Screening for cognitive impairment in older African-Caribbeans

Background. There are increasing numbers of older African-Caribbeans in the United Kingdom. Screening instruments are commonly used in the detection o f cognitive impairment, but have not been assessed within this population. This study aimed to develop culturally modified versions of screening instr uments for cognitive impairment (Mini-Mental State Examination (MMSE) and A bbreviated Mental Test (AMT)) and to determine their sensitivity and specif icity in the diagnosis of dementia. Methods. The instruments were modified using a process involving a communit y group of African-Caribbeans and an academic group of health professionals . They were used: in a two-stage study involving community resident African -Caribbeans aged 60 years or over in inner-city Manchester, comparing the s creening instruments against a computerized diagnostic interview. Results. One hundred and thirty people completed the study. The results for the largest subgroup, the Jamaicans (N = 96) were analysed. Effects of gen der, age and education on the MMSE and AMT scores were evaluated. The corre lations between the screening instruments and diagnostic interview were hig hly significant (P < 0.001). At appropriate cut-offs both screening instrum ents demonstrated high sensitivity and acceptable specificity levels. Conclusions. A defined process with lay input has assisted in producing cul turally modified versions of the MMSE and AMT that perform well compared wi th a diagnostic interview, if an appropriate cut-off is used. They are easy to administer and acceptable to older African-Caribbean people. The result s need to be viewed within the limitations of the current study.