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Effects of education and culture on the validity of the Geriatric Mental State and its AGECAT algorithm

  • Martin Prince (a1), Daisy Acosta (a2), Helen Chiu (a3), John Copeland (a4), Michael Dewey (a5), Marcia Scazufca (a6), Mathew Varghese (a7) and for the 10/66 Dementia Research Group...
Abstract
Background

The Geriatric Mental State (GMS) is the most widely used psychiatric research assessment for older persons. Evidence for validity comes from the developed world.

Aims

To assess the validity of GMS/AGECAT organicity and depression diagnoses in 26 centres in India, China, Latin America and Africa.

Method

We studied 2941 persons aged 60 years and over: 742 people with dementia and three groups free of dementia (697 with depression, 719 with high and 783 with low levels of education). Local clinicians diagnosed dementia (DSM–IV) and depression (Montgomery – Åsberg Depression Rating Scale score ⩾18).

Results

For dementia diagnosis GMS/AGECAT performed well in many centres but educational bias was evident. Specificity was poor in India and sensitivity sub-optimal in Latin America. A predictive algorithm excluding certain orientation items but including interviewer judgements improved upon the AGECAT algorithm. For depression, sensitivity was high. The EURO–D depression scale, derived from GMS items using European data, has a similar factor structure in Latin America, India and, to a lesser extent, China.

Conclusions

Valid, comprehensive mental status assessment across cultures seems achievable in principle.

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Copyright
Corresponding author
Professor Martin Prince, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel: +44 20 7848 0136; fax: +44 20 7277 0283; e-mail: m.prince@iop.kcl.ac.uk
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Declaration of interest

None.

Footnotes
References
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American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). Washington, DC: APA.
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Copeland, J. R., Prince, M., Wilson, K. C., et al (2002) The Geriatric Mental State Examination in the 21st century. International Journal of Geriatric Psychiatry, 17, 729732.
Ganguli, M., Chandra, V. & Gilbey, J. (1996) Cognitive test performance in a community-based non demented elderly sample in rural India: the Indo-US cross national dementia epidemiology study. International Psychogeriatrics, 8, 507524.
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Medical Research Council Cognitive Function and Ageing Study Neuropathology Group (MRC CFAS) (2001) Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Lancet, 357, 169175.
Montgomery, S. A. & Åsberg, M. (1979) A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382389.
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Prince, M. J., Reischies, F., Beekman, A. T. F., et al (1999) The development of the EURO–D scale – a European Union initiative to compare symptoms of depression in 14 European centres. British Journal of Psychiatry, 174, 330338.
Prince, M., Acosta, D., Chiu, H., et al (2003) Dementia diagnosis in developing countries: a cross-cultural validation study. Lancet, 361, 909917.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Effects of education and culture on the validity of the Geriatric Mental State and its AGECAT algorithm

  • Martin Prince (a1), Daisy Acosta (a2), Helen Chiu (a3), John Copeland (a4), Michael Dewey (a5), Marcia Scazufca (a6), Mathew Varghese (a7) and for the 10/66 Dementia Research Group...
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