ASSESSING COGNITIVE-ABILITIES AND DEMENTIA IN A PREDOMINANTLY ILLITERATE POPULATION OF OLDER INDIVIDUALS IN KINMEN

A community survey of dementia was conducted on a Chinese islet. A tot al of 221 men and 234 women in the age range of 50-92 were assessed. T he Cognitive Abilities Screening Instrument (CASI), a 100-point cognit ive test designed for cross-cultural studies and adapted in Chinese fo r individuals with little or no formal education, was administered twi ce by trained field workers with a retest interval of 3 to 4 weeks. In addition, all participants were assessed by physicians who did not kn ow the CASI scores. The physicians' assessment included a complete neu rological examination, plus semi-structured tests and interviews cover ing cognitive abilities, daily activities, depression, cerebrovascular disease, and Parkinson's disease. Dementia was diagnosed by consensus among the physicians according to the DSM-III-R criteria. Among the 4 55 participants, 16 cases of dementia were identified, including 13 wi th probable Alzheimer's disease and 1 each with vascular dementia, Par kinson's disease, and alcoholism. The rates of dementia were 0, 3.9 an d 11.5% for the age groups of 50-69, 70-79 and 80-92; and 4.4, 2.0 and 0% for the education groups of 0-1, 2-6 and 7-15 years of schooling. No sex difference was found after controlling for education. The Chine se version of the CASI had an intraclass retest reliability of 0.90. U sing a cut-off score of less than or equal to 50 for dementia, the sen sitivity was 0.88 and the specificity was 0.94. The preliminary study suggests that the CASI can be used in Chinese populations with general ly low education levels and that Alzheimer's disease was the most comm on type of dementia in this population.