The Diagnosis of Dementia in Subjects with Heterogeneous Educational Levels

Abstract

Performance in cognitive tests is influenced by age, education and culture. Many batteries for screening and diagnosing dementia were developed in countries where low education and illiteracy are uncommon and therefore they may not be suitable for evaluation of populations with heterogeneous educational backgrounds. In this chapter, we discuss the influences of education in the diagnosis of dementia and present the results of studies with the Brief Cognitive Screening Battery (BCSB) or Brief Cognitive Battery unbiased by education (BCB-Edu) developed by Nitrini et al. (1994). The BCB-Edu has been employed for the diagnosis of dementia and Alzheimer’s disease (AD) in subjects with heterogeneous educational background (illiterate, low/medium/high levels of education). The delayed recall (DR) test of BCB-Edu proved to be more accurate than DR of Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) battery for the diagnosis of dementia in illiterate subjects [sensitivity = 93.3%, specificity = 95.7%, area under receiver operator characteristic curves (AUC-ROC) = 0.975]. DR of BCB-Edu also showed high sensitivity (82.2%) and specificity (90.4%) for the diagnosis of AD in patients with medium/high levels of education. A mathematical model including the results of core tests is also suggested to be employed in clinical practice. The BCB-Edu is a simple and useful tool for diagnosis and screening of dementia, particularly AD, in populations with heterogeneously educated individuals.