The influence of schooling on cognitive screening test in the elderly

Christofoletti, Gustavo; Oliani, Merlyn Mércia; Stella, Florindo; Gobbi, Sebastião; Gobbi, Lílian Teresa Bucken

doi:10.1590/S1980-57642008DN10100008

Abstract

Introduction:

Tests for screening cognitive functions are gaining importance with the increasing incidence and prevalence of demential syndromes. For our elderly population, the challenge is to develop neuropsychological tests independent from the influence of educational level.

Objective:

To compare the influence of education on the elderly with or without cognitive decline, on the Brief Cognitive Screening Battery (BCSB).

Methods:

We studied 176 elderly people: 60 with cognitive decline (aged 73.6±9.3 years and with 5.7±0.7 years of education) and 116 without cognitive impairments (aged 73.4±0.6 years and with 5.6±0.5 years of education). The BCSB was applied in all subjects. The data were submitted to descriptive statistics and analyzed by Independent Student test with 95% confidence intervals.

Results:

The data showed that the BCSB is an appropriate battery for identifying cognitive status in normal elderly individuals, as well as cognitive decline in our elderly sample. The BCSB items were not significantly influenced by schooling years, making this test favorable for different groups characterized by illiterate individuals, as well as by those with low or high levels of formal education.

Conclusion:

The BCSB proved to be a useful cognitive screening test for old people with or without cognitive decline independent of their educational level.

Key words:
neuropsychological tests; cognition; elderly; education.

Resumo

Introdução:

Instrumentos capazes de aferir as funções cognitivas vêm ganhando importância com o aumento na incidência e prevalência de quadros demenciais. O desafio consiste em criar instrumentos que não sofram influência dos níveis de escolaridade.

Objetivo:

Analisar comparativamente a influência do nível de escolaridade na Bateria Breve de Rastreio Cognitivo (BBRC) em idosos com e sem declínio cognitivo.

Métodos:

Participaram do estudo 176 idosos, sendo 60 (idade de 73,6±9,3 anos e escolaridade de 5,7±0,7 anos) com declínio cognitivo e 116 (idade de 73,4±0,6 anos e escolaridade de 5,6±0,5 anos) sem queixas cognitivas. Foram aplicados a BBRC em todos os sujeitos. O tratamento dos dados consistiu na aplicação de estatística descritiva e do teste t-Student independente, admitindo-se um intervalo de confiança de 95%.

Resultados:

Os dados indicaram que a BBRC consiste em um instrumento apropriado para a identificação da condição cognitiva em idosos normais, bem como, para confirmar declínio cognitivo em idosos comprometidos do nosso meio. Os itens da BBRC não sofreram influência significativa dos anos de escolaridade, fator que favorece sua aplicação em diferentes grupos, compostos por indivíduos iletrados, bem como por sujeitos com pouca ou elevada escolaridade.

Conclusão:

A BBRC mostrou-se um instrumento útil para rastreio cognitivo em idosos, independentemente de serem ou não letrados.

Palavras-chave:
testes neuropsicológicos; cognição; idosos; educação.

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References

¹
Kupfermann I. Cognition and the Cortex. In: Kandel ER,Schwartz JH, Jessel TM. Essentials of Neural Science and Behavior. 4a ed. Norwalk: Appleton & Lange; 1995:347-63.
²
Cummings JL, Vinters HV Cole GM, Khachaturian ZS. Alzheimer's disease: etiologies, pathophysiology, cognitive reserve, and treatment opportunities. Neurology 1998;51:2-17.
³
Flaks MK,Yassuda MS, Regina ACB, et al. The short cognitiveperformance test (SKT): a preliminary study of its psychometric properties in Brazil. Int Psychogeriatr 2005;17:1-13.
⁴
Almeida O. Mini-exame do estado mental e o diagnóstico dedemência no Brasil. Arq Neuropsiquiatr 1998;56:605-612.
⁵
Caramelli P, Herrera Jr E, Nitrini R. O mini-exame do estado mental no diagnóstico de demência em idosos analfabetos. Arq Neuropsiquiatr 1997;57:S7.
⁶
Folstein MF, Folstein SE, McHugh PR. Mini-Mental State. Apractical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
⁷
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF,Okamoto JH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
⁸
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52:634-638.
⁹
Nitrini R, Caramelli P, Herrera EJr, et al. Performance of illiterate and literate nondemented elderly subjects two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.
¹⁰
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive evaluation in the diagnosis of mild Alzheimer's disease (Abstract). Arq Neuropsiquiatr 2005;63(Suppl 2):97.
¹¹
Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filis S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
¹²
World Health Organization. The ICD-10 Classification ofMental and Behavioral Disorders. Clinical descriptions and diagnostic guidelines. Genève; 1992.
¹³
Lezak MD. Neuropsychological assessment, 3ed. New York:Oxford Press; 1995.
¹⁴
Sunderland T, Hill JL, Melow AM, et al. Clock drawing inAlzheimer's disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-729.
¹⁵
Caramelli P, Carthery-Goulart T, Porto CS. CharchatFichman H, Nitrini R. Category fluency as a screening testfor Alzheimer disease in illiterate and literate patients. Azheimer Dis Assoc Disord (in press).
¹⁶
Brucki SMD, Malheiros SMF, Okamoto IH, Bertolucci PHF.Normative data for the animals category verbal fluency test in our environment. Arq Neuropsiquiatr 1997;55:56-61.
¹⁷
Radanovic M, Mansur LL, Scaff M. Normative data for theBrazilian population in the Boston diagnostic aphasia examination: influence of schooling. Braz J Med Biol Res 2004;37:1731-1738.
¹⁸
Okamoto IH. Cognitive aspects of Alzheimer´s disease in clocktest: assessment in a brazilian sample. Tese, Escola Paulista de Medicina da Universidade Federal de São Paulo, 2001.

Publication Dates

Publication in this collection
Jan-Mar 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Kupfermann I. Cognition and the Cortex. In: Kandel ER,Schwartz JH, Jessel TM. Essentials of Neural Science and Behavior. 4a ed. Norwalk: Appleton & Lange; 1995:347-63.

[2] ²
Cummings JL, Vinters HV Cole GM, Khachaturian ZS. Alzheimer's disease: etiologies, pathophysiology, cognitive reserve, and treatment opportunities. Neurology 1998;51:2-17.

[3] ³
Flaks MK,Yassuda MS, Regina ACB, et al. The short cognitiveperformance test (SKT): a preliminary study of its psychometric properties in Brazil. Int Psychogeriatr 2005;17:1-13.

[4] ⁴
Almeida O. Mini-exame do estado mental e o diagnóstico dedemência no Brasil. Arq Neuropsiquiatr 1998;56:605-612.

[5] ⁵
Caramelli P, Herrera Jr E, Nitrini R. O mini-exame do estado mental no diagnóstico de demência em idosos analfabetos. Arq Neuropsiquiatr 1997;57:S7.

[6] ⁶
Folstein MF, Folstein SE, McHugh PR. Mini-Mental State. Apractical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[7] ⁷
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF,Okamoto JH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[8] ⁸
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52:634-638.

[9] ⁹
Nitrini R, Caramelli P, Herrera EJr, et al. Performance of illiterate and literate nondemented elderly subjects two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.

[10] ¹⁰
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive evaluation in the diagnosis of mild Alzheimer's disease (Abstract). Arq Neuropsiquiatr 2005;63(Suppl 2):97.

[11] ¹¹
Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filis S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[12] ¹²
World Health Organization. The ICD-10 Classification ofMental and Behavioral Disorders. Clinical descriptions and diagnostic guidelines. Genève; 1992.

[13] ¹³
Lezak MD. Neuropsychological assessment, 3ed. New York:Oxford Press; 1995.

[14] ¹⁴
Sunderland T, Hill JL, Melow AM, et al. Clock drawing inAlzheimer's disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-729.

[15] ¹⁵
Caramelli P, Carthery-Goulart T, Porto CS. CharchatFichman H, Nitrini R. Category fluency as a screening testfor Alzheimer disease in illiterate and literate patients. Azheimer Dis Assoc Disord (in press).

[16] ¹⁶
Brucki SMD, Malheiros SMF, Okamoto IH, Bertolucci PHF.Normative data for the animals category verbal fluency test in our environment. Arq Neuropsiquiatr 1997;55:56-61.

[17] ¹⁷
Radanovic M, Mansur LL, Scaff M. Normative data for theBrazilian population in the Boston diagnostic aphasia examination: influence of schooling. Braz J Med Biol Res 2004;37:1731-1738.

[18] ¹⁸
Okamoto IH. Cognitive aspects of Alzheimer´s disease in clocktest: assessment in a brazilian sample. Tese, Escola Paulista de Medicina da Universidade Federal de São Paulo, 2001.

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