Ethnic differences in Mini-Mental State Examination (MMSE) scores: Where you live makes a difference

OBJECTIVES: To examine differences in correlates of the Mini-Mental State E xamination (MMSE) in a population-based sample of older Mexican Americans a nd European Americans and to provide empirical validation of the MMSE as an indicator of cognitive impairment in survey research in older Mexican Amer icans by comparing MMSE classification against performance on timed tasks w ith varying levels of cognitive demand. DESIGN: A population-based cross-sectional study. SETTING: Trained bilingual staff administered the MMSE as part of the San A ntonio Longitudinal Study of Aging (SALSA) home-based assessment battery. PARTICIPANTS: 827 community-dwelling Mexican Americans and European America ns, 65 and older, residing in three socioeconomically and culturally distin ct neighborhoods (barrio, transitional, suburban). MEASUREMENTS: The MMSE was compared against a variety of demographic, biome dical, and sociocultural variables ascertained by self-report and against p erformance-based measures of functional tasks representing varying levels o f cognitive demand (Structured Assessment of Independent Living Skills (SAI LS) subscales for food manipulation and money management). RESULTS: Mexican Americans were 2.2 times more likely than European America ns to have MMSE scores < 24, Multiple logistic regression analysis revealed that neighborhood was an independent predictor of low MMSE scores in Mexic an Americans, with the relationship between ethnic group and MMSE explained by neighborhood. After adjusting for neighborhood type, no differences wer e noted between Mexican Americans and European Americans. Independent of ot her factors examined, low education was associated with low MMSE scores in both Mexican Americans and European Americans. Mexican Americans with MMSE scores < 24 took significantly longer to complete four out of: five perform ance-based food manipulation tasks and all three money management tasks. CONCLUSIONS: Neighborhood typo was a predictor of cognitive impairment. Edu cation affected MMSE scores similarly in both ethnic groups. MMSE scores < 24, indicative of cognitive impairment, were uniformly associated with func tional impairment in both the Mexican Americans and European Americans. Amo ng older Mexican Americans, MMSE-classified cognitive impairment was signif icantly associated with poorer performance on timed tasks with varying leve ls of cognitive demand independent of ether correlates. A similar pattern o f association was observed in European Americans. Thus, the MMSE appears to be a valid indicator of cognitive impairment in survey research in both ol der Mexican Americans and European Americans.