Predictors of decline in MMSE scores among older Mexican Americans.

BACKGROUND The purpose of this analysis was to examine the association of sociodemographic variables and health-related conditions with 5-year declines in cognitive function among Mexican American elderly persons. METHODS The cognitive function of 1759 participants was assessed by using the Mini-Mental State Examination (MMSE) in 1993/1994 and again in 1998/1999. Cognitive decline was defined by two sets of criteria: (1) a drop to 17 or below on the MMSE at follow-up, and (2) a decline of at least three points, the mean change in MMSE scores among respondents who obtained scores at or above the 5th percentile distribution at baseline. RESULTS Cognitive decline was significantly associated with sociodemographic variables including age, education, marital status, and household composition. In addition, respondents with reported vision impairment, stroke, and diabetes were at increased risk for cognitive decline after controlling for multiple potential confounders. CONCLUSION Although age and education have been reported as the more salient predictors of cognitive deterioration, other sociodemographic and several medical conditions including stroke and diabetes should be considered as part of cognitive aging studies among Mexican American elders.

[1]  G. Ratcliff,et al.  Sensitivity and specificity for dementia of population-based criteria for cognitive impairment: the MoVIES project. , 1993, Journal of gerontology.

[2]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[3]  J. Goodwin,et al.  Hearing acuity in a healthy elderly population: effects on emotional, cognitive, and social status. , 1983, Journal of gerontology.

[4]  L. Radloff The CES-D Scale , 1977 .

[5]  L. Fratiglioni,et al.  Psychiatric history and related exposures as risk factors for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group. , 1991, International journal of epidemiology.

[6]  M. Folstein,et al.  Limits of the ‘Mini-Mental State’ as a screening test for dementia and delirium among hospital patients , 1982, Psychological Medicine.

[7]  D. W. Desmond,et al.  COGNITIVE IMPAIRMENT AND RISK OF STROKE IN THE OLDER POPULATION , 1996, Journal of the American Geriatrics Society.

[8]  B. Winblad,et al.  Cognitive changes in very old persons with dementia: the influence of demographic, psychometric, and biological variables. , 1997, Journal of clinical and experimental neuropsychology.

[9]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease , 1984, Neurology.

[10]  J. Morris,et al.  Variability in annual Mini-Mental State Examination score in patients with probable Alzheimer disease: a clinical perspective of data from the Consortium to Establish a Registry for Alzheimer's Disease. , 1999, Archives of neurology.

[11]  P. Boyle,et al.  ABC of colorectal cancer: Epidemiology , 2000, BMJ.

[12]  K. Markides,et al.  The influence of noncognitive factors on the Mini-Mental State Examination in older Mexican-Americans: findings from the Hispanic EPESE. Established Population for the Epidemiologic Study of the Elderly. , 1999, Journal of clinical epidemiology.

[13]  S. Bassett,et al.  Predicting Performance on the Mini‐Mental State Examination , 1987, Journal of the American Geriatrics Society.

[14]  R. Mayeux,et al.  Depressed mood and the incidence of Alzheimer's disease in the elderly living in the community. , 1996, Archives of general psychiatry.

[15]  P. Leaf,et al.  The effects of cognitive impairment on 9-year mortality in a community sample. , 1995, The journals of gerontology. Series B, Psychological sciences and social sciences.

[16]  P. Shrout,et al.  Use of the Mini-mental State Examination in a Probability Sample of a Hispanic Population , 1987, The Journal of nervous and mental disease.

[17]  R. Glynn,et al.  Association of Visual Impairment with Mobility and Physical Function , 1994, Journal of the American Geriatrics Society.

[18]  T. Tombaugh,et al.  The Mini‐Mental State Examination: A Comprehensive Review , 1992, Journal of the American Geriatrics Society.

[19]  B. Mulsant,et al.  The temporal relationship between depressive symptoms and dementia: a community-based prospective study. , 1999, Archives of general psychiatry.

[20]  C. M. van Duijn,et al.  Epidemiology of the dementias: recent developments and new approaches. , 1996 .

[21]  C. Brayne,et al.  Incidence of dementia and cognitive decline in over-75s in Cambridge: overview of cohort study , 1998, Social Psychiatry and Psychiatric Epidemiology.

[22]  R. Mayeux,et al.  Dementia after stroke , 1992, Neurology.

[23]  R. Hamman,et al.  Cognitive functioning and impairment among rural elderly Hispanics and non-Hispanic whites as assessed by the Mini-Mental State Examination. , 1999, The journals of gerontology. Series B, Psychological sciences and social sciences.

[24]  J. Escobar,et al.  Use of the Mini-Mental State Examination (MMSE) in a Community Population of Mixed Ethnicity: Cultural and Linguistic Artifacts , 1986, The Journal of nervous and mental disease.

[25]  S. Waldstein Hypertension and neuropsychological function: a lifespan perspective. , 1995, Experimental aging research.

[26]  T. Seeman,et al.  Do medical conditions affect cognition in older adults? , 1998, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[27]  L. George,et al.  Scoring nonresponse on the Mini-Mental State Examination , 1988, Psychological Medicine.

[28]  B E Fries,et al.  Windows to their world: the effect of sensory impairments on social engagement and activity time in nursing home residents. , 1997, The journals of gerontology. Series B, Psychological sciences and social sciences.

[29]  C. Brayne,et al.  Five‐year incidence and prediction of dementia and cognitive decline in a population sample of women aged 70–79 at baseline , 1997, International journal of geriatric psychiatry.

[30]  L. Berkman,et al.  Cognitive impairment and mortality in the community-dwelling elderly. , 2000, American journal of epidemiology.

[31]  M. Gold,et al.  Hearing loss in a memory disorders clinic. A specially vulnerable population. , 1996, Archives of neurology.

[32]  D. Snowdon,et al.  Age, Education, and Changes in the Mini‐Mental State Exam Scores of Older Women: Findings from the Nun Study , 1996, Journal of the American Geriatrics Society.

[33]  J. Goodwin,et al.  The association between chronic diseases and depressive symptomatology in older Mexican Americans. , 1998, The journals of gerontology. Series A, Biological sciences and medical sciences.

[34]  J. Richardson,et al.  Cognitive function in diabetes mellitus: the effects of duration of illness and glycaemic control. , 1990, The British journal of clinical psychology.

[35]  L. Thal,et al.  Mini-Mental State Examination and Mattis Dementia Rating Scale performance differs in Hispanic and non-Hispanic Alzheimer's disease patients , 1999, Journal of the International Neuropsychological Society.

[36]  W E Wilkinson,et al.  Discrimination between stages of Alzheimer's disease with subsets of Mini-Mental State Examination items. An analysis of Consortium to Establish a Registry for Alzheimer's Disease data. , 1994, Archives of neurology.

[37]  W C Wiederholt,et al.  The Association of Non‐Insulin‐Dependent Diabetes Mellitus and Cognitive Function in an Older Cohort , 1998, Journal of the American Geriatrics Society.

[38]  B. Winblad,et al.  Low blood pressure and dementia in elderly people: the Kungsholmen project , 1996, BMJ.

[39]  F. Bess,et al.  Validation of screening tools for identifying hearing-impaired elderly in primary care. , 1988, JAMA.