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Clinical Manifestations.

Isabella Hoang1, Joe Strong2, Jacqueline Pontes Monteiro1

  • 1Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.

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|December 25, 2025
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Summary
This summary is machine-generated.

Language barriers in cognitive testing can delay diagnoses. Higher education levels mitigate the negative impact of language mismatches on Mini-Mental Status Examination (MMSE) scores, suggesting education is key for accurate cognitive assessments.

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Area of Science:

  • Neuroscience
  • Cognitive Science
  • Psychometrics

Background:

  • Cognitive assessments like the Mini-Mental Status Examination (MMSE) may be less accurate for non-native English speakers.
  • Language barriers can lead to delayed diagnoses of cognitive impairment in English-speaking countries.
  • Limited research exists on how language mismatches affect MMSE scores and cognitive diagnoses.

Purpose of the Study:

  • To investigate the impact of language mismatches on MMSE scores.
  • To examine how factors like education, sex, and cognitive diagnosis influence the relationship between language mismatch and MMSE performance.
  • To analyze data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and the Health and Aging Brain Study - Health Disparities (HABS-HD).

Main Methods:

  • Merged data from ADNI (n=2202) and HABS-HD (n=2532).
  • Used Mann-Whitney and Kruskal-Wallis tests to compare MMSE scores across cognitive groups (cognitively normal, mild cognitive impairment, dementia) and between sexes.
  • Employed a Generalized Linear Model (GLM) to assess the effects of language mismatch and its interactions with education, diagnosis, age, and sex on MMSE scores.

Main Results:

  • 80 participants (3.6%) experienced a language mismatch.
  • Years of education significantly moderated the effect of language mismatch on MMSE scores (p=0.007).
  • Increased education reduced the negative impact of language mismatch on MMSE scores; no significant interactions were found with diagnosis, sex, or age.

Conclusions:

  • Education level is a significant factor in interpreting MMSE scores for individuals with language mismatches.
  • The findings highlight the importance of considering educational background and language concordance when assessing cognitive function using the MMSE.
  • This study provides critical insights for refining cognitive assessment models to account for linguistic diversity.