Cross-Cultural Comparison of MMSE and RUDAS in German and Turkish Patients With Alzheimer's Disease

Abstract

Objective: Given the increasing cultural, linguistic diversity in Europe, there is a growing need for cognitive screening tools that minimize the influence of linguistic, cultural, and demographic differences as they are the first means to determine the need for further clinical evaluation of individuals with suspected cognitive impairment. This cross-sectional study compared performance on the Mini-Mental State Examination (MMSE) and the Rowland Universal Dementia Assessment Scale (RUDAS) in Alzheimer's Disease (AD) patients in relation to cultural, demographic, and immigration-related factors (acculturation, bilingualism). Method: The study comprised Turkish immigrant (n = 21) and monolingual, nonimmigrant German (n = 20) and Turkish (n = 24) patients with AD. All participants were administered cognitive screening tools, measures of depression, and dementia severity. Results: The mean MMSE total score was significantly higher in German patients with AD compared to both patient groups, but did not differ between native-born Turkish and Turkish immigrant groups. After adjustment for years of education, differences in MMSE performance were no longer significant between groups. Furthermore, bilingualism was associated with better performance on the MMSE in Turkish-immigrant patients. The mean RUDAS total scores were similar between groups with and without adjustment for educational level. Performance on the RUDAS was not associated with demographic and immigration-related variables. Conclusions: The findings highlight the need to consider the educational background, linguistic integration of older non-Western immigrants for the objective characterization of cognitive profiles. The results provide support for the use of the RUDAS, particularly, among older Turkish immigrants with lower educational levels and varying degrees of acculturation, bilingualism.