Cognitive outcome measures used for assessing urban and rural disparities in dementia and cognition: A scoping review

Abstract

AbstractBackgroundEvidence of disparities in dementia and cognition by gender, race/ethnicity, and income‐level of countries has long been available. A growing body of literature examining urban/rural disparities has been recently accumulating. Most of the studies comparing within‐country regions indicate that rural older adults have a greater cognitive disadvantage and higher risk for dementia than their urban counterparts. These findings are not consistent across all studies. The purpose of this study was to examine the literature on rural/urban disparities in dementia and cognitive aging.MethodA scoping review of 16 studies examining differences in dementia and cognitive functioning of urban and rural older adults was conducted. Studies were categorized by country. Relevant information from their methods was systematized, based on their populations/samples, outcome measures and main finding of cognitive advantage (rural<urban, urban>rural, rural = urban).ResultMost of the studies addressing rural and urban disparities have been conducted in large, industrialized countries. The main focus of the studies reviewed has been on comparing dementia rates, not healthy aging. Most studies have administered cognitive screening questionnaires to identify dementia cases (MMSE, Modified MMSE, Telephone Interview for Cognitive Status, CSI‐D, etc.). The criteria used to define rurality and urbanity varied from study to study.ConclusionRegions of the world with larger rural areas are underrepresented in the study of rural and urban disparities of dementia and cognitive aging. From the group of studies reviewed, important conceptual and methodological lessons were identified. The variability in the operational definition of rurality between studies is a major challenge for consolidating the literature on urban and rural disparities in dementia and cognitive aging. A culturally appropriate neuropsychological battery could be used to identify true urban and rural disparities in cognitive functioning. None of the studies examined whether the assessment tools and cognitive factors were comparable for both rural and urban older adults, assuming the tests are equivalent across regions. Research focusing on the measurement equivalence of neuropsychological batteries between rural and urban regions are warranted.