Key points are not available for this paper at this time.
The North Manhattan Aging Project registry, using both Reporting and Survey Components, identifies dementia cases among Latino, African-American, and non-Latino white sociocultural groups (9,349 persons 65 years of age or older) in contiguous census tracts. During a 2-year prevalence period of the reporting component, 1,592 persons were reported to the Registry and screened with five widely used brief cognitive measures; 844 were evaluated in a “clinical core,” and 452 met research criteria for dementia, covering all subtypes, according to DSM-III-R criteria. Thirteen different case definitions for dementia were applied to the sociocultural groups at three levels of educational achievement, examining for associations with rates of dementia cases and controlling for age. The following findings were robust across case definitions: sociocultural membership was not associated, but lower education was associated, with increased rates of recorded dementia; however, the patterns of the association with education varied across sociocultural groups. The North Manhattan Aging Project registry, using both Reporting and Survey Components, identifies dementia cases among Latino, African-American, and non-Latino white sociocultural groups (9,349 persons 65 years of age or older) in contiguous census tracts. During a 2-year prevalence period of the reporting component, 1,592 persons were reported to the Registry and screened with five widely used brief cognitive measures; 844 were evaluated in a “clinical core,” and 452 met research criteria for dementia, covering all subtypes, according to DSM-III-R criteria. Thirteen different case definitions for dementia were applied to the sociocultural groups at three levels of educational achievement, examining for associations with rates of dementia cases and controlling for age. The following findings were robust across case definitions: sociocultural membership was not associated, but lower education was associated, with increased rates of recorded dementia; however, the patterns of the association with education varied across sociocultural groups. There have been numerous attempts over the past three decades to estimate the incidence and prevalence of dementia and its subtypes.1Cross P, Gurland B: Epidemiology of the dementing disorders. Contract report submitted to the Office of Technology Assessment, 1986Google Scholar Such data are valuable for indicating the need of health services and drawing epidemiological inferences about etiology. However, in a country of great cultural diversity such as the United States, there is a particular and necessary concern that these data should be collected and interpreted with sensitivity to sociocultural differences. Several studies have reported the possibility that rates of cognitive impairment and dementia may be higher in certain sociocultural groups, for example, African-American or Latino groups compared with non-Latino white subjects.2Baker FM Dementing illness in African-American populations: evaluation and management for the primary physician.International Journal of Geriatric Psychiatry. 1991; 24: 73-91Google Scholar, 3Gurland B Copeland J Kelleher M et al.The Mind and Mood of Aging. Haworth, New York1983Google Scholar, 4Heyman A Fillenbaum G Prosnitz B et al.Estimated prevalence of dementia among elderly Black and White community residents.Arch Neurology. 1991; 48: 594-598Crossref PubMed Scopus (124) Google Scholar, 5Holzer C Tischler G Leaf P et al.An epidemiologic assessment of cognitive impairment in a community population.Research in Community and Mental Health. 1984; 4: 3-32Google Scholar, 6Pfeiffer E A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.J Am Geriatr Soc. 1975; 22: 433-444Crossref Scopus (4051) Google Scholar, 7Robins L, Holzer J, Weissman M, et al: Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry; 41:949–958Google Scholar, 8Schoenberg BS Anderson DW Haerer AF Severe dementia: prevalence and clinical features in a biracial U.S. population.Arch Neurology. 1985; 42: 740-743Crossref PubMed Scopus (180) Google Scholar However, the groups with higher rates are usually also relatively disadvantaged in education, language, and familiarity with “mainstream” American culture, and they may be disadvantaged economically and in other ways as well.9Henderson AS Huppert FA The problem of mild dementia (editorial).Psychol Med. 1984; 14: 5-11Crossref PubMed Scopus (94) Google Scholar Some of these features of disadvantage may confound the effect of sociocultural membership on rates of cognitive impairment and dementia.10Burvill PW The impact of criteria selection on prevalence rates.Fifth Congress of the International Federation of Psychiatric Epidemiology, 1990, Montreal, Canada, Psychiatric Journal of the University of Ottawa. 1990; 15: 194-199Google Scholar, 11Nelson A Fogel B Faust D Bedside cognitive instruments.J Nerv Ment Dis. 1986; 174: 73-83Crossref PubMed Scopus (218) Google Scholar Identification of cases of dementia other than those at advanced and obvious stages may be complicated by the effects of previous levels of intelligence or education on performance in assessment procedures. Items in widely used screening tests of cognitive function appear to pose a greater degree of difficulty for poorly educated subjects,12Anthony JC LeResche L Niam V et al.Limits of the “Mini-Mental State” as a screening test for dementia and delirium among hospital patients.Psychol Med. 1982; 12: 397-408Crossref PubMed Scopus (903) Google Scholar, 13Cavanaugh S Wettstein R The relationship between severity of depression, cognitive function, and age in medical inpatients.Am J Psychiatry. 1986; 140: 495-496Google Scholar, 14Li G Shen YC Chen CM et al.An epidemiological survey of age-related dementia in an urban area of Beijing.Acta Psychiatr Scand. 1989; 79: 557-563Crossref PubMed Scopus (141) Google Scholar, 15Li GE Shen YC Chen CH et al.A 3-year follow-up study of age-related dementia in an urban area of Beijing.Acta Psychiatr Scand. 1991; 83: 99-104Crossref PubMed Scopus (148) Google Scholar, 16Murden RA McRae TD Kaner S et al.Mini-Mental State exam scores vary with education in Blacks and Whites.J Am Geriatr Soc. 1991; 39: 149-155Crossref PubMed Scopus (255) Google Scholar, 17Yu ES Liu WT Levy P et al.Cognitive impairment among elderly adults in Shanghai, China.J Gerontol. 1989; 44: S97-S106Crossref PubMed Scopus (123) Google Scholar for certain sociocultural groups,12Anthony JC LeResche L Niam V et al.Limits of the “Mini-Mental State” as a screening test for dementia and delirium among hospital patients.Psychol Med. 1982; 12: 397-408Crossref PubMed Scopus (903) Google Scholar, 18Baker FM Screening tests for cognitive impairment.Hosp Commun Psychiatry. 1989; 40: 339-340PubMed Google Scholar and for those not educated in Western customs19Henderson AS The epidemiology of Alzheimer's disease.Br Med J. 1986; 42: 3-10Google Scholar, 20Salmon DP Riekkinen PJ Katzman R et al.Cross-cultural studies of dementia: a comparison of Mini-Mental State Examination performance in Finland and China.Arch Neurol. 1989; 46: 769-772Crossref PubMed Scopus (111) Google Scholar or who have language barriers.21Jacobs J Bernard B Delgado A et al.Screening for organic mental syndromes in the medically ill.Ann Intern Med. 1977; 86: 40-46Crossref PubMed Scopus (348) Google Scholar Not all studies agree on the importance of educational confounds,22O'Connor DW Pollitt PA Treasure FP The influence of education and on the of dementia in a community Med. 1991; PubMed Scopus Google Scholar reported are or example, on all who in a hospital in the of and with to sociocultural AS The epidemiology of Alzheimer's disease.Br Med J. 1986; 42: 3-10Google Scholar, in the of dementia and of in the Med 1989; Google Scholar there are usually cases to to be between sociocultural or educational of dementia in J Psychiatry. 1991; PubMed Scopus Google Scholar, of Alzheimer's The Aging New Scholar and to reported of in rates of cognitive impairment and dementia are or in case data on in the rates of cognitive impairment and dementia in three sociocultural African-American, Latino, and non-Latino white the effects of education are and with in the language of the The to the findings are on the used for case is by at in the with of case The North Manhattan Aging Project a as a of cases of dementia and its a area and among persons 65 years of age or The is to and the great or of the cases of Alzheimer's and among persons 65 years of age and in a area of North may be on the of a reporting the Reporting and a survey of of in the Survey the of the findings on the be by of the of the findings on the reporting The area was by census in North the of the and of and community The area was to about persons 65 years and about cases of that for in rates of dementia and not the of the data that there be of persons in of the Latino, African-American, and non-Latino white groups. The of the area are to to in North the of is Latino and African-American, but the area also non-Latino white The features of the area are in features of the area age and education by by the of the United using data for the tracts. not or white were the White years of by the of the United using data for the tracts. not or white were the in a There are education and age among the three sociocultural groups in the study The non-Latino white the with a of age years or The are the with at age or and the have at age and the that the study area is a community in with non-Latino white have and been by Latino The African-American is and the age of all persons age 65 and in the United between educational among the three sociocultural groups are than age differences. of the non-Latino white and over of the or years of compared with of the of the than years of but over of the other groups and rates are in the study and are but A hospital all and of the and to the A of Latino or in the by and community are and in with are to the of the Registry a of reporting Reporting is the of case at the or who the study in to a and a report that a is to be a a is by the research A case is in of the following A is reported to be in or a of dementia Such services and in services on disorders such as Alzheimer's or or a report certain of for a of dementia, or to or and with dementia and to by or the of medical in the such as and or a report by with a in such as medical and or at community or to the community to the report of a case by or are health to and at persons as at according to the study definitions were they were for cognitive impairment A of persons reported as were also screened to the of the reporting A was five widely used cognitive screening the Mental M et for the of mental status in the J Psychiatry. PubMed Scopus Google Scholar the Mental E A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.J Am Geriatr Soc. 1975; 22: 433-444Crossref Scopus (4051) Google Scholar the and Gurland of for the assessment and evaluation Gerontol. 1984; 39: PubMed Scopus Google Scholar the R P et of a short test of cognitive J Psychiatry. 140: PubMed Scopus Google Scholar and the Mini-Mental State Examination The Mini-Mental a of the cognitive of for the Psychiatr 1975; 12: PubMed Scopus Google Scholar The was to between and a of the the an of A of the was by a in the of the was by with in mental were the and a an than a was in both and were to according to language for screening be data by the a study of P et al.Screening for dementia: of Journal of Geriatric Psychiatry. 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Gurland et al. (Sun,) studied this question.