title: Bias in discriminating very mild dementia for older adults with different levels of education in Hong Kong.
abstract: BACKGROUND
  Education has a profound effect on older adults' cognitive performance. In Hong Kong, some dementia screening tasks were originally designed for developed population with, on average, higher education.
  
  
  METHODS
  We compared the screening power of these tasks for Chinese older adults with different levels of education. Community-dwelling older adults who were healthy (N = 383) and with very mild dementia (N = 405) performed the following tasks: Mini-Mental State Examination, Alzheimer's Disease Assessment Scale-Cognitive subscales, Verbal Fluency, Abstract Thinking, and Visual/Digit Span. Logistic regression was used to examine the power of these tasks to predict Clinical Dementia Rating (CDR 0.5 vs. 0).
  
  
  RESULTS
  Logistic regression analysis showed that while the screening power of the total scores in all tasks was similar for high and low education groups, there were education biases in some items of these tasks.
  
  
  CONCLUSIONS
  The differential screening power in high and low education groups was not identical across items in some tasks. Thus, in cognitive assessments, we should exercise great caution when using these potentially biased items for older adults with limited education.
authors.affiliation: Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Jianfang
authors.initials: J
authors.lastname: Chang
authors.affiliation: Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Chi-Shing
authors.initials: CS
authors.lastname: Tse
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Grace Tak Yu
authors.initials: GT
authors.lastname: Leung
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Ada Wai Tung
authors.initials: AW
authors.lastname: Fung
authors.affiliation: Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Kit-Tai
authors.initials: KT
authors.lastname: Hau
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Helen Fung Kum
authors.initials: HF
authors.lastname: Chiu
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Linda Chiu Wa
authors.initials: LC
authors.lastname: Lam
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis; D060825:Cognitive Dysfunction / Q000175:diagnosis; D003704:Dementia / Q000175:diagnosis*; D004522:Educational Status; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015588:Observer Variation; D012680:Sensitivity and Specificity