Illiteracy and dementia

Brucki, Sonia Maria Dozzi

doi:10.1590/S1980-57642010DN40300002

Abstract

There is a current concept that illiteracy and lower educational levels are risk factors for cognitive decline and dementia. Our aims were to review the association between illiteracy and dementia; and to describe some results on neuropsychological findings in illiteracy. A literature search of the PubMed database was performed. The search terms were "dementia", "illiteracy", "neuropsychological evaluation", "educational levels", and "education". Only papers published in Portuguese, English, and Spanish were reviewed. Illiteracy is an incontestable risk factor for dementia. It influences performance on almost cognitive tests. Many other factors could be connected to the high prevalence of dementia among illiterates: low cognitive reserve, poor control of cerebrovascular disease risk factors, difficulties in cognitive evaluation, and poor adaptation of neuropsychological tests for this specific population. Functional tests must be coupled with cognitive tests to ameliorate diagnostic accuracy.

Key words:
dementia; illiteracy; cognition; education; neuropsychological evaluation

Resumo

Há um conceito corrente na literatura de que analfabetismo e baixos níveis educacionais são fatores de risco para declínio cognitivo e demência. Nossos objetivos foram revisar a associação entre analfabetismo e demência e descrever alguns resultados de achados neuropsicológicos no analfabetismo. A revisão de literatura foi realizada procurando-se os termos "dementia", "illiteracy", "neuropsychological evaluation", "educational levels" e "education". Somente artigos publicados em português, inglês e espanhol foram revistos. Analfabetismo é um fator de risco incontestável para demência, influenciando o desempenho em quase todos os testes. Muitos outros fatores podem ser ligados aos altos índices de demência entre analfabetos: baixa reserva cognitiva, controle pobre dos fatores de risco para doenças cerebrovasculares, dificuldades na avaliação cognitiva e adaptação pobre dos testes neuropsicológicos para este tipo de população. Testes funcionais devem ser acoplados aos testes cognitivos a fim de aumentar a acurácia diagnóstica.

Palavras-chave:
demência; analfabetismo; cognição; educação; evolução neuropsicológica

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

Luria AR. A construção da mente. São Paulo, Ícone Editora; 1992.
Scribner S, Cole M. The Psychology of Literacy. Cambridge. Harvard University Press; 1981.
Zhang M, Katzman R, Jin H, et al. The prevalence of dementia and Alzheimer's disease (AD) in Shanghai, China: impact of age, gender and education. Ann Neurol 1990;27:428-437.
Mortimer JA. Do psychosocial risk factors contribute to Alzheimer's disease? In: Etiology of dementia of Alzheimer's type. New York: John Wiley & Sons; 1988.
Nitrini R, Bottino CMC, Albala C, et al. Prevalence of dementia in Latin America: a collaborative study of population-based cohorts. Int Psychogeriatr 2009;21:622-630.
García FJ, Ayala MIS, Martín AP, et al. Prevalencia de demencia y de sus subtipos principales en sujetos mayors de 65 años: efecto de La educación y ocupación. Estudio Toledo. Med Clin (Barc) 2001;116:401-407.
Gavrila D, Antúnez C, Tormo MJ, et al. Prevalence of dementia and cognitive impairment in Southeastern Spain: the Ariadna study. Acta Neurol Scand 2009; 120:300-307.
Lopes MA, Hototian SR, Reis GC, Elkis H, Bottino CMC. Systematic review of dementia prevalence 1994 to 2000. Dement Neuropsychol 2007;3:230-240.
Rodriguez JJL, Ferri CP, Acosta D, Guerra M et al. Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey. Lancet 2008; 372:464-474.
Bowirrat A, Friedland RP, Farrer L, Baldwin C, Korczyn AD. Genetic and environmental risk factors for Alzheimer's disease in Israeli Arabs. J Mol Neurosci 2002;19:239-245.
De Silva HA, Gunatilake SB, Smith AD. Prevalence of dementia in a semi-urban population in Sri Lanka: report from a regional survey. Int J Geriatr Psychiatry 2003;18:711-715.
Bermejo-Pareja F, Benito-León J, Vega S, et al. Incidence and subtypes of dementia in three elderly populations of central Spain. J Neurol Sci 2008;264:63-72.
Kalaria RN, Maestre GE, Arizaga R, et al. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol 2008;7:812-826.
Lee JY, Chang SM, Jang HS, et al. Illiteracy and the incidence of Alzheimer's disease in the Yonchon County survey, Korea. Int Psychogeriatr 2008;20:976-985.
Bottino CM, Azevedo Jr D, Tatsch M, et al. Estimate of dementia prevalence in a community sample from São Paulo, Brazil. Dement Geriatr Cogn Disord 2008;26: 291-299.
Chandra V, Pandav R, Dodge HH, et al. Incidence of Alzheimer's disease in a rural community in India. The Indo-US study. Neurology 2001;57:985-989.
Salmon DP, Jin H, Zhong M, et al. Neuropsychological assessment of Chinese elderly in the Shanghai Dementia Survey. Clin Neuropsychol 1995;9:159-168.
Brucki SMD, Nitrini R. Mini-Mental State Examination among lower educational levels and illiterates: transcultural evaluation. Dement Neuropsychol 2010;4:120-125.
Messias E. Income inequality, illiteracy rate, and life expectancy in Brazil. Am J Public Health 2003;93:1296.
Scazufca M, Almeida OP, Menezes PR. The role of literacy, occupation and income in dementia prevention: the São Paulo Ageing & Health Study (SPAH). Int Psychogeriatr 2010;3:1-7.
Ardila A, Rosselli M, Rosas P. Neuropsychological Assessment in Illiterates: Visuospatial and Memory Abilities. Brain Cognition 1989;11:147-166.
Rosselli M, Ardila A, Rosas P. Neuropsychological Assessment in illiterates .II Language and praxic abilities. Brain Cognition 1990;12:281-296.
Grossi D, Correra G, Calise C, et al. Evaluation of the influence of illiteracy on neuropsychological performances by elderly persons. Percept Mot Skills 1993;77: 859-866.
Manly JJ, Jacobs DM, Sano M, et al. Effect of literacy on neuropsychological test performance in nondemented, education-matched elders. J Int Neuropsychol Soc 1999;5:191-202.
Reis A, Castro-Caldas A. Illiteracy: a cause for biased cognitive development. J Int Neuropsychol Soc 1997;3:444-450.
Nitrini R, Caramelli P, Herrera H, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.
Matute E, Leal F, Zarabozo D, Robles A, Cedillo C. Does literacy have an effect on stick construction tasks? J Int Neuropsychol Soc 2000;6:668-672.
Reis A, Petersson KM, Castro-Caldas A, Ingvar M. Formal schooling influences two- but not three-dimensional naming skills. Brain Cognition 2001;1-15.
Brucki SMD, Nitrini R. Cancellation task in very low educated people. Arch Clin Neuropsychol 2008;23:139-147.
Porto CS, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale: Diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.
Bertolucci PH, Okamoto IH, Brucki SM, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001; 59:532-536.
Schultz RR, Silviero MO, Bertolucci PHF. The cognitive subscale of the "Alzheimer`s Disease Assessment Scale" in a Brazilian sample. Braz J Med Biol Res 2001;34:1295-1302.
Bertolucci PHF, Brucki SMD, Campacci S, et al. O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Suggestions for utilization of the Mini-Mental State Examination in Brazil. Arq Neuropsiquiatr 2003;61:777-781.
Brito-Marques PR, Cabral-Filho JE. The role of education in Mini-Mental State Examination: a study in Northeast Brazil. Arq Neuropsiquiatr 2004;62:206-211.
Lourenço RA, Veras RP. Mini-Mental State Examination: psychometric characteristics in elderly outpatients. Rev Saúde Pública 2006;40:712-719.
Laks J, Baptista EM, Contino AL, de Paula EO, Engelhardt E. Mini-Mental State Examination norms in a community dwelling sample of elderly with low schooling in Brazil. Cad Saude Publica 2007;23:315-319.
Scazufca M, Almeida OP, Vallada HP, Tasse WA, Menezes PR. Limitations of the Mini-Mental State Examination for screening dementia in a community with low socioeconomic status. Results from the Sao Paulo Ageing & Health Study. Eur Arch Psychiatry Clin Neurosci 2009;259:8-15.
Kochhann R, Cerveira MO, Godinho C, Camozzato A, Chaves MLF. Evaluation of Mini-Mental State Examination scores according to different age and education strata, and sex, in a large Brazilian healthy sample. Dement Neuropsychol 2009;3: 88-93.
Kochhann R, Varela JS, Lisboa CSM, Chaves MLF. The Mini Mental State Examination. Review of cutoff points adjusted for schooling in a large Southern Brazilian sample. Dement Neuropsychol 2010;4:35-41.
Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
Bustamante SEZ, Bottino CMC, Lopes MA, et al. Instrumentos combinados na avaliação de demência em idosos: resultados preliminares. Arq Neuropsiquiatr . 2003;61:601-606.
Quiroga PL, Albala CB, Klaasen GP. Validation of a screening test for age associated cognitive impairment in Chile. Rev Med Chile 2004;132:467-478.
Bottino CM, Zevallos-Bustamante SE, Lopes MA, et al. Combined instruments for the screening of dementia in older people with low education. Arq Neuropsiquiatr 2009;67:185-190.

Publication Dates

Publication in this collection
Jul-Sep 2010

History

Received
18 Mar 2010
Accepted
03 July 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Luria AR. A construção da mente. São Paulo, Ícone Editora; 1992.

[2] Scribner S, Cole M. The Psychology of Literacy. Cambridge. Harvard University Press; 1981.

[3] Zhang M, Katzman R, Jin H, et al. The prevalence of dementia and Alzheimer's disease (AD) in Shanghai, China: impact of age, gender and education. Ann Neurol 1990;27:428-437.

[4] Mortimer JA. Do psychosocial risk factors contribute to Alzheimer's disease? In: Etiology of dementia of Alzheimer's type. New York: John Wiley & Sons; 1988.

[5] Nitrini R, Bottino CMC, Albala C, et al. Prevalence of dementia in Latin America: a collaborative study of population-based cohorts. Int Psychogeriatr 2009;21:622-630.

[6] García FJ, Ayala MIS, Martín AP, et al. Prevalencia de demencia y de sus subtipos principales en sujetos mayors de 65 años: efecto de La educación y ocupación. Estudio Toledo. Med Clin (Barc) 2001;116:401-407.

[7] Gavrila D, Antúnez C, Tormo MJ, et al. Prevalence of dementia and cognitive impairment in Southeastern Spain: the Ariadna study. Acta Neurol Scand 2009; 120:300-307.

[8] Lopes MA, Hototian SR, Reis GC, Elkis H, Bottino CMC. Systematic review of dementia prevalence 1994 to 2000. Dement Neuropsychol 2007;3:230-240.

[9] Rodriguez JJL, Ferri CP, Acosta D, Guerra M et al. Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey. Lancet 2008; 372:464-474.

[10] Bowirrat A, Friedland RP, Farrer L, Baldwin C, Korczyn AD. Genetic and environmental risk factors for Alzheimer's disease in Israeli Arabs. J Mol Neurosci 2002;19:239-245.

[11] De Silva HA, Gunatilake SB, Smith AD. Prevalence of dementia in a semi-urban population in Sri Lanka: report from a regional survey. Int J Geriatr Psychiatry 2003;18:711-715.

[12] Bermejo-Pareja F, Benito-León J, Vega S, et al. Incidence and subtypes of dementia in three elderly populations of central Spain. J Neurol Sci 2008;264:63-72.

[13] Kalaria RN, Maestre GE, Arizaga R, et al. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol 2008;7:812-826.

[14] Lee JY, Chang SM, Jang HS, et al. Illiteracy and the incidence of Alzheimer's disease in the Yonchon County survey, Korea. Int Psychogeriatr 2008;20:976-985.

[15] Bottino CM, Azevedo Jr D, Tatsch M, et al. Estimate of dementia prevalence in a community sample from São Paulo, Brazil. Dement Geriatr Cogn Disord 2008;26: 291-299.

[16] Chandra V, Pandav R, Dodge HH, et al. Incidence of Alzheimer's disease in a rural community in India. The Indo-US study. Neurology 2001;57:985-989.

[17] Salmon DP, Jin H, Zhong M, et al. Neuropsychological assessment of Chinese elderly in the Shanghai Dementia Survey. Clin Neuropsychol 1995;9:159-168.

[18] Brucki SMD, Nitrini R. Mini-Mental State Examination among lower educational levels and illiterates: transcultural evaluation. Dement Neuropsychol 2010;4:120-125.

[19] Messias E. Income inequality, illiteracy rate, and life expectancy in Brazil. Am J Public Health 2003;93:1296.

[20] Scazufca M, Almeida OP, Menezes PR. The role of literacy, occupation and income in dementia prevention: the São Paulo Ageing & Health Study (SPAH). Int Psychogeriatr 2010;3:1-7.

[21] Ardila A, Rosselli M, Rosas P. Neuropsychological Assessment in Illiterates: Visuospatial and Memory Abilities. Brain Cognition 1989;11:147-166.

[22] Rosselli M, Ardila A, Rosas P. Neuropsychological Assessment in illiterates .II Language and praxic abilities. Brain Cognition 1990;12:281-296.

[23] Grossi D, Correra G, Calise C, et al. Evaluation of the influence of illiteracy on neuropsychological performances by elderly persons. Percept Mot Skills 1993;77: 859-866.

[24] Manly JJ, Jacobs DM, Sano M, et al. Effect of literacy on neuropsychological test performance in nondemented, education-matched elders. J Int Neuropsychol Soc 1999;5:191-202.

[25] Reis A, Castro-Caldas A. Illiteracy: a cause for biased cognitive development. J Int Neuropsychol Soc 1997;3:444-450.

[26] Nitrini R, Caramelli P, Herrera H, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.

[27] Matute E, Leal F, Zarabozo D, Robles A, Cedillo C. Does literacy have an effect on stick construction tasks? J Int Neuropsychol Soc 2000;6:668-672.

[28] Reis A, Petersson KM, Castro-Caldas A, Ingvar M. Formal schooling influences two- but not three-dimensional naming skills. Brain Cognition 2001;1-15.

[29] Brucki SMD, Nitrini R. Cancellation task in very low educated people. Arch Clin Neuropsychol 2008;23:139-147.

[30] Porto CS, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale: Diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.

[31] Bertolucci PH, Okamoto IH, Brucki SM, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001; 59:532-536.

[32] Schultz RR, Silviero MO, Bertolucci PHF. The cognitive subscale of the "Alzheimer`s Disease Assessment Scale" in a Brazilian sample. Braz J Med Biol Res 2001;34:1295-1302.

[33] Bertolucci PHF, Brucki SMD, Campacci S, et al. O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.

[34] Brucki SMD, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Suggestions for utilization of the Mini-Mental State Examination in Brazil. Arq Neuropsiquiatr 2003;61:777-781.

[35] Brito-Marques PR, Cabral-Filho JE. The role of education in Mini-Mental State Examination: a study in Northeast Brazil. Arq Neuropsiquiatr 2004;62:206-211.

[36] Lourenço RA, Veras RP. Mini-Mental State Examination: psychometric characteristics in elderly outpatients. Rev Saúde Pública 2006;40:712-719.

[37] Laks J, Baptista EM, Contino AL, de Paula EO, Engelhardt E. Mini-Mental State Examination norms in a community dwelling sample of elderly with low schooling in Brazil. Cad Saude Publica 2007;23:315-319.

[38] Scazufca M, Almeida OP, Vallada HP, Tasse WA, Menezes PR. Limitations of the Mini-Mental State Examination for screening dementia in a community with low socioeconomic status. Results from the Sao Paulo Ageing & Health Study. Eur Arch Psychiatry Clin Neurosci 2009;259:8-15.

[39] Kochhann R, Cerveira MO, Godinho C, Camozzato A, Chaves MLF. Evaluation of Mini-Mental State Examination scores according to different age and education strata, and sex, in a large Brazilian healthy sample. Dement Neuropsychol 2009;3: 88-93.

[40] Kochhann R, Varela JS, Lisboa CSM, Chaves MLF. The Mini Mental State Examination. Review of cutoff points adjusted for schooling in a large Southern Brazilian sample. Dement Neuropsychol 2010;4:35-41.

[41] Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[42] Bustamante SEZ, Bottino CMC, Lopes MA, et al. Instrumentos combinados na avaliação de demência em idosos: resultados preliminares. Arq Neuropsiquiatr . 2003;61:601-606.

[43] Quiroga PL, Albala CB, Klaasen GP. Validation of a screening test for age associated cognitive impairment in Chile. Rev Med Chile 2004;132:467-478.

[44] Bottino CM, Zevallos-Bustamante SE, Lopes MA, et al. Combined instruments for the screening of dementia in older people with low education. Arq Neuropsiquiatr 2009;67:185-190.

Brasil