|
|
|
|
|
A. V Rayner, MD, School of Public Health, University of Louisville, 555 S. Floyd St, Louisville, KY 40202, 502 852-3003, arayner@jhsph.edu, Joseph L Hagan, MSPH, SPH, LSU, 1600 Canal St, Suite 800, New Orleans, LA 70112-2854, and Stephen W. Looney, PhD, Department of Bioinformatics and Biostatistics, University of Louisville, 555 South Floyd Street, Louisville, KY 40292.
Purpose: Education has been proposed as a protective factor in the development of dementia. However, there is little data on factors associated with presentation and evaluation of dementia in people with low levels of education. Methods: Retrospective review of a convenience sample of community dwelling people who underwent evaluation for memory disorders in western Kentucky. All patients underwent evaluation using the Washington University “initial subject protocol” and the CERAD psychometric test battery. Analysis was done using SPSS. Results: The mean level of education for the 230 patients was 9.2 years (range 0-19). Reported duration of illness was similar regardless of education (mean 2.9 years). Stage of dementia at the time of presentation was significantly greater in those with lower education (0-6 years, p<0.01). Clinical Dementia Rating Scale sum of the boxes (CDR-SB) reflected stage of disease more accurately than global measures at the lowest education level. Performance on psychometric testing was significantly poorer at each stage of disease for those with limited education. Those with low education had significantly more hallucinations (p=0.02) and delusions (p=0.023). Conclusions: Presentation at later stage of illness in those with limited education may be a function of delay in recognition, cultural acceptance of dementia, altered natural history, or lack of perceived health care benefit. Functional assessment rather than psychometric testing is imperative to understand the patient’s level of impairment. Information on natural history will lead to better understanding of the impact of education on dementing disorders.
Learning Objectives:
Keywords: Dementia, Health Disparities
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.