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Quality, and not Just Quantity, of Education Accounts for Differences in Psychometric Performance between African Americans and White Non-Hispanics with Alzheimer's Disease

Published online by Cambridge University Press:  03 February 2012

Alexander L. Chin ,
Selam Negash ,
Sharon Xie ,
Steven E. Arnold  and
Roy Hamilton
Alexander L. Chin
Affiliation:
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Selam Negash
Affiliation:
Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania
Sharon Xie
Affiliation:
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
Steven E. Arnold
Affiliation:
Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania
Roy Hamilton*
Affiliation:
Penn Memory Center, University of Pennsylvania, Philadelphia, Pennsylvania Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
*
Correspondence and reprint requests to: Roy Hamilton, Penn Memory Center, 3615 Chestnut Street, Philadelphia, PA 19104. E-mail: [email protected]
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Abstract

The effect of race on cognitive test performance in the evaluation of Alzheimer's disease (AD) remains controversial. One factor that may contribute substantially to differences in cognitive test performance in diverse populations is education. The current study examined the extent to which quality of education, even after controlling for formal years of education, accounts for differences in cognitive performance between African Americans and White Non-Hispanics (WNHs). The retrospective cohort included 244 patients diagnosed with AD who self-identified as African Americans (n = 51) or WNHs (n = 193). The Wechsler Test of Adult Reading (WTAR) was used as an estimate of quality of education. In an analysis that controlled for traditional demographics, including age, sex, and years of formal education, African Americans scored significantly lower than WNHs on the Mini-Mental State Examination, as well as on neuropsychological tests of memory, attention, and language. However, after also adjusting for reading level, all previously observed differences were significantly attenuated. The attenuating effect remained even after controlling for disease severity, indicating that reading scores are not confounded by severity of dementia. These findings suggest that quality, and not just quantity, of education needs to be taken into account when assessing cognitive performance in African Americans with AD. (JINS, 2012, 18, 277–285)

Keywords

Cross-cultural comparisonsNeuropsychological testsAging/psychologyDementiaEuropean Continental Ancestry Group/psychologyAfrican Americans/psychologyReadingDiagnostic errors/psychologyBias (epidemiology)Socioeconomic factorsPhiladelphia
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 18 , Issue 2 , March 2012 , pp. 277 - 285
Copyright
Copyright © The International Neuropsychological Society 2012

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References

Byrd, D.A., Touradji, P., Tang, X., Manly, J.J. (2004). Cancellation test performance in African American, Hispanic, and White elderly. Journal of the International Neuropsychological Society, 10, 401–411.CrossRefGoogle ScholarPubMed
Chandler, M.J., Lacritz, L.H., Hynan, L.S., Barnard, H.D., Allen, G., Deschner, M., Cullum, C.M. (2005). A total score for the CERAD neuropsychological battery. Neurology, 65, 102–106.CrossRefGoogle ScholarPubMed
Clark, C.M., Ewbank, D.C. (1996). Performance of the dementia severity rating scale: A caregiver questionnaire for rating severity in Alzheimer disease. Alzheimer Disease & Associated Disorders, 10, 31–39.Google Scholar
Demirovic, J., Prineas, R., Loewenstein, D., Bean, J., Duara, R., Sevush, S., Szapocznik, J. (2003). Prevalence of dementia in three ethnic groups: The South Florida program on aging and health. Annals of Epidemiology, 13, 472–478.CrossRefGoogle ScholarPubMed
Fillenbaum, G.G., Heyman, A., Huber, M.S., Ganguli, M., Unverzagt, F.W. (2001). Performance of elderly African American and White community residents on the CERAD Neuropsychological Battery. Journal of the International Neuropsychological Society, 7, 502–509.Google Scholar
Fillenbaum, G.G., Huber, M., Taussig, I.M. (1997). Performance of elderly White and African American community residents on the abbreviated CERAD Boston Naming Test. Journal of Clinical and Experimental Neuropsychology, 19, 204–210.CrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, S.E., McHugh, P.R. (2004). Mini mental state examination. Lutz, FL: Psychological Assessment Resources.Google Scholar
IBM SPSS, Inc. (2009). PASW statistics 18. Chicago, IL: IBM SPSS, Inc.Google Scholar
Kaplan, E., Goodglass, H., Weintraub, S. (1983). The Boston Naming Test. Philadelphia, PA: Lea and Febiger.Google Scholar
Kaufer, D.I., Cummings, J.L., Ketchel, P., Smith, V., MacMillan, A., Shelley, T., DeKosky, S.T. (2000). Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. Journal of Neuropsychiatry and Clinical Neurosciences, 12, 233–239.CrossRefGoogle ScholarPubMed
Maddrey, A.M., Cullum, C.M., Weiner, M.F., Filley, C.M. (1996). Premorbid intelligence estimation and level of dementia in Alzheimer's disease. Journal of the International Neuropsychological Society, 2, 551–555.CrossRefGoogle ScholarPubMed
Manly, J.J., Jacobs, D., Mayeux, R. (1999). Alzheimer's disease among different ethnic and racial groups. In R.D. Terry, R. Katzman, & K.L. Bick (Eds.), Alzheimer's disease (2nd ed., pp. 117–131). Philadelphia, PA: Lippincott Williams & Wilkins.Google Scholar
Manly, J.J., Jacobs, D.M., Sano, M., Bell, K., Merchant, C.A., Small, S.A., Stern, Y. (1998). Cognitive test performance among nondemented elderly African Americans and whites. Neurology, 50, 1238–1245.Google Scholar
Manly, J.J., Jacobs, D.M., Touradji, P., Small, S.A., Stern, Y. (2002). Reading level attenuates differences in neuropsychological test performance between African American and White elders. Journal of the International Neuropsychological Society, 8, 341–348.CrossRefGoogle ScholarPubMed
Manly, J.J., Touradji, P., Tang, X., Stern, Y. (2003). Literacy and memory decline among ethnically diverse elders. Journal of Clinical and Experimental Neuropsychology, 25, 680–690.Google Scholar
McFarlane, J., Welch, J., Rodgers, J. (2006). Severity of Alzheimer's disease and effect on premorbid measures of intelligence. British Journal of Clinical Psychology, 45, 453–463.CrossRefGoogle ScholarPubMed
Morris, J.C. (1997). Clinical dementia rating: A reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. International Psychogeriatrics, 9, 173–176.Google Scholar
Morris, J.C., Heyman, A., Mohs, R.C., Hughes, J.P., van Belle, G., Fillenbaum, G., Clark, C. (1989). The consortium to establish a registry for Alzheimer's disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’'s disease. Neurology, 39, 1159–1165.Google Scholar
O'Carroll, R.E., Prentice, N., Murray, C., van Beck, M., Ebmeier, K.P., Goodwin, G.M. (1995). Further evidence that reading ability is not preserved in Alzheimer's disease. British Journal of Psychiatry, 167, 659–662.Google Scholar
Paque, L., Warrington, E.K. (1995). A longitudinal study of reading ability in patients suffering from dementia. Journal of the International Neuropsychological Society, 1, 517–524.Google Scholar
Pedraza, O., Mungas, D. (2008). Measurement in cross-cultural neuropsychology. Neuropsychology Review, 18, 184–193.CrossRefGoogle ScholarPubMed
Petersen, R.C., Smith, G.E., Ivnik, R.J., Tangalos, E.G., Schaid, D.J., Thibodeau, S.N., Kurland, L.T. (1995). Apolipoprotein E status as a predictor of the development of Alzheimer's disease in memory-impaired individuals. Journal of the American Medical Association, 273, 1274–1278.CrossRefGoogle ScholarPubMed
Pfeffer, R.I., Kurosaki, T.T., Harrah, C.H., Chance, J.M., Filos, S. (1982). Measurement of functional activities in older adults in the community. Journal of Gerontology, 37, 323–329.Google Scholar
Reitan, R., Wolfson, D. (1993). The Halstead-Reitan Neuropsychological Test Battery: Theory and clinical interpretation (2nd ed.,). Tucson, AZ: Neuropsychology Press.Google Scholar
Schmand, B., Geerlings, M.I., Jonker, C., Lindeboom, J. (1998). Reading ability as an estimator of premorbid intelligence: Does it remain stable in emergent dementia? Journal of Clinical and Experimental Neuropsychology, 20, 42–51.Google Scholar
Stephenson, J. (2001). Racial barriers may hamper diagnosis, care of patients with Alzheimer disease. Journal of the American Medical Association, 286, 779–780.Google Scholar
Tang, M.X., Cross, P., Andrews, H., Jacobs, D.M., Small, S., Bell, K., Mayeux, R. (2001). Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology, 56, 49–56.CrossRefGoogle ScholarPubMed
Tombaugh, T.N., McIntyre, N.J. (1992). The mini-mental state examination: A comprehensive review. Journal of the American Geriatrics Society, 40, 922–935.Google Scholar
Wechsler, D. (1987a). Wechsler memory scale-revised manual. San Antonio, TX: The Psychological Corporation.Google Scholar
Wechsler, D. (1987b). Wechsler adult intelligence scale—Revised. San Antonio, TX: The Psychological Corporation.Google Scholar
Wechsler, D. (1997a). Wechsler adult intelligence scale—Third edition. San Antonio, TX: The Psychological Corporation.Google Scholar
Wechsler, D. (1997b). Wechsler memory scale—Third edition. San Antonio, TX: The Psychological Corporation.Google Scholar
Wechsler, D. (2001). Wechsler test of adult reading. San Antonio, TX: The Psychological Corporation.Google Scholar
Weintraub, S., Salmon, D., Mercaldo, N., Ferris, S., Graff-Radford, N.R., Chui, H., Morris, J.C. (2009). The Alzheimer's Disease Centers’ Uniform Data Set (UDS): The Neuropsychological Test Battery. Alzheimer Disease & Associated Disorders, 23, 91–101.CrossRefGoogle Scholar
Welsh, K.A., Fillenbaum, G., Wilkinson, W., Heyman, A., Mohs, R.C., Stern, Y., Beekly, D. (1995). Neuropsychological test performance in African-American and white patients with Alzheimer's disease. Neurology, 45, 2207–2211.Google Scholar
Whitfield, K.E., Wiggins, S. (2003). The impact of desegregation on cognition among older African Americans. Journal of African American Psychology, 29, 275–291.Google Scholar
Wilkinson, G.S. (1993). Wide range achievement test 3. Wilmington, DE: Wide Range, Inc.Google Scholar
Wood, R.Y., Giuliano, K.K., Bignell, C.U., Pritham, W.W. (2006). Assessing cognitive ability in research: Use of MMSE with minority populations and elderly adults with low education levels. Journal of Gerontologic Nursing, 32, 45–54.Google Scholar
Xie, S.X., Ewbank, D.C., Chittams, J., Karlawish, J.H., Arnold, S.E., Clark, C.M. (2009). Rate of decline in Alzheimer disease measured by a Dementia Severity Rating Scale. Alzheimer Disease & Associated Disorders, 23, 268–274.Google Scholar
Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M., Leirer, V.O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37–49.Google Scholar