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We compared the sensitivity and specificity of two delayed recall scores from the Modified Mini-Mental State (3MS) test with consensus clinical diagnosis to differentiate cognitive impairment due to Alzheimer's disease (AD) versus non-AD pathologies. At a memory disorders clinic, 117 cognitively impaired patients were administered a baseline 3MS test and received a contemporaneous consensus clinical diagnosis. Their brains were examined after death about 5 years later. Using logistic regression with forward selection to predict pathologically defined AD versus non-AD, 10-min delayed recall entered first (p = 0.001), followed by clinical diagnosis (p = 0.02); 1-min delayed recall did not enter. 10-min delayed recall scores ≤4 (score range = 0-9) were 87% sensitive and 47% specific in predicting AD pathology; consensus clinical diagnosis was 82% sensitive and 45% specific. For the 57 patients whose initial Mini-Mental State Examination scores were ≥19 (the median), 3MS 10-min delayed recall scores ≤4 showed some loss of sensitivity (80%) but a substantial gain in specificity (77%). In conclusion, 10-min delayed recall score on the brief 3MS test distinguished between AD versus non-AD pathology about 5 years before death at least as well as consensus clinical diagnosis that requires much more comprehensive information and complex deliberation.

Neuropsychological testing is important for the diagnosis and follow-up of dementia; it can also help provide consultation on patient care. However, lengthy testing is costly and can be stressful to the subjects. Tests developed for members of the majority culture often are inappropriate for ethnic minorities, especially those who speak a different language, have little or no formal education, and grew up in vastly different circumstances. Variables that directly affect test performance, such as education and acculturation instead of race or ethnicity, should be considered as explanatory variables for test performance. Reading level may be a better index for educational attainment than the number of years in school. Neuropsychological testing can be improved in several directions: (1) Use tests that are appropriate for the subject's background. (2) Use detailed scoring of a smaller number of test items to reduce test time, and establish discontinuation rules to limit the subject's experience of failure. (3) Develop parallel test forms for repeated assessment of the same individuals. (4) Strive for large and representative standardization samples. (5) Use computerized test norms based on findings of statistical analysis to better adjust for confounding variables.

The Cognitive Abilities Screening Instrument (CASI) contains nine cognitive domains. Its total score has been used to screen for dementia in epidemiological studies conducted in the US, Japan and Taiwan, but its usefulness in distinguishing different levels of dementia has not been examined. This study was conducted to compare CASI scores of patients with Alzheimer’s disease (AD) with different levels of severity of dementia. The CASI was administered to 475 AD patients with mild, moderate or severe dementia according to the Clinical Dementia Rating Scale. The patients’ scores were compared to the scores of 475 age-, education- and gender-matched control subjects. More specifically, each patient’s score, X, was transformed to a z score with reference to the mean and SD of the scores of the control group, where z = (X – mean)/SD. Then, the mean of the z scores and the percentage of patients with z scores of

We constructed a Chinese version of the cognitive component of the Alzheimer’s Disease Assessment Scale (ADAS-Cog). In order to accommodate illiteracy, the Chinese version used pictures instead of words for assessing recall and recognition. The Chinese ADAS-Cog was administered to 125 individuals with no dementia, 127 with questionable dementia, and 77 with Alzheimer’s disease (AD). Their age range was 51–92 years and their education range was 0–20 years. The Chinese ADAS-Cog had high internal consistency (Cronbach’s alpha = 0.87) and very high interrater reliability (intraclass correlation coefficient, or ICC, = 0.99) and test-retest reliability (ICC = 0.96). It had high correlations with scores on the Clinical Dementia Rating Scale (Pearson’s r = 0.85), the Cognitive Abilities Screening Instrument (CASI, Pearson’s r = –0.88), and CASI-estimated scores on the Mini-Mental State Examination (Pearson’s r = –0.85). Performance on the Chinese ADAS-Cog was uninfluenced by age or gender, nor by education level except within the low education range of 0–6 years. Its memory items were best for early detection of dementia; its language items were best for monitoring the progression of dementia. This study found that the Chinese ADAS-Cog is a good instrument for use with Chinese AD patients.

OBJECTIVES: To examine the associations of subjective memory complaint (SMC) in old age with (a) objective test performance, (b) past and subsequent cognitive decline, and (c) depression. DESIGN: A group of community residents were examined twice during a 3-year period. SETTING: Two townships on a rural Chinese islet. PARTICIPANTS: A total of 543 men and women aged 65 years and older. MEASUREMENTS: During each examination, neurologists interviewed and examined all participants for dementia and asked the question, “Do you have trouble with your memory?” In addition, research assistants administered (a) the Cognitive Abilities Screening Instrument (CASI) to assess cognitive abilities, including long-term memory (LTM) and short-term memory (STM), and (b) the Geriatric Depression Scale-Short Version (GDS-S) to assess symptoms of depression. RESULTS: At each examination, almost half of the subjects acknowledged having trouble with their memory (the SMC+ group). At both examinations, the SMC+ group scored significantly lower on the CASI and significantly higher on the GDS-S than the SMC− group. However, the presence of SMC was not associated with faster cognitive decline over the past or subsequent 3 years. There were no consistent associations between SMC and the demographic variables of age, gender, and education at the two examinations. Logistic regression analysis showed that SMC was associated with poorer memory test scores after controlling for gender, age, education, and depression. CONCLUSIONS: SMC was associated with poorer objective memory performance even after controlling the effect of depression and demographic data, but SMC did not predict faster cognitive decline or dementia over 3 years. J Am Geriatr Soc 48: 295–299, 2000.

OBJECTIVES: To examine the association of years spent in Japan during childhood with cognitive test performance in late life among Japanese American men, and to assess the influence of the language used for testing on this association. DESIGN: A cross-sectional study. SETTING/PARTICIPANTS: A total of 3734 Japanese American men, aged 71–93 years, who were first- or second-generation migrants and living on Oahu Island, Hawaii. MEASUREMENTS: The outcome variable was cognitive test performance assessed using the Cognitive Abilities Screening Instrument (CASI), which was developed for cross-cultural studies of cognitive impairment. The explanatory variable of main interest was the number of years spent in Japan during school-age childhood years (ages 6–17). The associations of CASI scores with childhood years in Japan was evaluated using a stepwise multiple linear regression model in which a total of 40 potential confounders were included as covariates. RESULTS: In the total sample, there was an inverse association between CASI scores and middle childhood years in Japan. This association remained significant after controlling for age, education, socioeconomic status, traditional Japanese food consumption, pulmonary function, apolipoprotein E4, proficiency in speaking Japanese, and other possible confounders. When data were analyzed separately for subgroups according to the language preferred at testing (English or Japanese), associations between childhood years in Japan and CASI scores were in opposite directions negative for the group tested in English and positive for the group tested in Japanese. The interaction between the testing language and childhood years in Japan was statistically significant. CONCLUSIONS: There was an inverse association between years spent in Japan during school-age years of childhood and cognitive test performance in late life. This association could not be accounted for by age, education, or other confounding factors. However, this finding was not observed in participants who preferred being tested in Japanese. To assess cognitive test performance in older people, it is of prime importance to use the most optimal language for testing, usually the subject's native language. J Am Geriatr Soc 48: 199–204, 2000.

A group of 317 healthy participants between 54 and 99 years of age performed a verbal fluency task. The participants included Chinese, Hispanic, and Vietnamese immigrants, as well as White and African American English speakers. They were given 1 min to name as many animals as possible in their native language. The results showed that more animal names were produced by younger people and those with more education. Language background was also an important factor: The Vietnamese produced the most animal names and the Spanish speakers produced the fewest. The exaggerated difference between these two groups is attributed to the fact that Vietnamese animal names are short (predominantly 1 syllable) while the Spanish animal names are longer than any other language in this study (2 and 3 syllables per word). Finally, although the ethnic groups named different animals, and appeared to vary in the variety of animal names they used, these factors did not affect overall verbal fluency performance. (JINS, 1998, 4, 531–538.)

We conducted an epidemiological study of several neurological disorders among the Chinese aged 50 years or older on the islet of Kinmen. All participants were interviewed and examined by neurologists. From the targeted population of 5,061 individuals, 3,915 (77.4%) of them completed the evaluations. Among the 4,087 individuals with whom face-to-face contact was made, the refusal rate was 4.2%. The disorders of interest were dementia, Parkinson's disease, essential tremor, stroke, transient ischemic attacks, and migraine. Among the 3,915 participants, 366 cases were found with 1 or more of the surveyed neurological disorders on the prevalence day, August 1, 1993, yielding a prevalence of 93.5/1,000. The purpose of this study, the general methodology, and some overall findings are presented in this communication in order to provide a common background for detailed findings on each disorder to be reported separately.

The Cognitive Abilities Screening Instrument (CASI) has been commonly used in dementia research and clinical practice to evaluate a subject's cognitive abilities and to follow-up possible progression of dementia. It has a detailed manual for test administration and scoring in order to minimize testing errors. The Chinese version of CASI (CASI C-2.0) has been used in many clinical and epidemiological studies in Taiwan. Since cognitive abilities are influenced by education, and there are high rates of illiterate or low education individuals among the elderly in Taiwan, the normative data of CASI, including its total score and its cognitive domain scores, should be divided into different education ranges. In clinical practice, the cut-off scores in differentiating between dementia and normal are suggested to be: 49/50 for Education year = 0; 67/68 for Education years = 1-5; and 79/80 for Education years more than 6.

Background: Most published studies have shown lower prevalence rates of Parkinson's disease (PD) in Asian and black African than in Western countries, leading to the hypothesis that Asians and blacks might be protected from PD. Objective: To investigate the prevalence of PD in a Chinese population. Design: Community-based survey. Setting: Registered residents 50 years of age or older (N=5061) on the islet of Kinmen located off the southeastern coast of the Republic of China (Taiwan). Method: Single-phase door-to-door survey by neurologists. All participants were administered a questionnaire and received motor examinations of the Unified Parkinson's Disease Rating Scale. Results: The participation rate was 96% (N=3915) among 4158 contacted individuals. Twenty-three cases of PD were identified, including three cases with dementia. The crude prevalence rate of PD was 587 (95% confidence interval (CI), 373 to 884) per 100 000 persons 50 years of age or older. Assuming no case of PD among individuals under 50 years of age, the prevalence rate was 119 (95% CI, 80 to 169) per 100000 for the total population. Conclusions: The prevalence rates of PD in Kinmen were much higher than those reported from mainland China, but slightly lower than those reported from more developed countries. The present findings suggest that, instead of genetic factors, differences in case-as-certainment, life expectancy, and the length of survival with PD may be more important contributors to the variations in observed PD prevalence rates.

The 12-item Modular Smell Identification Test (MODSIT) was administered to 239 male and 271 female Chinese subjects whose age ranged from 50 to 92 years (68.3 ± 10.9) and whose education ranged from 0 to 20 years (2.5 ± 4.3). Every participant was examined by a physician and was found to be free of dementia, stroke, and Parkinson's disease. Different from the standard procedures, only one-third of each odor pad was used for each subject, the four odor choices were presented orally for the majority of subjects, and they were not forced to make a selection when they could not detect or identify the odor. The average level of performance was 46% correct. The score was negatively associated with age, positively associated with education and with performance on a dementia screening test, and corroborated with subjects' report of smell deterioration in recent years. Nonsmokers and women performed better than smokers and men. The 12-item MODSIT had an internal consistency reliability of 0.73 and a 7-month retest stability of 0.57 with different examiners. The MODSIT is satisfactory for group studies, even when administered with suboptimal procedures such as those used in the present study.

Estimates of the prevalence rates for dementia vary significantly among countries. Such variation may be explained, at least in part, by methodologic differences in studies. The disparities in prevalence rates of dementia subtypes, particularly Alzheimer's disease and multi-infarct dementia, are especially apparent in studies conducted in Eastern and Western countries. In Japan and China, the prevalence of multi-infarct dementia exceeds that of Alzheimer's disease, whereas in the West, Alzheimer's disease predominates in the vast majority of studies. Clearly, cross-cultural studies of incidence using standard methods are needed to investigate whether a true difference in risk exists, and which risk factors differentially contribute to this variation. Migrant studies of genetically homogeneous populations offer a unique opportunity to answer these questions. This article explores the value of migrant studies, their application to etiologic questions of dementia and its subtypes, and recommendations concerning how to conduct such studies.

The Cognitive Abilities Screening Instrument (CASI) has a score range of 0 to 100 and provides quantitative assessment on attention, concentration, orientation, short-term memory, long-term memory, language abilities, visual construction, list-generating fluency, abstraction, and judgment. Scores of the Mini-Mental State Examination, the Modified Mini-Mental State Test, and the Hasegawa Dementia Screening Scale can also be estimated from subsets of the CASI items. Pilot testing conducted in Japan and in the United States has demonstrated its cross-cultural applicability and its usefulness in screening for dementia, in monitoring disease progression, and in providing profiles of cognitive impairment. Typical administration time is 15 to 20 minutes. Record form, manual, videotape of test administration, and quizzes to qualify potential users on the administration and scoring of the CASI are available upon request.

A door-to-door survey by neurologists in Kin-Hu township, Republic of China, of a sample of the Chinese population of 683 persons aged 50 years and over was performed in August, 1992. A total of 482 subjects (70.6%) completed the study. Kin-Hu, a township of Kinmen, is predominantly rural with agriculture as the main occupation. Six subjects (5 men, 1 woman) were diagnosed with Parkinson's disease (PD). Of these six, five were newly diagnosed; one of the five also had dementia. The crude prevalence rate per 1,000 persons over 50 years of age of PD in Kin-Hu was 6.2. The age-specific prevalence rates per 1,000 persons (95% confidence intervals) were 0 for age 50-59, 7.8 (0-22.9) for age 60-69, 17.5 (5.2-29.8) for age 70-79, and 25.4 (10.9-39.9) for ageor = 80. These rates are considerably higher than those reported in the People's Republic of China, and similar to rates found in Western countries. The higher prevalence of PD found in this pilot study suggests that environmental factors may be more important than racial factors in the pathogenesis of PD. If confirmed, the results suggest that epidemiologic studies looking for environmental risk factors might be of value.

The Common Objects Memory Test (COMT) was developed to assess age-related memory impairments in individuals with a range of educational, language and cultural backgrounds. The COMT is a list-learning protocol that uses photographs of common objects to bypass difficulties posed by written words for individuals who are illiterate or have limited education. Preliminary data are presented for 336 healthy adults and 90 patients with dementia. Their age ranged from 54 to 99 years, education ranged from 0 to 22 years, and they were from five culturally and linguistically distinct populations: Caucasian and African-American English speakers, and native Chinese, Spanish, and Vietnamese speakers. Performance on the COMT was influenced by age, but little influenced by education, and un-influenced by gender or ethnic background. Among 11 neuropsychological tests, the recall scores from the COMT best distinguished healthy individuals from patients with dementia, underscoring its clinical utility for ethnically diverse populations. (JINS, 2010, 16, 537–545.)

The 3RT Test consists of a simple, a choice, and a conditional reaction time (RT) task. The three tasks involve comparable visual stimuli and require identical manual responses, but they differ in the complexity of cognitive processing required. The nonverbal stimuli convey commonly known meanings. Responses can be made either on the keyboard or on response keys connected to the computer’s serial port. The computer’s internal timer/counter is used for millisecond timing. The test administration program allows flexible setting of the test conditions. The data analysis program provides summary data not only for each RT task as a whole, but also for separate trial types within each task. Summary statistics include measures of variation and central value that are not affected by extreme scores. In addition to laboratory studies with normal adults, the 3RT Test is suitable for life-span developmental studies, cross-cultural comparisons, and other uses in various clinical settings.

This paper examined whether education-, age-, and gender-matched Spanish- and English-speaking normals ( n = 30 pairs) had comparable scores on the Mattis dementia rating scale (MDRS). It provides preliminary normative data on Spanish-speaking volunteers aged 55–89 years old ( n = 54). It also compared the MDRS total score with its memory subscale score and the mini-mental state examination (MMSE) score on sensitivity and specificity for distinguishing normals from patients with dementia ( n = 61). Spanish-speaking normals scored significantly lower than English-speaking normals on MDRS total and its attention, conceptualization, and memory subscales. The area under the receiver operating characteristic curve distinguishing normals from patients with dementia was not significantly different among the MDRS total, its memory subscale, and the MMSE. We conclude that (a) the norms based on English-speaking individuals are not appropriate for use with Spanish-speaking individuals, and (b) to screen for dementia, the shorter MDRS Memory subscale and the MMSE are as good as the entire MDRS.

The authors know of no published studies that have evaluated the effect of Spanish- versus English-language on category fluency within a sample of United States Latinos only. As part of a pilot study for the institution of a cognitive screening program in a cohort of Latinos, we assessed category fluency (fruits, vegetables, and "other" supermarket items) in a sample of 90 self-identified Latino community residents (aged 52-84, 0-18 years of education). The primary demographic correlates of category fluency were age and education. The decrement in naming of fruits with age was limited to the older old subjects (>age 70). Relatively younger old subjects (aged 61-70) did not differ from middle-aged subjects on category fluency. Gender showed little relationship to category naming. Persons naming in Spanish named significantly fewer 'other supermarket' items, but did not differ from English speakers in the more common fluency categories of fruits and vegetables. This analysis of category fluency in an ethnically homogenous sample with a wide range of formal education provided an evaluation of the effects of chosen language free of possible confounding by cultural differences, and also provided a more complete evaluation of the influence of education on category fluency.

Complaints of poor memory are common among older individuals, but their clinical significance remains unclear. We compared patients’ self-report of poor memory with their caregivers’ report, and to compare the two reports’ associations with the patients’ dementia status and tested cognitive performance. Participants included 709 patients at the Memory Clinic of the Taipei Veterans General Hospital and their primary caregivers. A total of 493 of the patients were diagnosed with dementia according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV),1 including 78% with probable AD, 15% with vascular dementia, and 7% with mixed or other types of dementia. The diagnosis of dementia and its subtypes was made by a neurologist based on interview, physical examination, cognitive test, and laboratory findings. Each patient and caregiver was asked separately by a neuropsychologist to describe the patient’s memory as being good/average or poor. They also answered questions for the …

This work focused on refining the Cognitive Abilities Screening Instrument (CASI) by selecting a clinically significant subset of tests, and generating simple and useful models for dementia screening in a cross cultural populace. This is a retrospective study of 57 mild-to-moderately demented patients of African-American, Caucasian, Chinese, Hispanic, and Vietnamese origin and an equal number of age matched controls from a cross cultural pool. We used a Knowledge Discovery from Databases (KDD) approach. Decision tree learners (C4.5, CART), rule inducers (C4.5Rules, FOCL) and a reference classifier (Naive Bayes) were the machine learning algorithms used for model building. This study identified a clinically useful subset of CASI, consisting of only twenty Mini Mental State Examination (MMSE) attributes--CASI-MMS-M, saving test time and cost, while maintaining or improving dementia screening accuracy. Also, the machine learning algorithms (in particular C4.5 and CART) gave stable clinically relevant models for the task of screening with CASI-MMSE-M....

We conducted a single-stage community-based study of dementia on all registered residents > or =65 years in age in a rural Chinese community. Neurologists conducted semistructured interviews and examined all participants; they also interviewed family members in cases where dementia was suspected. The diagnosis was made by consensus according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, revised (DSM-III-R). Among the 2,055 contacted individuals, 1,736 (84.5%) participated in the study and 44 ( 13 men and 31 women) were diagnosed as having dementia, including 35 (80%) with probable Alzheimer disease (AD) and 3 (7%) with vascular dementia (VsD). The rates of dementia were 0.5% for ages 65-74 years, 2.9% for ages 75-84 years, and 12.0% for ages 85-101 years. The overall rate was 2.5% for age > or =65 years. After controlling for age, neither a lack of formal education nor being a woman was a risk factor for dementia. At 2-year follow-up, 30 of the 44 demented participants had died, yielding a 2-year survival rate of 32%. The present results corroborated our previous findings of lower prevalence rates of dementia among the Chinese than among Western populations, and both genetic and sociocultural factors may have contributed to the low rates. The lack of neuroradiological imaging studies in the present study may have contributed to the finding of an unusually low rate of VsD.

Background. Two recent surveys of depression among Chinese elderly people sampled different populations, used different case ascertainment methods and resulted in a seven-fold difference in prevalence rates. The present study was conducted to compare prevalence rates obtained with two commonly used methods in the same population, and to examine the risk factors for depression. Methods. The target population included all residents aged 65 years and over in a rural Chinese community. Participants were interviewed for demographic and medical information, examined by a neurologist and administered Chinese versions of the Geriatric Depression Scale-Short Form (GDS-S), the Cognitive Abilities Screening Instrument (CASI) and an Activities of Daily Living (ADL) form. Individuals who screened positive on the GDS-S were also interviewed by a psychiatrist for diagnosis according to the DSM-III-R criteria. Results. Among the 1313 participants, 26 % screened positive on the GDS-S and 13 % were diagnosed as having a depressive disorder, including 6.1% with major depression. Individuals with depressive disorders were more likely to have poor ADL scores, lower CASI scores, and chronic physical illnesses. They were also more likely to be female, older, illiterate and without a spouse, but adding these variables did not increase the overall association with the GDS-S score. Conclusions. Depression was quite common in this Chinese rural geriatric population. The prevalence rate was twice as high when judged by depression symptomatology rather than clinical diagnosis. The critical risk factors were functional impairments, poor cognitive abilities and the presence of chronic physical illnesses.

OBJECTIVE: To study the prevalence rate of dementia in Taiwan, the relative frequencies of its subtypes, and its associations with age, education, gender, and residence location. PARTICIPANTS: A total of 2753 men and 2544 women from four urban and four rural communities participated. Their age ranged from 41 to 88 years; 28% of them were at least 65 years old. Their education ranged from 0 to 20 years; 27% of them had less than 1 year of formal schooling. DESIGN: Phase I was a screening survey by trained nurses who administered a Chinese version of the Mini-Mental State Examination, the MMSE-T1, to all participants. Phase II involved the assessment for dementia by neurologists on the 1521 individuals who had scored less than 24 on the 30-point MMSE-T1. MAIN RESULTS: Thirty-one cases of dementia were identified by the DSM-III-R criteria, including 18 cases of Alzheimer's disease, 10 cases of vascular dementia, and three cases of other dementias. The prevalence rate in individuals aged 65 and over was 2.0%. Aging and illiteracy were associated with higher rates of dementia; gender and residence location made no difference. CONCLUSIONS: The prevalence rate of dementia was low in this Chinese population. consistent with common findings from other parts of the world, a high rate of dementia was associated with older age and illiteracy, and Alzheimer's disease was the most frequent cause.

Article abstract-The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) provides ratings of an individual's changes in everyday cognitive functions during the previous 10 years. Original studies conducted in Australia showed that its score was not influenced by the subjects' educational backgrounds and that it performed at least as well as the Mini-Mental State Examination (MMSE) as a screening instrument for dementia. The subjects of the present study were Chinese and included 399 community residents and 61 dementia patients. Their ages ranged from 50 to 92 years; their education levels ranged from 0 to 19 years, and 63% of them had never attended school. We administered the IQCODE to informants and the Cognitive Abilities Screening Instrument (CASI), from which a CASI-estimated score of the MMSE (MMSE-CE) can be obtained, to the subjects. The diagnosis of dementia was made independently by physicians according to the DSM-III-R criteria based on semistructured interview and testing, neurologic examination, and standardized assessments of cerebral vascular disease, Parkinson's disease, and depression. The Chinese IQCODE showed no association with the subjects' education level or gender, low association with their age, and moderately high association with their MMSE-CE score. The area under the receiver operating characteristic curve of the IQCODE was significantly larger than that of the MMSE-CE for the whole group and for the subgroup with 1 to 19 years of education but not for the subgroup with 0 years of education. Nine of the 26 items of the IQCODE could be deleted without appreciable reduction in sensitivity and specificity. The IQCODE (1) can be shortened to 17 items, (2) had good cross-cultural applicability, and (3) was better than the MMSE-CE as a screening tool for dementia in a population with large variation in educational backgrounds.NEUROLOGY 1995;45: 92-96

Objective: To examine the relation between performance on a dementia screening test and the demographic variables of age, education, gender, and urban vs rural residency. Design: Community survey with cluster sampling. Setting: One urban and one rural community from each of four geographic regions in Taiwan, Republic of China. Participants: A total of 5265 nondemented individuals approximately equally divided between men and women and between urban and rural residency with a range in age from 41 to 88 years and in education from 0 to 20 years. Main Outcome Measure: Score on a Chinese adaptation of the Mini-Mental State Examination. Results: Lower test scores were associated with older age and less education. The decrease in score with age was faster among participants who had never attended school. Better performance by men and by urban residents was found only among participants with fewer than 6 years of schooling. In this group, the magnitudes of sex and residency differences were comparable among those subjects aged 41 to 64 years and those aged 65 to 88 years. Women who had never worked outside of the home performed poorer than those who had worked outside of the home. Conclusions: The influence of educational background on test performance is most evident in individuals with less education. Commonly used dementia screening tests may be unfair to poorly educated individuals, especially women and rural residents. Efforts should be made to develop ecologically relevant cognitive tests for the intended study populations. To help distinguish test bias from different rates of cognitive decline, the study populations should include individuals in predementia age ranges.

To compare the Mental Alternation Test, a new 60-second bedside test of cognition, with the Mini-Mental State Exam (MMSE) and the Trailmaking Test, parts A and B, in patients with human immunodeficiency virus (HIV) infection.Cohort study.Sixty-two inpatients with HIV infection.The AIDS service of a referral hospital.Scores on the MMSE; the Trailmaking Test, parts A and B; and the Mental Alternation Test were compared using correlation calculations and analyses of variance. Receiver operating curves were constructed to identify the best cutoff score on the Mental Alternation Test for detecting impaired performance on the MMSE and the Trailmaking Test.The Mental Alternation Test score correlated significantly with MMSE (r = 0.68, P0.01) and Trailmaking Test, part B, scores (r = -0.54, P0.01). The receiver operating curves showed that a Mental Alternation Test cutoff score of 15 yielded the best results for the detection of abnormal performance on the MMSE (sensitivity, 95% [95% CI, 90% to 100%]; specificity, 79% [CI, 69% to 89%]) and the Trailmaking Test, part B (sensitivity, 78% [CI, 68% to 88%]; specificity 93% [CI, 90% to 100%]). Patients making fewer than 15 alternations in 30 seconds were significantly more likely to have abnormal MMSE (P0.0001) and Trailmaking Test, part B, scores (P0.0001). The Mental Alternation Test had good reproducibility; analyses of reliability included test-retest correlation (r = 0.80) and inter-rater reliability (r = 0.85, kappa = 0.84). Time of administration was approximately 60 seconds.The Mental Alternation Test of cognition has good sensitivity and specificity and is easily administered. It is a valuable test to identify patients who may need further cognitive evaluation.

The development of neuromotor patterns in relation to birth weight was studied in the rabbit, a perinatal brain developer. In order to induce intrauterine growth retardation and to increase the number of low birth weight rabbits, experimental ischemia to half the fetuses in each doe was achieved by total ligation of approximately 30% of spiral vessels to the placenta, during the last trimester of gestation. Following natural delivery, the rabbit pups were periodically observed for the appearance of eye-opening and righting reflex, and for the cessations of falling, circling and dragging of hind limbs. An index of neuromotor development was assigned to each rabbit by summing up the age (in days) of appearance of each of the neuromotor milestones. An association was found between low birth weight and delayed neuromotor development at 2 weeks of age. The most significant correlation was found between low birth weight and delayed disappearance of falling. The latter may represent incoordination as an expression of cerebellar dysfunction.

84 male and 76 female high school students were individually examined on two tests which involve right-left discrimination. The Hand Test requires distinguishing drawings of right from left hands. The Route Test involves walking out patterns with various turns according to diagrams drawn on cards. Results on both tests showed a wide range of performance, but differences between the sexes were minute and statistically nonsignificant. In addition to right-left discrimination, each test also taps different additional spatial functions. Both tests are easy to administer in clinical settings; normative data given here can be useful in evaluating patients' performance.

Fifty-six subjects each listened to four types of dichotic input: digit-digit, tone-tone, digit (left ear)-tone (right ear), and tone (left ear)-digit (right ear). When digits were paired with tones, performance improved substantially over that with digit-digit and tone-tone input, and material-specific ear differences disappeared. The results indicate that both capacity limitation and an advantage of the contra-lateral over the ipsilateral input appear only when inputs from the two ears compete for the same kind of processing.

Fifty-four patients with Alzheimer's disease performed on the Dementia Assessment Battery that comprised of finger tapping, forward digit span, naming, verbal memory, visual memory, Token Test, digit cancellation, word-list generation, symbol-digit substitution, and copying geometric designs. Four forms of the battery were administered at weekly intervals. The equivalence of the forms, the relative difficulty of the tests, retest reliability, and factorial composition of the battery are presented. Performance improved with repetition. Impairments in visuo-spatial and verbal abilities were independent of each other. The fragility of the patients' working memory was identified as a main cause for their poor recall. The importance of "component analysis" in individual assessment is illustrated.

A group of 11 patients with a variety of lesions affecting the 3rd ventricle have been treated using a direct transcallosal interfornicial approach to the region. In 3 patients, no attendant hydrocephalus was present. In an effort to minimize potential cortical injury related to the approach, we studied the venous anatomy in the region of the coronal suture. Based on this study, appropriate flap placement and interhemispheric entry points were defined. Although no lasting, clinically apparent morbidity was observed in any of the 11 cases, we performed more sophisticated studies of the interhemispheric transfer of somesthetic and perceptual motor tasks, as well as psychometric testing related to parameters of intelligence and memory, 3 to 8 months postoperatively in 6 cases. The results and clinical material indicate that this surgical technique is a safe, feasible alternative in the management of a wide spectrum of pathological lesions within this region. A transcallosal, interfornicial approach offers excellent visualization of the entire 3rd ventricle without the dependence on hydrocephalus or an extensive extra-axial mass to enhance the exposure. With proper planning and technique. it may be accomplished with a minimum of physiological consequence.

Summary Six commissurotomized patients were tested and the performances of their left and right hemisphere on a dot counting task were compared during unilateral and bilateral input to study aspects of interhemispheric interference. From 1 to 5 dots were flashed, either in the left or the right visual field alone, or in each of the two fields simultaneously, and the patients were asked to indicate the number of dots seen in each field by extending the same number of fingers with the ipsilateral hand. Comparison trials were also presented where the number of dots were replaced by a corresponding numeral to eliminate counting. Comparable incidences of responses extinction to the dots and to the numerals were frequently observed during bilateral input. Their occurrence bore no clear relationship to the performance levels during unilateral input. Rather, the predominant side of extinction varied among the patients and seems to be related to the presence of some contralateral brain damage. Despite frequent response extinctions, no concurrent increase in counting errors was observed during bilateral input, indicating that interhemispheric interference in the present case is not equally present in all stages of the input-output chain, but takes the form of an all-or-none rivalry in some gating mechanism. Ancillary findings support different modes of information processing by the two hemispheres, and a possible presence of weak ipsilateral projection of visual information.

A questionnaire survey was conducted among Chinese students divided between a grade-school sample and a university sample. Social pressure for right-handed writing and eating was effective, but showed limited transfer influence on other activities. Details of the handedness distribution varied with particular item combinations, but the general features of the distribution showed the same characteristics found in Caucasian samples. Distributions of lateral preferences in foot and eye uses, as well as the inter-correlations among hand, foot and eye preferences, were also comparable with Western results. No difference was obtained between the grade-school sample and the university sample, indicating a lack of association between lateral preferences and intelligence in the non-clinical population.

A questionnaire survey of 4143 Chinese was conducted. Social pressure for right-handed writing and eating was effective on these two target skills but showed little indirect influence on hand use in other activities. Neither primiparous birth nor birth to older mothers affected handedness. Twinning, however, seemed to be associated with both decreased right-handedness and lower intelligence.

56 right-handed adults (23 men, 33 women) with IQs ranging from 79 to 140 on the Quick Test each performed on two dichotic tests, one with digital input, one with tonal input. The average magnitude of the right-ear advantage for digits was comparable to that of the left-ear advantage for tones, but there was greater between-subject variability with tonal input than with digital input. Ear advantage with digits was unrelated with ear advantage with tones, and high intelligence was not associated with clearly opposite directions of ear advantage for the two types of test material. The results were discussed in terms of hemispheric specializations, as well as the reliability and validity of the dichotic ear effects.