The effect of illiteracy on performance in screening tools for dementia: A systematic review and meta-analysis

Caragh Maher*, Clara Calia

*Corresponding author for this work

Research output: Contribution to journalMeeting abstractpeer-review

Abstract / Description of output

Background: Research indicates that many tools designed for screening dementia are affected by literacy level (Ardila et al., 2010; Kosmidis, 2018). However, no systemic analysis exists to evaluate the overall effects of this important confounding factor. We systematically reviewed and meta-analytically estimated the differences in performance in dementia screening tools between literate and illiterate individuals.
Method: Electronic databases (MEDLINE, PsycINFO, and EMBASE) were searched from 1975 to February 2020 to identify empirical studies examining performance in dementia screening tools in literate and illiterate individuals over 50 years old. Data for effect sizes, participant demographic information, and study information were extracted.
Results: We identified 28 studies collectively comprising of 28,298 individuals classified as literate and 15,995 individuals classified as illiterate. Of the 28 studies, 24 included the Mini-Mental State Examination (MMSE) or an adapted version of the MMSE. Eleven studies included a cognitive screening tool that was adapted for use in illiterate/low educated participants. Nineteen studies were methodologically suitable for meta-analysis. Multi-level random-effects modelling demonstrated a significant overall effect, with literate participants scoring significantly higher than illiterate participants (g = -1.2962, 95% CI = -1.6200, -0.9723, p < 0.001; Figure 1). Moderator analyses indicated significant effects of test type and the presence of cognitive impairment on the extent of the difference in performance between literate and illiterate participants. The difference in performance between groups was smaller in screening tests designed or modified for illiterate individuals (p < 0.05), and in individuals with cognitive impairment (p < 0.01).
Conclusion: Our findings confirm the unsuitability of many dementia screening tools for individuals who are illiterate. The results of this systematic review and meta-analysis emphasise the need for the development, validation, and use of tools that are suitable for individuals of all literacy abilities. References: Ardila, Bertolucci, P. H., Braga, L. W., Castro-Caldas, A., Judd, T., Kosmidis, M. H., Rosselli, M. (2010). Illiteracy: the neuropsychology of cognition without reading. Arch Clin Neuropsychol, 25(8), 689-712. doi:10.1093/arclin/acq079. Kosmidis, M. H. (2018). Challenges in the neuropsychological assessment of illiterate older adults. Language, Cognition and Neuroscience, 33(3), 373-386. doi:10.1080/23273798.2017.1379605
Original languageEnglish
Article numbere049670
JournalAlzheimer's & Dementia: The Journal of the Alzheimer's Association
Issue numberS6
Publication statusPublished - 31 Dec 2021
EventAlzheimer’s Association International Conference AAIC - Amsterdam
Duration: 25 Jul 202130 Jul 2021

Keywords / Materials (for Non-textual outputs)

  • dementia
  • meta analysis
  • illiteracy
  • screening test


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