Assessing Cognitive Decline in Amazonian Indigenous Elders: A Comparative Study of Mini-Mental State Examination and Rowland Universal Dementia Assessment Scale in Shipibo-Conibo Communities
Claudia Cruzalegui Bazán1, Gerardo Luna-Peralta1, Sandra Uriol Alvino1, Hamilet Huaccho1, Carlos Rodrigo Vicuña2
1Sociedad Científica de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú, 2Grupo de Investigación Neurociencias, Metabolismo, Efectividad Clínica y Sanitaria (NEMECS), Universidad Científica del Sur, Lima, Perú
Objective:
To compare the performance of two cognitive impairment screening tools, the Mini-Mental State Examination (MMSE) and the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE), among elderly members of the Shipibo-Conibo, an Amazonian indigenous group living in native communities in the Yarinacocha district, Pucallpa, Peru.
Background:
Evaluating cognitive decline in elderly populations is critical, particularly in remote, underserved regions. This study focuses on Shipibo-Conibo communities, an indigenous group with distinct sociocultural characteristics, to assess cognitive screening tools' effectiveness. Understanding cognitive impairment in these Amazonian populations is key to addressing health disparities in isolated indigenous groups.
Design/Methods:
The study compared MMSE and RUDAS-PE scores in elderly adults from three native Shipibo-Conibo communities. Both tests were administered by blinded evaluators. Linear correlation between the tests was analyzed, and RUDAS-PE's diagnostic accuracy was assessed using the Area Under the Curve (AUC), sensitivity, and specificity.
Results:
The sample included 79 participants, mostly males (63.3%), with an average age of 69.0 ± 7.1. The mean RUDAS-PE score was 22.4 ± 5.3 (questionable cognitive impairment), while the MMSE mean score was 20 ± 6.2 (definitive cognitive impairment). A linear regression analysis between the two tests revealed a correlation coefficient (r) of 0.80 (p < 0.05). The MMSE showed a stronger correlation with education level (r = 0.54, p < 0.01) compared to RUDAS-PE (r = 0.38, p < 0.01). The AUC for RUDAS-PE was 0.11 (95% CI 0.04-0.18), with an ideal cutoff point of 20/21, resulting in a sensitivity of 52.5% and specificity of 5.13%.
Conclusions:
There were discrepancies between RUDAS-PE and MMSE results in the Shipibo-Conibo population, questioning RUDAS-PE's effectiveness for cognitive impairment screening in this group. Further research is needed to develop culturally appropriate tools for Amazonian indigenous communities.
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