International Psychogeriatrics

Education effects on cognitive function in a healthy aged Arab population

Rivka Inzelberg a1a2c1, Edna Schechtman a3, Amin Abuful a1, Magda Masarwa a1, Aziz Mazarib a4, Rosa Strugatsky a1, Lindsay A. Farrer a5, Robert C. Green a5 and Robert P. Friedland a6
a1 Department of Neurology, Hillel Yaffe Medical Center, Hadera, Israel
a2 Rappaport Faculty of Medicine, Technion, Haifa, Israel
a3 Department of Industrial Engineering, Ben Gurion University, Israel
a4 Department of Neurology, Ziv Medical Center, Zfat, Israel
a5 Departments of Medicine (Genetics Program), Neurology, Genetics & Genomics, Epidemiology, and Biostatistics, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, USA
a6 Laboratory of Neurogeriatrics, Department of Neurology, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA

Article author query
inzelberg r   [PubMed][Google Scholar] 
schechtman e   [PubMed][Google Scholar] 
abuful a   [PubMed][Google Scholar] 
masarwa m   [PubMed][Google Scholar] 
mazarib a   [PubMed][Google Scholar] 
strugatsky r   [PubMed][Google Scholar] 
farrer la   [PubMed][Google Scholar] 
green rc   [PubMed][Google Scholar] 
friedland rp   [PubMed][Google Scholar] 


Background: The Mini-mental State Examination (MMSE) has not been validated in Arabic speaking populations. The Brookdale Cognitive Screening Test (BCST) has been developed for use in low schooling populations. We investigated the influence of gender, education and occupation in a cognitively normal community sample which was assessed using an Arabic translation of the MMSE and the BCST.

Methods: Cognitively normal subjects (n = 266, 59.4% males, mean age (SD): 72.4 (5.5) years) from an Arab community in northern Israel (Wadi Ara) were evaluated. Education was categorized into levels: 1 = 0–4 years, 2 = 5–8 years, 3 = 9–12 years. Effects of gender, education and occupation on MMSE and BCST were analyzed by ANOVA, taking age as a covariate.

Results: The mean MMSE score of males [26.3 (4.1)] was higher than that of females [23.6 (4.2) points]. Two-way ANOVA showed a significant interaction between gender and education on MMSE (p = 0.0017) and BCST scores (p = 0.0002). The effect of gender on MMSE and BCST was significant in education level 1 (p < 0.0001, both tests) and level 2 (p < 0.05, both tests). For education level 1, MMSE and BCST scores were higher for males, while both scores were higher for females in education level 2. The effect of occupation was not significant for both genders.

Conclusion: Education and gender influence performance when using the Arabic translation of the MMSE and BCST in cognitively normal elderly. Cognitively normal females with 0–4 years of education scored lower than males. These results should be taken into consideration in the daily use of these instruments in Arabic.

(Received March 27 2006)
(revision requested May 1 2006)
(revised version received May 31 2006)
(Accepted June 1 2006)
(Published Online October 20 2006)

Key Words: Mini-mental State Examination; MMSE; cognitive; Arabic; elderly; gender; education.

c1 Correspondence should be addressed to: Rivka Inzelberg, Department of Neurology, Hillel Yaffe Medical Center, Hadera, 38100, Israel. Phone: +972 4 6304262, Fax: +972 4 6304805. Email: