Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-02T21:34:46.609Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact of illiteracy on the assessment of cognition and dementia: a critical issue in the developing countries

Published online by Cambridge University Press:  28 August 2014

Maryam Noroozian ,
Alia Shakiba Open the ORCID record for Alia Shakiba [Opens in a new window]  and
Shahrzad Iran-nejad
Maryam Noroozian*
Affiliation:
Neurologist, Memory and Behavioral Neurology Department, Roozbeh Hospital, Tehran University of Medical Sciences, Iran
Alia Shakiba
Affiliation:
Psychiatrist, Roozbeh Hospital, Tehran University of Medical Sciences, Iran
Shahrzad Iran-nejad
Affiliation:
Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran
*
Correspondence should be addressed to: Maryam Noroozian, MD, Associate Professor of Neurology, Director, Memory and Behavioral Neurology Department, Roozbeh Hospital, 606, South Kargar Avenue, 1333795914, Tehran, Iran. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Dementia and Alzheimer's disease (AD) is considered a major public health challenge in this decade and in the future. Early detection of AD through appropriate screening tools would be valuable approach in facing the burden of disease specifically in developing societies with insufficient resources. Selecting a screening tool which is non-expensive, non-invasive and implementable by trained primary healthcare providers is the first and probably the most important step in detecting high risk individuals. The goal of this review is to address the key issues in assessment tools in developing countries with a high level of illiteracy.

Method:

We set about a review on literature on the subject of cognitive function assessment among minorities, people with low or no education, and people who live in underdeveloped societies. We also reviewed the studies on validation of such tests in a new society.

Results:

The most popular assessment tools are more or less biased by the level of education; not all of them are useful for any type of dementia as they assess only some domains of cognitive function.

Conclusion:

Even though people with lower level of education have a higher rate of developing dementia, cognitive function cannot be accurately assessed because of limitations of current available tools. It is strongly suggested that special attention be paid to assess them by functional scales and activity daily living scales. For a more efficient assessment, cognitive tests can also benefit from illustrative questions, proverbs, metaphors, traditions, religious rituals and historical events.

Keywords

educationdementiacognitive assessmentneuropsychological testingdeveloping country
Type
Review Article
Information
International Psychogeriatrics , Volume 26 , Special Issue 12: young onset dementia , December 2014 , pp. 2051 - 2060
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ardila, A., Ostrosky-Solis, F., Rosselli, M. and Gomez, C. (2000). Age-related cognitive decline during normal aging: the complex effect of education. Archives of Clinical Neuropsychology, 15, 495–513.Google Scholar
Ardila, A. et al. (2010). Illiteracy: the neuropsychology of cognition without reading. Archives of Clinical Neuropsychology, 25, 689–712.Google Scholar
Avila, R., Moscoso, M. A. A., Ribeiz, S., Arrais, J., Jaluul, O. and Bottino, C. M. C. (2009). Influence of education and depressive symptoms on cognitive function in the elderly. International Psychogeriatrics, 21, 560–567.Google Scholar
Babacan-Yildiz, G. et al. (2013). COST: Cognitive State Test, a brief screening battery for Alzheimer disease in illiterate and literate patients. International Psychogeriatrics, 25, 403–412. International Psychogeriatrics, 25, 10.Google Scholar
Brayne, C. et al. (2010). Education, the brain and dementia: neuroprotection or compensation?: EClipSE collaborative members. Brain, 133, 2210–2216.Google Scholar
Brookmeyer, R., Gray, S. and Kawas, C. (1998). Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset. American Journal of Public Health, 88, 1337–1342.CrossRefGoogle ScholarPubMed
Brookmeyer, R., Johnson, E., Ziegler-Graham, K. and Arrighi, H. M. (2007). Forecasting the global burden of Alzheimer's disease. Alzheimers Dement, 3, 186–191.CrossRefGoogle ScholarPubMed
Brown, J. E. and Wright-Harp, W. Y. (2001). Cultural and generational factors influencing proverb recognition. Contemporary Issues in Communication Science & Disorders, 38, 26–35.Google Scholar
Brucki, S. M. D. and Nitrini, R. (2010a). Illiteracy and Dementia. Dementia and Neuropsychologia, 4, 153–157.Google Scholar
Brucki, S. M. D. and Nitrini, R. (2010b). Mini-mental state examination among lower educational levels and illiterates: transcultural evaluation. Dementia and Neuropsychologia, 4, 120–125.CrossRefGoogle ScholarPubMed
Caramelli, P., Carthery-Goulart, M. T., Porto, C. S., Charchat-Fichman, H. and Nitrini, R. (2007). Category fluency as a screening test for Alzheimer disease in illiterate and literate patients. Alzheimer Disease and Associated Disorders, 21, 65–67.CrossRefGoogle ScholarPubMed
Castro Caldas, A., Reis, A. and Guerreiro, M. (1997). Neuropsychological aspects of illiteracy. Neuropsychological Rehabilitation, 7, 327–338.Google Scholar
Chandra, V. et al. (1998). Practical issues in cognitive screening of elderly illiterate populations in developing countries. The Indo-US cross-national dementia epidemiology study. Aging (Milano), 10, 349–357.Google Scholar
Chen, J. H., Lin, K. P. and Chen, Y. C. (2009). Risk factors for dementia. Journal of the Formosan Medical Association, 108, 754–764.Google Scholar
Cordell, C. B. et al. (2013). Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the medicare annual wellness visit in a primary care setting. Alzheimer's Dementia, 9, 141–150.Google Scholar
Fichman, H. C. et al. (2009). Age and educational level effects on the performance of normal elderly on category verbal fluency tasks. Dementia and Neuropsychologia, 3, 49–54.CrossRefGoogle ScholarPubMed
Fillenbaum, G. G., Chandra, V., Ganguli, M., Pandav, R., Gilby, J. E. and Seaberg, E. C. (1999). Development of an activities daily living scale to screen dementia in an illiterate rural older population in India. Age and Aging, 28, 161–167.Google Scholar
Folia, V. and Kosmidis, M. H. (2003). Assessment of memory skills in illiterates: strategy differences or test artifact? The Clinical Neuropsychologist, 17, 143–152.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Houx, P. J. et al. (2002). Testing cognitive function in elderly populations: the PROSPER study. PROspective study of pravastatin in the elderly at risk. Journal of Neurology, Neurosurgery and Psychiatry, 73, 385–389.CrossRefGoogle ScholarPubMed
UNFPA, HelpAge International. (2012). Ageing in the Twenty-First Century, A Celebration and A Challenge. Newyork-London: UNFPA and HelpAge International.Google Scholar
Jeanette Colby, M. W. a. A. (2000). Defining quality in education. The International Working Group on Education (p. 44). Florence, Italy: UNICEF.Google Scholar
Lezak, M. D., Howieson, D. B. and Loring, D. W. (2004). Neuropsychological Assessment. New York: Oxford University Press.Google Scholar
Manly, J. J., Touradji, P., Tang, M. X. and Stern, Y. (2003). Literacy and memory decline among ethnically diverse elders. Journal of Clinical and Experimental Neuropsychology, 25, 680–690.Google Scholar
Mortamais, M. et al. (2013). Education modulates the impact of white matter lesions on the risk of mild cognitive impairment and dementia. American Journal of Geriatric Psychiatry. Advance online publication. doi: 10.1016/j.jagp.2013.06.002 Google Scholar
Munang, L. A., Chan, M. and Lim, W. S. (2010). Diagnostic performance of the clock drawing test using a pre-drawn circle in persons with early dementia. Asian Journal of Gerontology and Geriatrics, 5, 54–61.Google Scholar
NIH (2011). Alzheimer's Disease Fact Sheet (p. 8). NIH publication.Google Scholar
Nitrini, R. et al. (2004). Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. Journal of the International Neuropsychological Society, 10, 634–638.CrossRefGoogle ScholarPubMed
Ostrosky-Solís, F. (2004). Can literacy change brain anatomy? International Journal of Psychology, 39, 1–4.CrossRefGoogle Scholar
Parente, M. A. M. P., Fonseca, R. P. and Scherer, L. C. (2008). Literacy as a determining factor for brain organization: from Lecours' contribution to the present day. Dementia and Neuropsychologia, 2, 165–172.CrossRefGoogle Scholar
Parker, C. and Philp, I. (2004). Screening for cognitive impairment among older people in black and minority ethnic groups. Age Ageing, 33, 447–452.Google Scholar
Peña-Casanova, J. (1997). Alzheimer's disease assessment scale–cognitive in clinical practice. International Psychogeriatrics, 9, 1741–1750.Google Scholar
Petersson, K. M., Reis, A. and Ingvar, M. (2001). Cognitive processing in literate and illiterate subjects: a review of some recent behavioral and functional neuroimaging data. Scandinavian Journal of Psychology, 42, 251–267.Google Scholar
Pirozzolo, F. J., Mahurin, R. K., Loring, D. W., Appel, S. H. and Maletta, G. J. (1985). Choice reaction time modifiability in dementia and depression. International Journal of Neuroscience, 26, 1–7.Google Scholar
Prince, M., Prina, M. and Guerchet, M. (2013). World Alzheimer Report 2013 Journey of Caring An analysis of Long-Term care for Dementia. London: Alzheimer's Disease International.Google Scholar
Reisberg, B. (1988). Functional assessment staging (FAST). Psychopharmacology Bulletin, 24, 653–659.Google Scholar
Reisberg, B. (2007). Global measures: utility in defining and measuring treatment response in dementia. International Psychogeriatrics, 19, 421–456.Google Scholar
Reisberg, B. et al. (2001). The Alzheimer's disease activities of daily living international scale (ADL-IS). International Psychogeriatrics, 13, 163–181.Google Scholar
Scazufca, M., Almeida, O. P., Vallada, H. P., Tasse, W. A. and Menezes, P. R. (2009). Limitations of the mini-mental state examination for screening dementia in a community with low socioeconomic status: results from the sao paulo ageing & health study. European Archives of Psychiatry and Clinical Neuroscience, 259, 8–15.Google Scholar
Schmidt, G. L. and Seger, C. A. (2009). Neural correlates of metaphor processing: the roles of figurativeness, familiarity and difficulty. Brain and Cognition, 71, 375–386.Google Scholar
Seyedian, M., Fallah, M., Nourouzian, M., Nejat, S., Delavar, A. and Ghasemzadeh, H. A. (2008). Validity of the farsi version of mini-mental state examination. Journal of Medical Council of I.R.I., 25, 408–414.Google Scholar
Smith, T., Gildeh, N. and Holmes, C. (2007). The montreal cognitive assessment: validity and utility in a memory clinic setting. Canadian Journal of Psychiatry, 52, 329–332.Google Scholar
Snowdon, D. A., Kemper, S. J., Mortimer, J. A., Greiner, L. H., Wekstein, D. R. and Markesbery, W. R. (1996). Linguistic ability in early life and cognitive function and Alzheimer's disease in late life. Findings from the nun study. The Journal of the American Medical Association, 275, 528–532.Google Scholar
Sperber, A. D. (2004). Translation and validation of study instruments for cross-cultural research. Gastroenterology, 126, S124–S128.Google Scholar
Stephanie, S. Richards, R. A. s. (2009). Dementia. In Sadock, B. J., Sadock, V. A. and Kaplan, H. I. (eds.), Kaplan and Sadock's Comprehensive Textbook of Psychiatry (p. 1169). Philadelphia, PA: Lippincott Williams & Wilkins.Google Scholar
UNESCO (2006). Education for all Global Monitoring Report. France: UNESCO.Google Scholar
UNESCO (2008). UNESCO Institute for Statistics. Country Profiles, Iran (islamic republic of): UNESCO.Google Scholar
UNESCO (2013). Adult and Youth Literacy.Google Scholar
Van Lancker, D. and Klein, K. (1990). Preserved recognition of familiar personal names in global aphasia. Brain and Language, 39, 511–529.Google Scholar
Verghese, J. et al. (2012). Picture-based memory impairment screen for dementia. American Journal of Geriatric Society, 60, 2116–2121.Google Scholar
Weiss, B. D., Reed, R., Kligman, E. W. and Abyad, A. (1995). Literacy and performance on the mini-mental state examination. Journal of the American Geriatrics Society, 43, 807–810.Google Scholar
Whalley, L. J., Starr, J. M., Athawes, R., Hunter, D., Pattie, A. and Deary, I. J. (2000). Childhood mental ability and dementia. Neurology, 55, 1455–1459.Google Scholar
Woodford, H. J. and George, J. (2007). Cognitive assessment in the elderly: a review of clinical methods. QJM, 100, 469–484.CrossRefGoogle ScholarPubMed