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Amin Abuful, Rivka Inzelberg, Magda Masarwa, Aziz Mazarib, Edna Schechtman Rosa Strugatsky & Robert P. Friedland
Hillel Yaffe Medical Center, Technion Rappaport Faculty of Medicine, Ben Gurion University, Israel & Case Western University School of Medicine, Cleveland, Ohio, USA
Background
The prevalence of Alzheimer's disease is increasing. There is a need for accurate and easily administered screening instruments. The Minimental State Examination (MMSE) is widely used. It has been validated in North America, Europe and Asia , but not in Arabic populations.
Aim
To present gender differences in the normative data of an Arabic translation of the MMSE.
Methods
The present work is part of our epidemiological study of brain aging related disorders carried out in Wadi Ara villages in northern Israel.
Study team
All participants were examined in their homes by a fluently Arabic speaking native team The team comprised an academic nurse, a social worker and neurologists.
Methods Occupation
Questionnaires about occupation (present and past) Categorized for statistical analysis 1=never worked outside the house, or housewife 2=handy work (trader in shop, cook, carpenter, builder, etc), 3=agriculture 4=office.
Results
442 subjects approached 438 agreed (refusal rate 0.9 %) Four were excluded: severe systemic nonnonneurological disease
Cognitively normal
The study population consisted of 266 subjects (158 males) (158 Mean age (SD) was 72.4 (5.5) years 72. Range 65 -91 years Mean age: Males: 72.8 (5.6); females: 71.6 (5.4) 72. 71. years (p>0.1) (p>0
Results
Mean MMSE entire population = 25 (4) Mean BCST entire population = 19 (4) points Highly significant correlation between MMSE and Brookdale scores in the entire group (r=0.852, p<0.0001) (r=0 852, p<0 0001) Males r=0.8223, Females r=0.854, r=0 8223, r=0 854, p<0 p<0.0001 both
Education levels
90 80 70 60 50
%
within
males females
gender 30
M M S E
males females
p<0.05 p<0.0001
0-4 yrs
5-8 yrs
>8 yrs
Education years
p<0.05
males females
p<0.0001
0-4 yrs
5-8 yrs
>8 yrs
Education years
Occupation categories
p<0 p<0.05
Conclusions
We described normative data for an Arabic translation of the MMSE by gender.
Conclusions
Mean values of the MMSE scores were comparable to population-based norms populationdescribed in English in the USA at all correspondent education levels (Crum et al. JAMA, 1993). 1993).
Conclusions
We found a divergent effect of gender in different education levels. Females with low-schooling (<=4 years) low(<=4 perform significantly worse than males. However, females with higher schooling (>=5 (>=5 years) perform significantly better than males.
Discussion
We verified whether working in the community might contribute to the performance. We found that scores are influenced by education and not by occupation within genders, when these two factors are analyzed. Influence of social exposure and life-style ? life-
Conclusions
Different cut-off scores should be used in cutdifferent education strata. Scores of females at low education levels should be considered cautiously to prevent false positive interpretation. Information on education is mandatory. Still, MMSE may serve for measuring change over time.
Thank you
Rob P. Friedland, Case Western Reserve University- Lab of UniversityNeurogenetics , USA Lindsay Farrer, Boston UniversityUniversityGenetics Program, USA Edna Schechtman, Ben Gurion UniversityUniversity- Dept. Industrial Engineering, Beer Sheva, Israel Hillel Yaffe Medical Center, Hadera, Israel Rivka Inzelberg Aziz Mazarib Magda Masarwa Saif Abo-Mouch AboRosa Strugatsky Gital Gamliel
% within gender
males females
% within gender
30 20 10 0
%
within gender
40 20 0
Occupation category
p<0.05
%
within gender
30 20 10 0
Occupation category
p<0.05