Validating screening instruments for cognitive impairment in older South Asians in the United Kingdom

Background. The numbers of older South Asians in the United kingdom are rising. Investigation of their mental health has been neglected compared to their physical health. Objectives. This study aimed to determine the sensitivity and specificity of modified versions of two screening instruments for cognitive impairment (Mini-Mental State Examination and Abbreviated Mental Test) in a community-based population. Design. Two-stage study comparing screening instruments against diagnostic interview. Setting. South, central and north Manchester. Subjects. Community-resident South Asians aged 60 years and over. Methods. Subjects were approached via their general practitioners and interviewed at home. Sensitivity and specificity for the screening instruments were calculated using receiver operating characteristic (ROC) curve analysis. Results. For the Gujarati population, the MMSE cutoff was greater than or equal to 24 (sensitivity 100%, specificity 95 %) and AMT greater than or equal to 6 (sensitivity 100%, specificity 95%). For the Pakistani population, the MMSE cutoff was greater than or equal to 27 (sensitivity 100%, specificity 77%) and AMT greater than or equal to 7 (sensitivity 100%, specificity 87%). Conclusions. Culturally modified versions of the Mini-Mental State Examination and Abbreviated Mental Test are acceptable and may have a high degree of sensitivity. They may assist with the recognition of cognitive impairment, if an appropriate cutoff is used. Copyright (C) 2000 John Wiley & Sons, Ltd.