Cognitive screening in a population‐based sample of community‐living elderly: Effects of age and education on the construct of cognitive status

This study examined the measurement properties of a cognitive screening test, the Halifax Mental Status Scale (HMSS), in a population‐based sample of community‐living elderly subjects (N = 361) and a clinic sample (N = 20) of patients with Alzheimer's disease. Receiver operating characteristic analyses yielded estimates of sensitivity and specificity of approximately 90% for this test. Factor analysis confirmed a three‐factor solution for the HMSS. Although both age and education were correlated with the HMSS total score, their relationship to the factor scores differed. Our study shows that comprehensive cognitive status tests do not measure a unitary construct and that adjustment of summary scores for education is unlikely to optimize sensitivity and specificity. In population‐based studies, only those components of a test that reflect education should be adjusted.