title: Ethnic and educational differences in cognitive test performance on mini-mental state examination in Asians.
abstract: OBJECTIVE
  The objective of this study is to examine ethnic differences in Mini-Mental State Examination (MMSE) test performance in discriminating between demented and nondemented elderly Asians.
  
  
  METHODS
  A nationally representative population sample (N = 1,092) of community-living elderly, comprising Chinese, Malays, and Indians in Singapore, was interviewed using MMSE, Geriatric Mental State, and demographic and health questionnaires.
  
  
  RESULTS
  There were significant ethnic differences in mean MMSE scores among Chinese (26.2), Indians (25.0), and Malays (23.6), but only in noneducated subjects. No ethnic differences in MMSE were observed in higher educated subjects. The sample proportion of subjects with dementia was 4.2% in Chinese, 9.4% in Malays, and 8.8% in Indians. Overall, MMSE discriminated well between subjects with and without dementia (cutoff: 23/24, area under the curve: 95%, sensitivity: 97.5%, specificity: 75.6%). MMSE test performance was much better in higher educated subjects (higher specificity: 85.2%). Lower specificities were shown in less educated subjects (57.3%), and in Malays (62.8%), and especially in less educated Malays (35.3%) and Indians (50.0%). Significant differences in MMSE scores in less educated subjects persisted after adjusting for differences in sociodemographic, health, and behavioral variables
  
  
  CONCLUSIONS
  Ethnic nonequivalence in MMSE test performance should be taken into account in dementia screening in Asians in less educated subjects. Known correlates of cognitive functioning did not sufficiently explain these differences.
authors.affiliation: Gerontological Research Programme, National University of Singapore, Department of Psychological Medicine, National University Hospital, Singapore. pcmngtp@nus.edu.sg
authors.forename: Tze-Pin
authors.initials: TP
authors.lastname: Ng
authors.forename: Matthew
authors.initials: M
authors.lastname: Niti
authors.forename: Peak-Chiang
authors.initials: PC
authors.lastname: Chiam
authors.forename: Ee-Heok
authors.initials: EH
authors.lastname: Kua
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology; D044466:Asian People / Q000208:ethnology / Q000523:psychology*; D003431:Cross-Cultural Comparison; D003937:Diagnosis, Differential; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008609:Mental Status Schedule / Q000706:statistics & numerical data*; D008875:Middle Aged; D011594:Psychometrics / Q000706:statistics & numerical data; D012307:Risk Factors; D012846:Singapore / Q000208:ethnology; D013223:Statistics as Topic