The role of culture and literacy in screening for major neurocognitive disorders for elderly patients on Reunion Island: A cross-sectional study on the concordance between the French Mini-Mental State Examination and an adapted version (MMS-Run)

BackgroundOn Reunion Island, literacy rates are estimated to be 62% for the elderly population. Education is a widely recognized protective factor for major neurocognitive disorders (MNCDs), including Alzheimer's disease, however during cognitive assessments by healthcare professionals, it can also act as a barrier.ObjectiveThis study aims to evaluate the concordance of the scores between the French version of the Mini-Mental State Examination (GRECO-MMSE) and an adapted version to the cultural context and literacy levels of the elderly Reunionese population (MMS-Run).MethodsA cross-sectional, single-center study was conducted at the University Hospital of Reunion Island from April 14, 2023 to April 12, 2024. The GRECO-MMSE and MMS-RUN were performed one day apart to elderly participants who were hospitalized in the Department of Physical Medicine and Rehabilitation (PM&R) and the Department of Geriatrics. Analyses of concordance, correlation and distribution of scores as well as analyses by cognitive domains and by literacy levels (illiterate or literate) were carried out.ResultsAmong the 61 participants, a discordance between the GRECO-MMSE and MSS-Run was observed (kappa=0.54), especially in the cognitive domains assessing orientation, attention and language (items that benefited most from adaptations). More than half of the participants were self-reported as illiterate (57%), and illiteracy was associated with increased discordance between the two tests.ConclusionsThe MMS-Run could be better suited for MNCD screening in the elderly Reunionese population. A validation study is necessary to determine appropriate threshold scores in the future.