Cognitive Functioning and Impairment Among Rural Elderly Hispanics and Non-Hispanic Whites as Assessed by the Mini-Mental State Examination

Abstract

We conducted a cross-sectional study to determine the distribution of cognitive functioning as measured by the Mini-Mental State Examination (MMSE) among a sample of Hispanic and non-Hispanic White (NHW) residents from two counties in rural, southern Colorado. Residents aged 60 years and older (N = 1,360) were administered the full MMSE, a sociodemographic and medical interview. Protocols were developed to administer the MMSE equitably in both ethnic groups. Younger Hispanics tended to be categorized as severely impaired more than similarly aged NHWs (OR at age 70 = 4.14), however, older Hispanics and NHWs performed similarly after adjusting for education and gender (OR at age 90 = 1.00). The use of a modified MMSE scale that removed the ethnic bias demonstrated that NHWs and Hispanics had similar levels of severe impairment after full adjustment (OR = 0.93). Given the widespread use of the MMSE, these findings indicate the need for further validation of this instrument.

Prevalence of Disorders of Executive Cognitive Functioning among the Elderly: Findings from the San Luis Valley Health and Aging Study

“…We are unable to determine what this might be. It is, however, in contrast with our findings regarding mental status [48], where we found that the Hispanic excess of cognitive impairment decreased with advancing age.…”

“…Our previous work with the BDS had shown a more modest relationship between the two variables. This finding is, however, consistent with studies showing an association between grater education and intact cognitive functioning among older persons [48][49].…”

“…There were no gender differences, but the prevalence of dysexecutive impairment increased with age, so that by the 80s, over one half of the persons in our sample were impaired, with nearly one Prevalence estimates for executive cognitive impairment also increased with decreasing years of education. While the relationship between BDS score and age was expected based on previous research, including a study of MMSE performance in this same population [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]48], the strength of the correlation between education and BDS score was not anticipated. Our previous work with the BDS had shown a more modest relationship between the two variables.…”

Mild Cognitive Impairment in Hispanic Americans: An Overview of the State of the Science

“…Other results from cross-sectional studies using the MMSE in Hispanic populations have shown that stroke and diabetes may be predictors of cognitive deterioration in this population (Nguyen et al, 2002); that Hispanic persons perform significantly worse on the serial subtraction component of the MMSE (Hohl et al, 1999); that younger old Hispanics (60 -69 years old) perform worse as compared with matched non-Hispanic White control subjects (Mulgrew et al, 1999); and that modifications to the MMSE, such as season and county, may be more appropriate for Hispanics (Bird et al, 1987). Each of these studies is limited by a cross-sectional design, with the inability to draw cause-and-effect conclusions based on the results.…”

“…Although the Mini-Mental State Examination (MMSE) is not known to be a diagnostic test for MCI, it has been used in a number of studies on MCI in the Hispanic population (Bird et al, 1987;Black et al, 1999;Hohl, Grundman, Salmon, Thomas, & Thal, 1999;Mulgrew et al, 1999;Nguyen, Black, Ray, Espino, & Markides, 2002). No publication that specifically addressed the administration and scoring of either the CDR or the GDS in a Hispanic population was identified.…”