Mini-Mental State Examination among lower educational levels and illiterates: Transcultural evaluation

Cognitive performance among illiterates and low educational levels is poorer than that observed in individuals with greater schooling. This difference can be a confounding factor in reaching an accurate diagnosis of cognitive impairment. In addition, there is great heterogeneity in performance among illiterates, probably due to different environmental demands and sociocultural backgrounds. Many reports have described the influence of education on neuropsychological measures and screening tests such as the Mini-Mental State Examination (MMSE). OBJECTIVES: To analyze performance in two samples with the same educational level, but different social and cultural backgrounds. METHODS: Subjects from two different locations in Brazil (rural sample from Northern region and urban sample residing in the largest city of the Southeastern region) were matched for age and education, and submitted to the MMSE. RESULTS: Significant differences between the groups were found in total scores on the MMSE and in temporal orientation and serial-sevens sub-items for which the urban sample performed best but analysis of illiterates alone yielded the same results, except for the copying pentagons task which was performed better by the rural sample. CONCLUSIONS: Cultural and social backgrounds, as well as demands from the environment, influence results of screening tests. Factors other than education must be taken into account when analyzing tests.