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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2019; 77(04): 279-288
DOI: 10.1590/0004-282X20190024
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Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review

Rastreio para doença de Alzheimer em idosos brasileiros de baixa escolaridade ou analfabetos: revisão sistemática
Luciane de Fátima Viola Ortega 
1   Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Gerontologia, Campinas SP, Brasil;
,
Ivan Aprahamian 
2   Faculdade de Medicina de Jundiaí, Grupo de Investigação em Multimorbidades e Saúde Mental em Idosos, Disciplina de Geriatria e Gerontologia, Jundiaí SP, Brasil;
3   Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil;
,
Marcus Kiiti Borges 
3   Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil;
,
João de Castilho Cação 
4   Faculdade de Medicina de São José do Rio Preto, Unidade de Geriatria, São José do Rio Preto SP, Brasil;
,
Mçnica Sanches Yassuda 
1   Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Gerontologia, Campinas SP, Brasil;
5   Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brasil.
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ABSTRACT

Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD).

Objective: To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate.

Methods: Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education.

Results: We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy.

Conclusion: For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.

RESUMO

Os instrumentos de rastreio cognitivo sofrem influência educacional e/ou cultural. No Brasil, como as taxas de analfabetismo e baixa escolaridade são altas, é necessário identificar os instrumentos com maior acurácia diagnóstica para a doença de Alzheimer (DA).

Objetivo: identificar os instrumentos de rastreio cognitivo aplicados na população brasileira com maior acurácia para detectar DA em indivíduos com baixo nível de escolaridade ou que são analfabetos.

Métodos: Busca sistemática de estudos que utilizaram testes de rastreio cognitivo para detectar DA em idosos brasileiros de baixa escolaridade ou analfabetos, nas bases de dados: SCIELO, PUBMED E LILACS.

Resultados: Foram encontrados 328 artigos e 9 preencheram os critérios de inclusão. Os instrumentos identificados apresentaram acurácia diagnóstica adequada ou elevada.

Conclusão: Para um rastreio cognitivo válido é importante considerar os fatores socioculturais e educacionais na interpretação dos resultados. A construção de instrumentos epecíficos para idosos de baixa escolaridade ou analfabetos deve ser incentivada para melhor refletir as dificuldades dos idosos brasileiros de diferentes regiões.

Keywords:

Cognition - education - Alzheimer disease - literacy - dementia

Palavras-chave:

Cognição - educação - doença de Alzheimer - alfabetização - demência

Support

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES. Prof. Dr. Ivan Aprahamian recebe Bolsa Produtividade nível 2 do CNPq.




Publication History

Received: 24 May 2018

Accepted: 18 December 2018

Article published online:
16 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Shulman KI, Herrmann N, Brodaty H, Chiu H, Lawlor B, Ritchie K, et al. IPA survey of brief cognitive screening instruments. Int Psychogeriatr. 2006 Jun;18(2):281-94. https://doi.org/10.1017/S1041610205002693
  • 2 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98. https://doi.org/10.1016/0022-3956(75)90026-6
  • 3 Aprahamian I, Martinelli JE, Neri AL, Yassuda MS. The accuracy of the Clock Drawing Test compared to that of standard screening tests for Alzheimer's disease: results from a study of Brazilian elderly with heterogeneous educational backgrounds. International psychogeriatrics / IPA. 2010;22(1):64-71. https://doi.org/10.1017/S1041610209991141
  • 4 Silva T, Yassuda MS, Guimarães VV, Florindo AA. Fluência verbal e variáveis sociodemográficas no processo de envelhecimento: um estudo epidemiológico. Psicol Reflex Crit. 2011;24(4):739-46. https://doi.org/10.1590/S0102-79722011000400014
  • 5 Caramelli P, Carthery-Goulart MT, Porto CS, Charchat-Fichman H, Nitrini R. Category fluency as a screening test for Alzheimer disease in illiterate and literate patients. Alzheimer Dis Assoc Disord. 2007 Jan-Mar;21(1):65-7. https://doi.org/10.1097/WAD.0b013e31802f244f
  • 6 Almeida OP. [Mini mental state examination and the diagnosis of dementia in Brazil]. Arq Neuropsiquiatr. 1998 Sep;56 3B:605-12. Portuguese. https://doi.org/10.1590/S0004-282X1998000400014
  • 7 Machado O, Correia SM, Mansur LL. [Performance of normal Brazilian adults in a semantic test: effect of literacy]. Pro Fono. 2007 Jul-Sep;19(3):289-94. Portuguese. https://doi.org/10.1590/S0104-56872007000300007
  • 8 Bertolucci PH, Brucki SM, Campacci SR, Juliano Y. O [The Mini-Mental State Examination in a general population: impact of educational status]. Arq Neuropsiquiatr. 1994 Mar;52(1):1-7. Portuguese. https://doi.org/10.1590/S0004-282X1994000100001
  • 9 Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. [Suggestions for utilization of the mini-mental state examination in Brazil]. Arq Neuropsiquiatr. 2003 Sep;61 3B:777-81. Portuguese. https://doi.org/10.1590/S0004-282X2003000500014
  • 10 Brito-Marques PR, Cabral-Filho JE. The role of education in mini-mental state examination: a study in Northeast Brazil. Arq Neuropsiquiatr. 2004 Jun;62(2a 2A):206-11. https://doi.org/10.1590/S0004-282X2004000200003
  • 11 Aprahamian I, Martinelli JE, Yassuda MS. Doença de Alzheimer em idosos com baixa escolaridade: o teste do Desenho do Relógio pode ser útil no rastreio cognitivo? Rev Soc Bras Clin Med. 2008;6(4):130-4.
  • 12 Ostrosky-Solís F, Ramirez M, Ardila A. Effects of culture and education on neuropsychological testing: a preliminary study with indigenous and nonindigenous population. Appl Neuropsychol. 2004;11(4):188-95. https://doi.org/10.1207/s15324826an1104_3
  • 13 Ardila A, Rosselli M, Puente AE. Neuropsychological evaluation of the Spanish speaker. Springer Science & Business Media; 1994. https://doi.org/10.1007/978-1-4899-1453-8
  • 14 Rosselli M, Ardila A. The impact of culture and education on non-verbal neuropsychological measurements: a critical review. Brain Cogn. 2003 Aug;52(3):326-33. https://doi.org/10.1016/S0278-2626(03)00170-2
  • 15 Rosselli M, Ardila A. Effects of age, education, and gender on the Rey-Osterrieth Complex Figure. Clin Neuropsychol. 1991;5(4):370-6. https://doi.org/10.1080/13854049108404104
  • 16 Ardila A, Rosselli M, Rosas P. Neuropsychological assessment in illiterates: visuospatial and memory abilities. Brain Cogn. 1989 Nov;11(2):147-66. https://doi.org/10.1016/0278-2626(89)90015-8
  • 17 Instituto Brasileiro de Geografia e Estatística – IBGE. Censo demográfico: características gerais da população, religião e pessoas com deficiências. Rio de Janeiro Instituto Brasileiro de Geografia e Estatística; 2010.
  • 18 Jacinto AF, Brucki S, Porto CS, Martins MA, Nitrini R. Detection of cognitive impairment in the elderly by general internists in Brazil. Clinics (São Paulo). 2011;66(8):1379-84. https://doi.org/10.1590/S1807-59322011000800012
  • 19 Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015 Jan;4(1):1. https://doi.org/10.1186/2046-4053-4-1
  • 20 Aprahamian I, Martinelli JE, Cecato J, Izbicki R, Yassuda MS. Can the CAMCOG be a good cognitive test for patients with Alzheimer's disease with low levels of education? Int Psychogeriatr. 2011 Feb;23(1):96-101. https://doi.org/10.1017/S104161021000116X
  • 21 Aprahamian I, Martinelli JE, Cecato J, Yassuda MS. Screening for Alzheimer's disease among illiterate elderly: accuracy analysis for multiple instruments. J Alzheimers Dis. 2011;26(2):221-9. https://doi.org/10.3233/JAD-2011-110125
  • 22 Araujo NB, Nielsen TR, Engedal K, Barca ML, Coutinho ES, Laks J. Diagnosing dementia in lower educated older persons: validation of a Brazilian Portuguese version of the Rowland Universal Dementia Assessment Scale (RUDAS). Rev Bras Psiquiatr. 2018 Jul-Sep;40(3):264-9. https://doi.org/10.1590/1516-4446-2017-2284
  • 23 Damasceno A, Delicio AM, Mazo DF, Zullo JF, Scherer P, Ng RT, et al. [Validation of the Brazilian version of mini-test CASI-S]. Arq Neuropsiquiatr. 2005 Jun;63(2b 2B):416-21. Portuguese. https://doi.org/10.1590/S0004-282X2005000300010
  • 24 Fichman-Charchat H, Miranda CV, Fernandes CS, Mograbi D, Oliveira RM, Novaes R, et al. Brief Cognitive Screening Battery (BCSB) is a very useful tool for diagnosis of probable mild Alzheimer´s disease in a geriatric clinic. Arq Neuropsiquiatr. 2016 Feb;74(2):149-54. https://doi.org/10.1590/0004-282X20150202
  • 25 Martinelli JE, Cecato JF, Martinelli MO, de Melo BA, Aprahamian I. Performance of the Pentagon Drawing test for the screening of older adults with Alzheimer's dementia. Dement Neuropsychol. 2018 Jan-Mar;12(1):54-60. https://doi.org/10.1590/1980-57642018dn12-010008
  • 26 Porto CS, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr. 2003 Jun;61 2B:339-45. https://doi.org/10.1590/S0004-282X2003000300004
  • 27 Storey JE, Rowland JT, Basic D, Conforti DA, Dickson HG. The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. Int Psychogeriatr. 2004 Mar;16(1):13-31. https://doi.org/10.1017/S1041610204000043
  • 28 Brucki SM, Rocha MS. Category fluency test: effects of age, gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Braz J Med Biol Res. 2004 Dec;37(12):1771-7. https://doi.org/10.1590/S0100-879X2004001200002
  • 29 Teng EL, Hasegawa K, Homma A, Imai Y, Larson E, Graves A, et al. The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr. 1994;6(1):45-58. https://doi.org/10.1017/S1041610294001602
  • 30 Jacobs DM, Sano M, Dooneief G, Marder K, Bell KL, Stern Y. Neuropsychological detection and characterization of preclinical Alzheimer's disease. Neurology. 1995 May;45(5):957-62. https://doi.org/10.1212/WNL.45.5.957
  • 31 Nitrini R, Caramelli P, Porto CS, Charchat-Fichman H, Formigoni AP, Carthery-Goulart MT, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol. 2007 Jan-Mar;1(1):32-6. https://doi.org/10.1590/S1980-57642008DN10100006
  • 32 Bourke J, Castleden CM, Stephen R, Dennis M. A comparison of clock and pentagon drawing in Alzheimer's disease. Int J Geriatr Psychiatry. 1995;10(8):703-5. https://doi.org/10.1002/gps.930100811
  • 33 Mattis S. Mental status examination for organic mental syndrome in the elderly patients. Geriatric Psychiatry A Hand Book for Psychiatrics and Primary Care Physicians; 1976.
  • 34 Bernstein IH, Lacritz L, Barlow CE, Weiner MF, DeFina LF. Psychometric evaluation of the Montreal Cognitive Assessment (MoCA) in three diverse samples. Clin Neuropsychol. 2011 Jan;25(1):119-26. https://doi.org/10.1080/13854046.2010.533196
  • 35 Rossetti HC, Lacritz LH, Cullum CM, Weiner MF. Normative data for the Montreal Cognitive Assessment (MoCA) in a population-based sample. Neurology. 2011 Sep;77(13):1272-5. https://doi.org/10.1212/WNL.0b013e318230208a
  • 36 Apolinario D, Lichtenthaler DG, Magaldi RM, Soares AT, Busse AL, Amaral JR, et al. Using temporal orientation, category fluency, and word recall for detecting cognitive impairment: the 10-point cognitive screener (10-CS). Int J Geriatr Psychiatry. 2016 Jan;31(1):4-12. https://doi.org/10.1002/gps.4282
  • 37 Babacan-Yildiz G, Isik AT, Ur E, Aydemir E, Ertas C, Cebi M, et al. COST: cognitive State Test, a brief screening battery for Alzheimer disease in illiterate and literate patients. Int Psychogeriatr. 2013 Mar;25(3):403-12. https://doi.org/10.1017/S1041610212001780
  • 38 Caldas VV, Zunzunegui MV, Freire AN, Guerra RO. Translation, cultural adaptation and psychometric evaluation of the Leganés cognitive test in a low educated elderly Brazilian population. Arq Neuropsiquiatr. 2012 Jan;70(1):22-7. https://doi.org/10.1590/S0004-282X2012000100006
  • 39 de Paula JJ, Costa MV, Bocardi MB, Cortezzi M, De Moraes EN, Malloy-Diniz LF. The Stick Design Test on the assessment of older adults with low formal education: evidences of construct, criterion-related and ecological validity. Int Psychogeriatr. 2013 Dec;25(12):2057-65. https://doi.org/10.1017/S1041610213001282
  • 40 Park S, Park SE, Kim MJ, Jung HY, Choi JS, Park KH, et al. Development and validation of the Pictorial Cognitive Screening Inventory for illiterate people with dementia. Neuropsychiatr Dis Treat. 2014 Sep;10:1837-45. https://doi.org/10.2147/NDT.S64151
  • 41 Rezende GP, Cecato J, Martinelli JE. Cognitive abilities screening instrument-short form, mini-mental state examination and functional activities questionnaire in the illiterate elderly. Dement Neuropsychol. 2013 Oct-Dec;7(4):410-5. https://doi.org/10.1590/S1980-57642013DN74000009
  • 42 Rideaux T, Beaudreau SA, Fernandez S, O'Hara R. Utility of the abbreviated Fuld Object Memory Evaluation and MMSE for detection of dementia and cognitive impairment not dementia in diverse ethnic groups. J Alzheimers Dis. 2012;31(2):371-86. https://doi.org/10.3233/JAD-2012-112180
  • 43 Radford K, Mack HA, Draper B, Chalkley S, Delbaere K, Daylight G, et al. Comparison of three cognitive screening tools in older urban and regional Aboriginal Australians. Dement Geriatr Cogn Disord. 2015;40(1-2):22-32. https://doi.org/10.1159/000377673
  • 44 Tappen RM, Rosselli M, Engstrom G. Use of the MC-FAQ and MMSE-FAQ in cognitive screening of older African Americans, Hispanic Americans, and European Americans. Am J Geriatr Psychiatry. 2012 Nov;20(11):955-62. https://doi.org/10.1097/JGP.0b013e31825d0935
  • 45 Paradela EM, Lourenço RA. Is the Cambridge Cognitive Examination - revised a good tool for detection of dementia in illiterate Brazilian older adults? Geriatr Gerontol Int. 2014 Oct;14(4):763-8. https://doi.org/10.1111/ggi.12161
  • 46 Lourenço RA, Ribeiro-Filho ST, Moreira IF, Paradela EM, Miranda AS. The Clock Drawing Test: performance among elderly with low educational level. Br J Psychiatry. 2008 Dec;30(4):309-15. https://doi.org/10.1590/S1516-44462008000400002
  • 47 Kochhann R, Cerveira MO, Godinho C, Camozzato A, Chaves ML. Evaluation of Mini-Mental State Examination scores according to different age and education strata, and sex, in a large Brazilian healthy sample. Dement Neuropsychol. 2009 Apr-Jun;3(2):88-93. https://doi.org/10.1590/S1980-57642009DN30200004
  • 48 de Oliveira GM, Yokomizo JE, Vinholi e Silva LS, Saran LF, Bottino CM, Yassuda MS. The applicability of the cognitive abilities screening instrument-short (CASI-S) in primary care in Brazil. Int Psychogeriatr. 2016 Jan;28(1):93-9. https://doi.org/10.1017/S1041610215000642
  • 49 Nielsen TR, Vogel A, Gade A, Waldemar G. Cognitive testing in non-demented Turkish immigrants—comparison of the RUDAS and the MMSE. Scand J Psychol. 2012 Dec;53(6):455-60. https://doi.org/10.1111/sjop.12018
  • 50 Nielsen TR, Vogel A, Waldemar G. Comparison of performance on three neuropsychological tests in healthy Turkish immigrants and Danish elderly. Int Psychogeriatr. 2012 Sep;24(9):1515-21. https://doi.org/10.1017/S1041610212000440
  • 51 LoGiudice D, Strivens E, Smith K, Stevenson M, Atkinson D, Dwyer A, et al. The KICA Screen: the psychometric properties of a shortened version of the KICA (Kimberley Indigenous Cognitive Assessment). Australas J Ageing. 2011 Dec;30(4):215-9. https://doi.org/10.1111/j.1741-6612.2010.00486.x
  • 52 Ardila A, Bertolucci PH, Braga LW, Castro-Caldas A, Judd T, Kosmidis MH, et al. Illiteracy: the neuropsychology of cognition without reading. Arch Clin Neuropsychol. 2010 Dec;25(8):689-712. https://doi.org/10.1093/arclin/acq079
  • 53 Baiyewu O, Unverzagt FW, Lane KA, Gureje O, Ogunniyi A, Musick B, et al. The Stick Design test: a new measure of visuoconstructional ability. J Int Neuropsychol Soc. 2005 Sep;11(5):598-605. https://doi.org/10.1017/S135561770505071X
  • 54 Paula JJ, Schlottfeldt CG, Moreira L, Cotta M, Bicalho MA, Romano-Silva MA, et al. Psychometric properties of a brief neuropsychological protocol for use in geriatric populations. Rev Psiquiatr Clín. 2010;37(6):251-5. https://doi.org/10.1590/S0101-60832010000600002
  • 55 Atalaia-Silva KC, Lourenço RA. Tradução, adaptação e validação de construto do Teste do Relógio aplicado entre idosos no Brasil. Rev Saude Publica. 2008;42(5):930-7. https://doi.org/10.1590/S0034-89102008000500020
  • 56 Teixeira Fabricio A, Aprahamian I, Sanches Yassuda M. Qualitative analysis of the Clock Drawing Test by educational level and cognitive profile. Arq Neuropsiquiatr. 2014 Apr;72(4):289-95. https://doi.org/10.1590/0004-282X20140004
  • 57 de Paula JJ, Costa MV, de Andrade GF, Ávila RT, Malloy-Diniz LF; Paula JJd. Validity and reliability of a “simplified” version of the Taylor Complex Figure Test for the assessment of older adults with low formal education. Dement Neuropsychol. 2016 Jan-Mar;10(1):52-7. https://doi.org/10.1590/s1980-57642016dn10100010
  • 58 Gómez F, Zunzunegui M, Lord C, Alvarado B, García A. Applicability of the MoCA-S test in populations with little education in Colombia. Int J Geriatr Psychiatry. 2013 Aug;28(8):813-20. https://doi.org/10.1002/gps.3885
  • 59 Ribeiro Filho ST, Lourenço RA. The performance of the Mini-Cog in a sample of low educational level elderly. Dement Neuropsychol. 2009 Apr-Jun;3(2):81-7. https://doi.org/10.1590/S1980-57642009DN30200003
  • 60 Carnero-Pardo C, Cruz-Orduña I, Espejo-Martínez B, Martos-Aparicio C, López-Alcalde S, Olazarán J. Utility of the mini-cog for detection of cognitive impairment in primary care: data from two Spanish studies. Int J Alzheimer Dis. 2013;2013:285462. https://doi.org/10.1155/2013/285462