title: Effects of demographic and environmental variables on cognitive performance in a rural community sample of elderly people living in Southern Italy.
abstract: OBJECTIVE
  The aim of our study was to understand how demographic and environmental factors may be associated with cognitive functions in a rural population of Southern Italy, with a very high percentage of elderly persons with little formal education.
  
  
  METHODS
  From the population registry of San Marcellino (province of Caserta), out of 1089 persons aged over 60 years, a random sample of 300 residents received a door-to-door visit. Two hundred and twenty-six subjects were judged as not having significant cognitive impairment, on the basis of their personal history and Clinical Dementia Rating score (< 1). They were administered the Mini Mental State Examination (MMSE).
  
  
  RESULTS
  A positive statistically significant correlation was observed between MMSE score and education, but not between MMSE score, age and gender. Normative data showed that 90% of the normal population from this area had an adjusted MMSE score of more than 16.20, a value far below the traditional cut-off score of 23/24 for diagnosis of dementia. Subjects living with their families showed better performance than persons living alone or only with spouses.
  
  
  CONCLUSIONS
  This finding is consistent with other epidemiologic surveys, and suggests the possible role of ecological and environmental factors in preventing or compensating cognitive decline, at least in persons coming from homogeneous rural areas. Low social demands in a protective family environment do not stimulate high intellectual performance, and signs of dementia may not be recognized by persons living in this context until the patient reaches a severe stage of disease.
authors.affiliation: Department of Clinical and Experimental Medicine, University "Federico II", Napoli, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: Milan
authors.forename: Alessandro
authors.initials: A
authors.lastname: Iavarone
authors.forename: Nicola F
authors.initials: NF
authors.lastname: Vargas
authors.forename: Natascia M
authors.initials: NM
authors.lastname: Vargas
authors.forename: Francesco
authors.initials: F
authors.lastname: Fiorillo
authors.forename: Filomena
authors.initials: F
authors.lastname: Galeone
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gallotta
authors.forename: Alfredo
authors.initials: A
authors.lastname: Postiglione
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology*; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology; D003710:Demography; D004777:Environment; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012424:Rural Population