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Screening Older Latinos for Dementia in the Primary Care Setting

Published online by Cambridge University Press:  14 August 2014

Ellen Grober ,
Amy R. Ehrlich ,
Yaritza Troche ,
Steven Hahn  and
Richard B. Lipton
Ellen Grober*
Affiliation:
Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
Amy R. Ehrlich
Affiliation:
Division of Geriatrics of the Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
Yaritza Troche
Affiliation:
Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
Steven Hahn
Affiliation:
Department of Medicine, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York
Richard B. Lipton
Affiliation:
Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York Department of Epidemiology and Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
*
Correspondence and reprint requests to: Ellen Grober, Kennedy Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461. E-mail: [email protected]
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Abstract

The purpose was to compare the Spanish language picture version of the Free and Cued Selective Reminding Test with Immediate Recall (pFCSRT+IR) and the Mini Mental State Exam (MMSE) in identifying very mild dementia among Spanish speaking Latino patients. The tests and an independent diagnostic assessment were administered to 112 Latino patients free of medically diagnosed dementia from an urban primary care clinic. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to examine differences in the operating characteristics of the pFCSRT+IR and the MMSE. Cut scores were manipulated to equate sensitivities (specificities) at clinically relevant values to compare differences in specificities (sensitivities) using the Pearson Chi Square test. Youden’s index was used to select the optimal cut scores. Twenty-four of the 112 primary care patients (21%) received a research dementia diagnosis, indicating a substantial burden of unrecognized dementia. MMSE scores but not free recall scores were associated with years of education in patients free of dementia. AUC was significantly higher for free recall than for MMSE. Free recall performed significantly better than the MMSE in sensitivity and in specificity. Using optimal cut scores, patients with impaired free recall were 10 times more likely to have dementia than patients with intact recall, and patients with impaired MMSE scores were 4.5 times more likely to have dementia than patients with intact scores. These results suggest that the Spanish language pFCSRT+IR may be an effective tool for dementia screening in educationally diverse Latino primary care populations. (JINS, 2014, 20, 1–8)

Keywords

MemoryDementiaPrimary careLatino patientsFree and Cued Selective Reminding TestMini Mental State Exam
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 20 , Issue 8 , September 2014 , pp. 848 - 855
Copyright
Copyright © The International Neuropsychological Society 2014 

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References

Alzheimer’s Association (2004). Hispanic/Latinos and Alzheimer’s Disease. Retrieved from http://www.alz.org/national/documents/report_sp_hispanic.pdf.Google Scholar
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association Press.Google Scholar
Auriacombe, S., Helmer, C., Amieva, H., Berr, C., Dubois, B., & Dartigues, J.F. (2010). Validity of the free and cued selective reminding test in predicting dementia: The 3C Study. Neurology, 74(22), 1760–1767.Google Scholar
Blessed, G., Tomlinson, B.E., & Roth, M. (1968). The association between quantitative measures and senile changes in the cerebral gray matter of elderly subjects. British Journal of Psychiatry, 114, 797–811.Google Scholar
Boustani, M., Peterson, B., Hanson, L., Harris, R., & Lohr, K.N. (2003). Screening for dementia in primary care: A summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 138(11), 927–937.Google Scholar
Brayne, C., Fox, C., & Boustani, M. (2007). Dementia screening in primary care: Is it time? Journal of the American Medical Association, 298(20), 2409–2411. doi: 10.1001/jama.298.20.2409 Google Scholar
Callahan, C.M., Hendrie, H.C., & Tierney, W.M. (1995). Documentation and evaluation of cognitive impairment in elderly primary care patients. Annals of Internal Medicine, 122(6), 422–429.CrossRefGoogle ScholarPubMed
Clark, C.M., DeCarli, C., Mungas, D., Chui, H.I., Higdon, R., Nunez, J., & van Belle, G. (2005). Earlier onset of Alzheimer disease symptoms in Latino individuals compared with anglo individuals. Archives of Neurology, 62(5), 774–778. doi: 10.1001/archneur.62.5.774 CrossRefGoogle ScholarPubMed
Dartigues, J.F., Commenges, D., Letenneur, D., Barberger-Gateau, P., Gilleron, V., Fabrigoule, C., & Salamon, R. (1997). Cognitive predictors of dementia in elderly community residents. Neuroepidemiology, 16(1), 29–39.Google Scholar
de Souza, L.C., Chupin, M., Lamari, F., Jardel, C., Leclercq, D., Colliot, O., & Sarazin, M. (2012). CSF tau markers are correlated with hippocampal volume in Alzheimer’s disease. Neurobiology of Aging, 33(7), 1253–1257. doi: 10.1016/j.neurobiolaging.2011.02.022 Google Scholar
Derby, C.A., Burns, L.C., Wang, C., Katz, M.J., Zimmerman, M.E., L’Italien, G., & Lipton, R.B. (2013). Screening for predementia AD: Time-dependent operating characteristics of episodic memory tests. Neurology, 80(14), 1307–1314.CrossRefGoogle ScholarPubMed
Diamond, E.L., Miller, S., Dickerson, B.C., Atri, A., DePeau, K., Fenstermacher, E., & Sperling, R.A. (2007). Relationship of fMRI activation to clinical trial memory measures in Alzheimer disease. Neurology, 69(13), 1331–1341. doi: 10.1212/01.wnl.0000277292.37292.69 Google Scholar
Dubois, B., Feldman, H.H., Jacova, C., Cummings, J.L., Dekosky, S.T., Barberger-Gateau, P., & Scheltens, P. (2010). Revising the definition of Alzheimer’s disease: A new lexicon. The Lancet Neurology, 9(11), 1118–1127.CrossRefGoogle ScholarPubMed
Dubois, B., Feldman, H.H., Jacova, C., DeKosky, S.T., Barberger-Gateau, P., Cummings, J., & Scheltens, P. (2007). Research criteria for the diagnosis of Alzheimer’s disease: Revising the NINCDS-ADRDA criteria. The Lancet Neurology, 6(8), 734.Google Scholar
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). The Mini-Mental State: A practical method for grading cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Freeman, M., Leach, L., Kaplan, E., Winocur, G., Schulman, K., & Delis, D. (1994). Clock drawing: A neuropsychological analysis. New York: Oxford University Press.Google Scholar
Galasko, D., Bennett, D. A., Sano, M., Marson, D., Kaye, J., & Edland, S. D. (2006). ADCS Prevention Instrument Project: assessment of instrumental activities of daily living for community-dwelling elderly individuals in dementia prevention clinical trials. Alzheimer Dis Assoc Disord, 20(4 Suppl. 3), S152–169.Google Scholar
González, H.M., Tarraf, W., Gouskova, N., & Mosley, T.H. (2014). Neurocognitive function among middle-aged and older Hispanic/Latinos: Results from the Hispanic Community Health Study/Study of Latinos (unpublished manuscript).Google Scholar
Grober, E. (1984). Nonlinguistic memory in aphasia. Cortex, 20, 67–73.Google Scholar
Grober, E., & Buschke, H. (1987). Genuine memory deficits in dementia. Developmental Neuropsychology. 3, 13–36.Google Scholar
Grober, E., Buschke, H., Crystal, H., Bang, S., & Dresner, R. (1988). Screening for dementia by memory testing. Neurology, 38(6), 900–903.Google Scholar
Grober, E., Dickson, D., Sliwinski, M.J., Buschke, H., Katz, M., Crystal, H., & Lipton, R.B. (1999). Memory and mental status correlates of modified Braak staging. Neurobiology of Aging, 20(6), 573.Google Scholar
Grober, E., Hall, C., Lipton, R.B., & Teresi, J. (2008). Primary care screen for early dementia. Journal of the American Geriatrics Society, 56, 206–213.Google Scholar
Grober, E., Hall, C., McGinn, M., Nicholls, T., Stanford, S., Ehrilich, A., & Lipton, R.B. (2008). Neuropsychological strategies for detecting early dementia. Journal of the International Neuropsychological Society, 14, 130–142.Google Scholar
Grober, E., Hall, C., Sanders, A., & Lipton, R.B. (2008). Free and cued selective reminding distinguishes Alzherimer’s disease from vascular dementia. Journal of the American Geriatrics Society, 56(5), 944–946.Google Scholar
Grober, E., Lipton, R.B., Hall, C., & Crystal, H. (2000). Memory impairment on free and cued selective reminding predicts dementia. Neurology, 54(4), 827–832.CrossRefGoogle ScholarPubMed
Grober, E., Lipton, R.B., Katz, M., & Sliwinski, M. (1998). Demographic influences on free and cued selective reminding performance in older persons. Journal of Clinical and Experimental Neuropsychology, 20, 221–226.Google Scholar
Grober, E., Sanders, A., Hall, C., & Lipton, R.B. (2010). Free and cued selective reminding identifies very mild dementia in primary care. Alzheimer Disease and Associated Disorders, 24, 284–290.CrossRefGoogle ScholarPubMed
Gurland, B.J., Wilder, D.E., Cross, P., Teresi, J., & Barrett, V.W. (1992). Screening scales for dementia: Toward reconciliation of conflicting cross-cultural findings. International Journal of Geriatric Psychiatry, 7(2), 105–113. doi: 10.1002/gps.930070207 Google Scholar
Haan, M.N., Mungas, D.M., Gonzalez, H.M., Ortiz, T.A., Acharya, A., & Jagust, W.J. (2003). Prevalence of dementia in older Latinos: The influence of type 2 diabetes mellitus, stroke and genetic factors. Journal of the American Geriatrics Society, 51(2), 169–177. doi: doi:10.1046/j.1532-5415.2003.51054.x Google Scholar
Harris, D.P., Ortiz, F., Adler, F.M., Yu, K., Maines, M.L., Barba, D., & Vickrey, B.G. (2011). Challenges to screening and evaluation of memory impairment among Hispanic elders in a primary care safety net facility. [Research Support, U.S. Gov’t, Non-P.H.S.]. International Journal of Geriatric Psychiatry, 26(3), 268–276.CrossRefGoogle Scholar
Ivnik, R.J., Smith, G.E., & Lucas, J.A. (1997). Free and cued selective reminding test: MOANS norms. Journal of Clinical and Experimental Neuropsychology, 19, 676–691.CrossRefGoogle ScholarPubMed
Katz, M.J., Lipton, R.B., Hall, C.B., Zimmerman, M.E., Sanders, A.E., Verghese, J., & Derby, C.A. (2012). Age-specific and sex-specific prevalence and incidence of mild cognitive impairment, dementia, and Alzheimer dementia in blacks and whites: A report from the Einstein Aging Study. Alzheimer Disease and Associated Disorders, 26(4), 335–343.Google Scholar
Knopman, D.S., Donohue, J.A., & Gutterman, E.M. (2000). Patterns of care in the early stages of Alzheimer’s disease: Impediments to timely diagnosis. Journal of the American Geriatrics Society, 48, 300–304.Google Scholar
Koric, L., Ranjeva, J.P., Felician, O., Guye, M., de Anna, F., Soulier, E., & Ceccaldi, M. (2013). Cued recall measure predicts the progression of gray matter atrophy in patients with amnesic mild cognitive impairment. Dementia and Geriatric Cognitive Disorders, 36(3-4), 197–210.Google Scholar
Lekeu, F., Van der Linden, M., Chicherio, C., Collette, F., Degueldre, C., Franck, G., & Salmon, E. (2003). Brain correlates of performance in a free/cued recall task with semantic encoding in Alzheimer disease. Alzheimer Disease and Associated Disorders, 17(1), 35–45.Google Scholar
Lin, J.S., O’Connor, E., Rossom, R.C., Perdue, L.A., & Eckstrom, E. (2013). Screening for cognitive impairment in older adults: A systematic review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 159(9), 601–612.Google Scholar
Lemos, R., Simoes, M.R., Santiago, B., & Santana, I. (2014). The free and cued selective reminding test: Validation for mild cognitive impairment and Alzheimer’s disease. J Neuropsychol, 3(10), 12048.Google Scholar
Lindenberger, U., & Reischies, F.M. (1999). Limits and potentials of intellectual functioning in old age. New York: Cambridge University Press.Google Scholar
Luchsinger, J.A., Reitz, C., Honig, L.S., Tang, M.X., Shea, S., & Mayeux, R. (2005). Aggregation of vascular risk factors and risk of incident Alzheimer disease. Neurology, 65(4), 545–551. doi: 10.1212/01.wnl.0000172914.08967.dc Google Scholar
Mahieux, F., Onen, F., Berr, C., Volteau, M., Habert, M., & Legrain, S., … Pre-Al Study Group. (2009). Early detection of patients in the pre demented stage of Alzheimer’s disease: The Pre-Al study. The Journal of Nutrition, Health & Aging, 13(1), 21–26. doi: 10.1007/s12603-009-0004-2 CrossRefGoogle ScholarPubMed
Manly, J. (2006). Deconstructing race and ethnicity: Implications for measurement and health outcomes. Medical Care, 44(11, Suppl. 3), S10–S16.Google Scholar
Marin, G., Sabogal, F., & Vanoss, M.B. (1987). Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Science, 9, 183–205.Google Scholar
McLaren, D.G., Sreenivasan, A., Diamond, E.L., Mitchell, M.B., Van Dijk, K.R., Deluca, A.N.,& Atri, A. (2012). Tracking cognitive change over 24 weeks with longitudinal functional magnetic resonance imaging in Alzheimer’s disease. Neuro-degenerative Diseases, 9(4), 176–186. doi: 10.1159/000335876 Google Scholar
Mejia, S., Gutierrez, L.M., Villa, A.R., & Ostrosky-Solis, F. (2004). Cognition, functional status, education, and the diagnosis of dementia and mild cognitive impairment in Spanish-speaking elderly. Applied Neuropsychology, 11(4), 194–201.Google Scholar
Morris, J.C. (1993). Clinical dementia rating: Current version and scoring rules. Neurology, 43, 2412–2414.Google Scholar
Mungas, D. (2006). Neuropsychological assessment of Hispanic elders: Challenges and psychometric approaches. In G. Yeo & D. Gallagher-thompson (Eds.), Ethnicity and the dementias (2nd ed.), Washington, DC: Routledge.Google Scholar
Ortiz, F., & Fitten, L.J. (2000). Barriers to healthcare access for cognitively impaired older Hispanics. [Article]. Alzheimer Disease & Associated Disorders, 14(3), 141–150.Google Scholar
Ostrosky-Solis, F., Lopez-Arango, G., & Ardila, A. (2000). Sensitivity and specificity of the Mini-Mental State Examination in a Spanish-speaking population. Applied Neuropsychology, 7(1), 25–31.Google Scholar
Pena-Casanova, J., Gramunt-Fombuena, N., Quinones-Ubeda, S., Sanchez-Benavides, G., Aguilar, M., & Badenes, D., … for the NEUROORMA Study Team (2009). Spanish Multicenter Normative Studies (NEURONORMA Project): Norms for the Rey-Osterrieth complex figure (copy and memory), and free and cued selective reminding test. Archives of Clinical Neuropsychology, 24(4), 371–393. doi: 10.1093/arclin/acp041 Google Scholar
Petersen, R.C., Jack, C.R., Xu, Y.C., Waring, S.C., O’Brien, P.C., Smith, G.E., & Kokmen, E. (2000). Memory and MRI-based hippocampal volumes in aging and AD. Neurology, 54(3), 581.Google Scholar
Petersen, R.C., Smith, G.E., Ivnik, R.J., Kokmen, E., & Tangalos, E.G. (1994). Memory function in very early Alzheimer’s disease. Neurology, 44(5), 867–872.Google Scholar
Petersen, R.C., Stevens, J.C., Ganguli, M., Tangalos, E.G., Cummings, J.L., & DeKosky, S.T. (2001). Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review). Neurology, 56, 1133–1142.Google Scholar
Pillon, B., Deweer, B., Agid, Y., & Dubois, B. (1993). Explicit memory in Alzheimer’s, Huntington’s, and Parkinson’s diseases. Archives of Neurology, 50(4), 374–379. doi: 10.1001/archneur.50.4.374 Google Scholar
Rami, L., Fortea, J., Bosch, B., Sole-Padulles, C., Llado, A., Iranzo, A.,& Molinuevo, J.L. (2011). Cerebrospinal fluid biomarkers and memory present distinct associations along the continuum from healthy subjects to AD patients. Journal of Alzheimers Disease, 23(2), 319–326. doi: 10.3233/jad-2010-101422 Google Scholar
Rosen, W. (1980). Verbal fluency in aging and dementia. Journal of Clinical Neuropsychology, 2, 135–146.Google Scholar
Sano, M., Egelko, S., Jin, S., Cummings, J., Clark, C.M., & Pawluczyk, S., … the members of the Alzheimer’s Disease Cooperative Study Group. (2006). Spanish Instrument Protocol: New Treatment Efficacy Instruments for Spanish-speaking Patients in Alzheimer Disease Clinical Trials. Alzheimer Disease & Associated Disorders, 20(4), 232–241.Google Scholar
Sarazin, M., Berr, C., De Rotrou, J., Fabrigoule, C., Pasquier, F., Legrain, S., & Dubois, B. (2007). Amnestic syndrome of the medial temporal type identifies prodromal AD: A longitudinal study. Neurology, 69(19), 1859–1867. doi: 10.1212/01.wnl.0000279336.36610.f7 Google Scholar
Sarazin, M., Chauvire, V., Gerardin, E., Colliot, O., Kinkingnehun, S., De Souza, L., & Dubois, B. (2010). The amnestic syndrome of hippocampal type in Alzheimer’s disease: An MRI study. Journal of Alzheimer’s Disease, 22, 285–294.Google Scholar
Skoog, I., Nilsson, L., Persson, G., Lernfelt, B., Landahl, S., Palmertz, B., & Svanborg, A. (1996). 15-year longitudinal study of blood pressure and dementia. The Lancet, 347(9009), 1141–1145.Google Scholar
Teresi, J.A., Golden, R.R., Cross, P., Gurland, B., Kleinman, M., & Wilder, D. (1995). Item bias in cognitive screening measures: Comparisons of elderly white, Afro-American, Hispanic and high and low education subgroups. Journal of Clinical Epidemiology, 48(4), 473.Google Scholar
Teresi, J.A., Stewart, A.L., Morales, L.S., & Stahl, S.M. (2006). Measurement in a multi-ethnic society: Overview to the special issue. [Editorial]. Medical Care, 44(Suppl. 3), S3–S4.CrossRefGoogle Scholar
Tounsi, H., Deweer, B., Ergis, A., Van der Linden, M., Pillon, B., Michon, A., &Dubois, B. (1999). Sensitivity to semantic cuing: An index of episodic memory dysfunction in early Alzheimer disease. Alzheimer Disease and Associated Disorders, 13(1), 38–46.Google Scholar
Traykov, L., Baudic, S., Raoux, N., Latour, F., Rieu, D., Smagghe, A., & Rigaud, A.-S. (2005). Patterns of memory impairment and perseverative behavior discriminate early Alzheimer’s disease from subcortical vascular dementia. Journal of the Neurological Sciences, 75, 229–230.Google Scholar
Wagner, M., Wolf, S., Reischies, F.M., Daerr, M., Wolfsgruber, S., Jessen, F., & Wiltfang, J. (2012). Biomarker validation of a cued recall memory deficit in prodromal Alzheimer disease. Neurology, 78(6), 379–386. doi: 10.1212/WNL.0b013e318245f447 Google Scholar
Welsh, K.A., Butters, N., Mohs, R.C., Beekly, D., Edland, S., Fillenbaum, G., & Heyman, A. (1994). The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part V. A normative study of the neuropsychological battery. Neurology, 44(4), 609–614.Google Scholar
Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M., & Leirer, V.O. (1982–1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37–49.Google Scholar
Youden, W.J. (1950). Index for rating diagnostic tests. Cancer, 3(1), 32–35.Google Scholar
Zimmerman, M.E., Pan, J.W., Hetherington, H.P., Katz, M.J., Verghese, J., Buschke, H., & Lipton, R.B. (2008). Hippocampal neurochemistry, neuromorphometry, and verbal memory in nondemented older adults. Neurology, 70(18), 1594–1600. doi: 10.1212/01.wnl.0000306314.77311.be Google Scholar
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