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Clinical Manifestations.
Kate Ruiz1, Melanie L Johnson2,3, Diane M Jacobs1,4,5,6,7
1University of California, San Diego, La Jolla, CA, USA.
Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 26, 2025
Summary
Adjusting cognitive test scores using grade equivalency, rather than years of education, may underestimate cognitive impairment in Spanish-speaking U.S. Latinos. This highlights the need for careful interpretation of neuropsychological test results in this population.
Area of Science:
- Neuropsychology
- Cognitive Science
- Latino Health
Background:
- Neuropsychological test norms often adjust for years of education.
- Educational quality and attainment vary, making years of education an inadequate measure.
- Grade-equivalency scores offer a more nuanced view of educational experience.
Purpose of the Study:
- To investigate the impact of adjusting cognitive test results using grade equivalency versus years of education.
- To compare the interpretation of cognitive test results in Spanish-speaking U.S. Latinos using two different educational adjustment methods.
Main Methods:
- 140 Spanish-speaking Latinos with subjective cognitive decline underwent cognitive testing.
- The Woodcock-Muñoz Letter-Word Identification Test estimated grade-equivalency.
- Cognitive test scores were standardized (Z-scores) adjusting for age, sex, language, and either years of education or grade-equivalency.
Main Results:
- Grade equivalency scores were significantly higher than self-reported years of education.
- Cognitive test Z-scores adjusted for grade equivalency were significantly lower than those adjusted for years of education.
- A greater percentage of participants fell below cognitive impairment cutoffs when adjusting for grade equivalency.
Conclusions:
- Adjusting for grade equivalency may underestimate cognitive impairment in Spanish-speaking U.S. Latinos.
- Self-reported years of education may not fully capture the educational experiences of this diverse group.
- Caution is advised when interpreting education-adjusted neuropsychological test scores for this population.
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