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Screening for dementia in populations with little education

We have read with interest the review article: ‘Brief cognitive screening instruments: an update’ by Ismail, Rajji and Shulman (Int J Geriatr Psychiatry 2010;25: 111–120). It provides evidence that screening for dementia in populations with little education is a difficult task since most screening tests require reading, writing and arithmetical ability and have been developed in populations with at least primary and often secondary education. The lack of cognitive tests for populations with low levels of education is a pressing need since most people with dementia today live in middle and low income countries and many have little or no schooling. We would like to call your attention to a test that was developed precisely to screen for dementia in populations with little education. Results of the psychometric and criterion validation of this test compared to the clinical diagnosis of dementia have been published in this journal (Zunzunegui et al., 2000; Garcia de Yébenes et al., 2003). The ‘Prueba Cognitiva de Leganes’ (PCL) was developed and tested in a population of community dwelling people of Leganes, Spain. French and Portuguese versions of this test are currently being used for research purposes in Brazil, Burkina Faso and Cameroon. The PCL combines selected items from previous cognitive tests (East Boston memory Test, Pfeiffer) and includes orientation (eight items), pattern recognition (six objects with line drawings), immediate (six objects) and cued delayed memory (six objects) and logical memory/attention (recall of a short story with six main ideas). The score ranges from 0 to 32. For a cut-off point of 23/24, its sensitivity was 93% and its specificity was 94% in a validation study conducted in 525 community dwelling people over 65. More importantly, it minimizes education bias and is well accepted by populations with little education since it does not require use of paper and pens. We are currently conducting research on the advantages of combining the PCL with the Clock Drawing Test.