clinical and research findings confirm that the MMSE is an appropriate test for assessing global cognitive functioning in the oldest old population.…”

Preliminary Evidence of Validity of the Revised Criteria for Alzheimer Disease Diagnosis

“…9 Depressive and anxious symptoms were assessed with the pertinent subscales of the Brief Symptoms Inventory. 10 The neuropsychologic battery included tests tapping learning (3 objects 3 places, 11 logical memory, 12 Rey figure-delayed recall 13,14 ), short-term memory (digit and spatial span 15,16 ), language (token test 12,17 , letter, and semantic fluency 18,19 ), visuospatial abilities (Rey figure copy 13,14 ), and frontal/executive functions (Raven matrices,20,21 and Trail making test B-A 22,23 ). Scores were corrected for age and education according to Italian (case 1) or English-speaking (case 2) normative populations.…”