Age, education and gender effects on neuropsychological functions in healthy Indian older adults

Tripathi, Ravikesh; Kumar, Keshav; Bharath, Srikala; Marimuthu, P.; Varghese, Mathew

doi:10.1590/S1980-57642014DN82000010

ABSTRACT

It is essential to use culturally appropriate, sensitive and specific tests that reflect true cognitive performance. However, several factors including age, education and gender can influence neuropsychological test performance.

Objective:

To examine the effects of age, education and gender on neuropsychological function in older adults using measures of global cognitive screening, attention, working memory, executive functions, memory, construction, language and parietal focal signs.

Methods:

This is a cross sectional normative study of 180 community-dwelling normal older adults. All participants were screened with the Hindi Mental Status Examination (HMSE), Everyday Activities Scale for India (EASI), Edinburgh handedness inventory (EDI) and MINI Screen, and followed by a detailed neuropsychological assessment.

Results:

Stepwise regression analysis revealed that education was associated with better performance on all the neuropsychological tests. Females performed significantly better on measures of memory. Further, most of the illiterate subjects, including low educated participants, refused to cooperate on measures of executive functioning.

Conclusion:

Education was found to be the strongest determinant of neuropsychological test performance followed by age and gender. Our study demonstrates that Indian healthy normal older adults with low education perform poorly on measures of planning and working memory. Traditional measures of planning and working memory should be avoided or used cautiously in the presence of low education. There is an urgent need to develop tasks for measuring executive functions, especially in low educated Indian older adults.

Key words
neuropsychological tests; older adults; literacy and cognition

RESUMO

É essencial o uso de testes específicos, sensíveis e culturalmente apropriados que reflitam o verdadeiro desempenho cognitivo. Todavia, vários fatores como idade, educação e gênero podem influenciar o desempenho neuropsicológico em testes.

Objetivo:

Examinar os efeitos de idade, educação e gênero na função neuropsicológica em adultos idosos usando medidas de rastreio cognitivo global, atenção, memória operacional, funções executivas, memória, construção, linguagem e sinais parietais focais.

Métodos:

Este é um estudo normativo de corte transversal de 180 idosos vivendo em comunidade. Todos os paticipantes foram rastreados com o Exame do Estado Mental Hindu (HMSE), Escala de Atividades de Vida Diária para Índia (EASI), Inventário de Dominância Manual de Edinburgh (EDI) e MINI Screen seguidos por uma detalhada avaliação neuropsicológica.

Resultados:

A análise de regressão stepwise revelou que a educação esteve associada ao melhor desempenho cognitivo em cada teste neuropsicológico. As mulheres tiveram desempenho significativamente melhor em medidas de memória. Além disso, a maioria dos analfabetos incluindo idosos com baixo nível educacional recusou-se a participar em medidas de função executiva.

Conclusão:

Educação foi o mais forte determinante do desempenho em testes neuropsicológicos seguido por idade e gênero. Nosso esrudo demonstra que idosos indianos saudáveis com baixo nível educacional tem desempenho pobre em medidas de planejamento e memória de trabalho. Medidas tradicionais de planejamento e memória de trabalho devem ser evitadas ou usadas cautelosamente na presença de baixa escolaridade. Há necessidade urgente do desenvolvimento de tarefas de funções executivas especialmente para idosos indianos com baixo nível educacional.

Palavras-chave
testes neuropsicológicos; idosos; alfabetismo; cognição

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REFERENCES

¹
Brickman AM, Cabo R, Manly JJ. Ethical issues in cross-cultural neuropsychology.Appl Neuropsychol 2006;13:91-100.
²
Chan AS, Shum D, Cheung RW. Recent development of cognitive and neuropsychological assessment in Asian countries. Psychol Assessment 2003;15:257-67.
³
Tripathi R, Kumar K. Illiteracy and Cognition in Older Adults. Indian J Psychol Med 2012;34:406.
⁴
Chandra V, Ganguli M, Ratcliff G, et al. Practical issues in cognitive screening of elderly illiterate populations in developing countries: The Indo-US Cross-National Dementia Epidemiology Study. Aging Clin Exp Res 1998; 10:349-57.
⁵
Chey J, Park H. Neuropsychology of Korea. In: Fujii DEM, editor. Neuropsychology of Asian Americans. New York: Psychology Press: Taylor and Francis. 2011:247-267.
⁶
Ostrosky-Solis F, Ardila A, Rosselli M, Lopez-Arango G, Uriel-Mendoza V. Neuropsychological test performance in illiterate subjects. Arch Clin Neuropsychol 1998;13:645-660.
⁷
Ardila A, Bertolucci PH, Braga LW, et al. Illiteracy: The neuropsychology of cognition without reading. Arch Clin Neuropsychol 2010;25:689-712.
⁸
Das SK, Banerjee TK, Mukherjee CS, et al. An urban community-based study of cognitive function among non-demented elderly population in India. Neurol. Asia 2006;11:37-48.
⁹
Mathuranath PS, Cherian JP, Mathew R, George A, Alexander A, Sarma SP. Mini Mental State Examination and the Addenbrooke's cognitive examination: Effect of education and norms for a multicultural population. Neurol India 2007;55:106-10.
¹⁰
Liu KP, Kuo MC, Tang KC, et al.Effects of age, education and gender in the Consortium to Establish a Registry for the Alzheimer's Disease (CERAD)-Neuropsychological assessment battery for Cantonese-speaking Chinese elders. Int Psychogeriatr 2011;23:1575-1581.
¹¹
Wang Q, Sun J, Ma X, et al. Normative data on a battery of neuropsychological tests in the Han Chinese population. J Neuropsychol 2011; 5:126-142.
¹²
van Hooren SAH, Valentijn AM, Bosma H, Ponds RWHM, van Boxtel M P J, Jolles J. Cognitive functioning in healthy older adults aged 64-81: A cohort study into the effects of age, sex, and education. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2007;14:40-54.
¹³
Messinis L, Tsakona I, Malefaki S, Papathanasopoulos P. Normative data and discriminant validity of Rey's Verbal Learning Test for the Greek adult population. Arch Clin Neuropsychol 2007;22:739-52.
¹⁴
Proust-Lima C, Amieva H, Letenneur L, Orgogozo J M, Jacqmin-Gadda H, Dartigues JF. Gender and education impact on brain aging: A general cognitive factor approach. Psychol Aging 2008;23:608-20.
¹⁵
Salthouse TA. The processing-speed theory of adult age differences in cognition. Psychol Rev 1996;103:403-428.
¹⁶
Park DC, Lautenschlager G, Hedden T, Davidson NS, Smith AD, Smith PK. Models of visuospatial and verbal memory across the adult life span. Psychol Aging 2002;17:299-320.
¹⁷
Park DC, Reuter-Lorenz P. The adaptive brain: Aging and neurocognitive scaffolding. Annu Rev Psychol 2008;60:173-196.
¹⁸
Mathuranath PS, Hodges JR, Mathew R, Cherian PJ, George A, Bak TH. Adaptation of the ACE for a Malayalam speaking population in southern India. Int J Geriatr Psychiatry 2004;19:1188-1194.
¹⁹
Tripathi R. Development and standardization of neuropsychological test battery for older adults. Unpublished Ph.D. Thesis, Department of Clinical Psychology, NIMHANS (Deemed University), Bangalore, India; 2012.
²⁰
Tripathi R, Kumar J K, Bharath S, Marimuthu P, Varghese M. Clinical validity of NIMHANS neuropsychological battery for elderly (NNB-E): A preliminary report. Indian J Psychiatry 2013;55:203-206
²¹
Ganguli M, Chandra V, Gilby J E, et al. Cognitive test performance in a community-based nondemented elderly sample in rural India: The Indo-U.S.cross - National Dementia Epidemiology Study. Int Psychogeriatr 1996;8:507-524.
²²
Oldfield RC. The assessment and analysis of handedness: The Edinburgh inventory. Neuropsychologia 1971;9: 97-113.
²³
Ganguli M, Ratcliff G, Chandra V, et al. A Hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in India. Int J Geriatr Psychiatry 1995; 10:367-377.
²⁴
Fillenbaum GG, Chandra V, Ganguli M, et al. Development of an activities of daily living scale to screen for dementia in an illiterate rural older population in India. Age Ageing 1999 28:161-168.
²⁵
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The M.I.N.I. (Mini International Neuropsychiatric Interview). J Clin Psychiatry 1998;59:22-33.
²⁶
Alzheimer's and Related Disorders Society of India. The Dementia India Report: prevalence, impact, costs and services for Dementia. In: Shaji KS, Jotheeswaran AT, Girish N, et al. editors. New Delhi: ARDSI; 2010.
²⁷
Kumar K. Neuropsychology in India. In: Fujii DE, editor. Neuropsychology of Asian Americans. New York: Psychology Press: Taylor and Francis; 2011:219-236.
²⁸
Stern Y. Cognitive reserve. Neuropsychologia 2009;47:2015-2028.
²⁹
Lezak MD, Howieson DB, Bigler ED, Trane, D. Neuropsychological Assessment. New York: Oxford University Press; 2004.

Publication Dates

Publication in this collection
Apr-Jun 2014

History

Received
14 Feb 2014
Accepted
30 Apr 2014

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

[1] ¹
Brickman AM, Cabo R, Manly JJ. Ethical issues in cross-cultural neuropsychology.Appl Neuropsychol 2006;13:91-100.

[2] ²
Chan AS, Shum D, Cheung RW. Recent development of cognitive and neuropsychological assessment in Asian countries. Psychol Assessment 2003;15:257-67.

[3] ³
Tripathi R, Kumar K. Illiteracy and Cognition in Older Adults. Indian J Psychol Med 2012;34:406.

[4] ⁴
Chandra V, Ganguli M, Ratcliff G, et al. Practical issues in cognitive screening of elderly illiterate populations in developing countries: The Indo-US Cross-National Dementia Epidemiology Study. Aging Clin Exp Res 1998; 10:349-57.

[5] ⁵
Chey J, Park H. Neuropsychology of Korea. In: Fujii DEM, editor. Neuropsychology of Asian Americans. New York: Psychology Press: Taylor and Francis. 2011:247-267.

[6] ⁶
Ostrosky-Solis F, Ardila A, Rosselli M, Lopez-Arango G, Uriel-Mendoza V. Neuropsychological test performance in illiterate subjects. Arch Clin Neuropsychol 1998;13:645-660.

[7] ⁷
Ardila A, Bertolucci PH, Braga LW, et al. Illiteracy: The neuropsychology of cognition without reading. Arch Clin Neuropsychol 2010;25:689-712.

[8] ⁸
Das SK, Banerjee TK, Mukherjee CS, et al. An urban community-based study of cognitive function among non-demented elderly population in India. Neurol. Asia 2006;11:37-48.

[9] ⁹
Mathuranath PS, Cherian JP, Mathew R, George A, Alexander A, Sarma SP. Mini Mental State Examination and the Addenbrooke's cognitive examination: Effect of education and norms for a multicultural population. Neurol India 2007;55:106-10.

[10] ¹⁰
Liu KP, Kuo MC, Tang KC, et al.Effects of age, education and gender in the Consortium to Establish a Registry for the Alzheimer's Disease (CERAD)-Neuropsychological assessment battery for Cantonese-speaking Chinese elders. Int Psychogeriatr 2011;23:1575-1581.

[11] ¹¹
Wang Q, Sun J, Ma X, et al. Normative data on a battery of neuropsychological tests in the Han Chinese population. J Neuropsychol 2011; 5:126-142.

[12] ¹²
van Hooren SAH, Valentijn AM, Bosma H, Ponds RWHM, van Boxtel M P J, Jolles J. Cognitive functioning in healthy older adults aged 64-81: A cohort study into the effects of age, sex, and education. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2007;14:40-54.

[13] ¹³
Messinis L, Tsakona I, Malefaki S, Papathanasopoulos P. Normative data and discriminant validity of Rey's Verbal Learning Test for the Greek adult population. Arch Clin Neuropsychol 2007;22:739-52.

[14] ¹⁴
Proust-Lima C, Amieva H, Letenneur L, Orgogozo J M, Jacqmin-Gadda H, Dartigues JF. Gender and education impact on brain aging: A general cognitive factor approach. Psychol Aging 2008;23:608-20.

[15] ¹⁵
Salthouse TA. The processing-speed theory of adult age differences in cognition. Psychol Rev 1996;103:403-428.

[16] ¹⁶
Park DC, Lautenschlager G, Hedden T, Davidson NS, Smith AD, Smith PK. Models of visuospatial and verbal memory across the adult life span. Psychol Aging 2002;17:299-320.

[17] ¹⁷
Park DC, Reuter-Lorenz P. The adaptive brain: Aging and neurocognitive scaffolding. Annu Rev Psychol 2008;60:173-196.

[18] ¹⁸
Mathuranath PS, Hodges JR, Mathew R, Cherian PJ, George A, Bak TH. Adaptation of the ACE for a Malayalam speaking population in southern India. Int J Geriatr Psychiatry 2004;19:1188-1194.

[19] ¹⁹
Tripathi R. Development and standardization of neuropsychological test battery for older adults. Unpublished Ph.D. Thesis, Department of Clinical Psychology, NIMHANS (Deemed University), Bangalore, India; 2012.

[20] ²⁰
Tripathi R, Kumar J K, Bharath S, Marimuthu P, Varghese M. Clinical validity of NIMHANS neuropsychological battery for elderly (NNB-E): A preliminary report. Indian J Psychiatry 2013;55:203-206

[21] ²¹
Ganguli M, Chandra V, Gilby J E, et al. Cognitive test performance in a community-based nondemented elderly sample in rural India: The Indo-U.S.cross - National Dementia Epidemiology Study. Int Psychogeriatr 1996;8:507-524.

[22] ²²
Oldfield RC. The assessment and analysis of handedness: The Edinburgh inventory. Neuropsychologia 1971;9: 97-113.

[23] ²³
Ganguli M, Ratcliff G, Chandra V, et al. A Hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in India. Int J Geriatr Psychiatry 1995; 10:367-377.

[24] ²⁴
Fillenbaum GG, Chandra V, Ganguli M, et al. Development of an activities of daily living scale to screen for dementia in an illiterate rural older population in India. Age Ageing 1999 28:161-168.

[25] ²⁵
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The M.I.N.I. (Mini International Neuropsychiatric Interview). J Clin Psychiatry 1998;59:22-33.

[26] ²⁶
Alzheimer's and Related Disorders Society of India. The Dementia India Report: prevalence, impact, costs and services for Dementia. In: Shaji KS, Jotheeswaran AT, Girish N, et al. editors. New Delhi: ARDSI; 2010.

[27] ²⁷
Kumar K. Neuropsychology in India. In: Fujii DE, editor. Neuropsychology of Asian Americans. New York: Psychology Press: Taylor and Francis; 2011:219-236.

[28] ²⁸
Stern Y. Cognitive reserve. Neuropsychologia 2009;47:2015-2028.

[29] ²⁹
Lezak MD, Howieson DB, Bigler ED, Trane, D. Neuropsychological Assessment. New York: Oxford University Press; 2004.

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