Neuropsychological Test Performance in Cognitively Normal Spanish-speaking Nonagenarians with Little Education

Abstract

To find associations of age, sex, and education with neuropsychological test performance in cognitively normal Spanish-speaking Costa Rican nonagenarians with little education; to provide norms; and to compare their performance with similar Puerto Ricans. For 95 Costa Ricans (90–102 years old, 0–6 years of education), multiple regression assessed associations with demographics of performance on six neuropsychological tests. Analyses of covariance compared them with 23 Puerto Ricans (90–99 years old). Younger age and being female—but not education—were associated with better performance on some neuropsychological tests, in particular episodic memory. The Puerto Ricans performed better on learning and memory tasks. In cognitively intact Spanish-speaking nonagenarians with little or no education, education did not affect test performance. Additional studies of the effect of education on cognitive performance are warranted in other samples with extremely low education or old age. National differences in performance highlight the importance of group-specific norms.

Relationship between Cognitive Performance and Measures of Neurodegeneration among Hispanic and White Non-Hispanic Individuals with Normal Cognition, Mild Cognitive Impairment, and Dementia

“…Individuals with greater cognitive reserve may also perform at a higher level on cognitive tests and functional measures, than would otherwise be expected for the severity of their underlying neurodegenerative or vascular brain disease. In this study, no difference in cognitive reserve between the two ethnic groups would be expected, based on our findings that no statistical difference in age and education level was present between the Hispanic and WNH participants within each diagnostic group, a finding consistent with other studies (Espino et al, 2004; Gasquoine, 1999; Guerrero-Berroa et al, 2014, 2016; Uzzell, Ponton, & Ardila, 2013). …”

“…Individuals who are representative of a dominant culture in which the test was developed, may also have an advantage over those who belong to a non-dominant culture. For example, it is well known that the MMSE has poor sensitivity and specificity for identifying cognitive impairment among minority populations (Boone et al, 2007; Gasquoine, 1999; Guerrero-Berroa et al, 2016) even after accounting for other factors, such as age and educational level. Individuals with greater cognitive reserve may also perform at a higher level on cognitive tests and functional measures, than would otherwise be expected for the severity of their underlying neurodegenerative or vascular brain disease.…”

“…Studies comparing White non-Hispanics (WNHs) to ethnic minorities on tests of cognitive performance among individuals with dementia have consistently shown lower scores in memory, executive function, and overall cognitive performance among Hispanics, even when controlling for factors such as age, sex, education, and socioeconomic status (Boone, Victor, Wen, Razani, & Pontón, 2007; Castora-Binkley, Peronto, Edwards, & Small, 2015; Espino & Lewis, 1998; Espino, Lichtenstein, Palmer, & Hazuda, 2004; Gasquoine, 1999; Guerrero-Berroa et al, 2014, 2016). Among the elderly, one explanation for these differences in cognitive performance could be the greater reported prevalence of neurodegenerative disease, such as Alzheimer’s disease (AD).…”