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The United States population of Hispanics aged 65 and older grew to a total of more than one million between 1980 and 1990, a growth rate double that of older non-Hispanics. [1,2] The rapid increase in the population of Hispanic elders, along with greater awareness of and concern about dementia in older individuals, has brought increased attention to the importance of accurately assessing the mental status of Hispanic elderly. [3,4] The Mini-Mental State Examination (MMS) [5] is widely used as a screening test for identifying dementia and is one of the few tests translated into Spanish and tested for cross-cultural utility. [6,7] However, the MMS score is affected by level of education, age, and ethnic status. [8-13] Higher rates of cognitive impairment among ethnic-minority populations compared with non-Hispanic white populations may reflect excessive false-positives among ethnic-minority individuals and an underestimation of their cognitive functioning, [13,14] calling into question the utility of the MMS with minority elderly. MMS performance decrements in minorities may be a function of lower levels of education in these groups. [11,15]
Studies focusing specifically on Hispanics have also attributed poor performance on cognitive tests to low education. Bird et al. [6] and Escobar et al., [7] both studying non-elderly samples, found that education significantly influences MMS performance. Gurland et al., [14] in a large-scale study involving white, black, and Hispanic elderly subjects, found that conventional cutoff points for the MMS and other mental status tests resulted in increased false-positives for the minority groups, and especially for the Hispanic group. The authors suggested that the results reflected lower educational levels of the Hispanic persons tested in addition to sociocultural bias within the scales.
Several studies have recommended adjusting MMS scores to account for demographic characteristics, particularly education and age. [8,11,13,14] Given the need to accurately assess the mental …
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