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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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