HIghlights
- •Improved understanding of the burden of cognitive impairment among the growing population of older incarcerated persons is important. We evaluated impairments in global cognition (MoCA), as well as processing speed and set shifting (Trails A & B), in 239 racially diverse, incarcerated males age ≥50 years. Cognitive impairment is common in older incarcerated persons, despite applying education- and race-specific norms. Notable race differences highlight need for validated assessments for this diverse population.
ABSTRACT
Objective
Assess cognitive impairment (global cognition and executive functioning) in older
incarcerated males overall, and according to education and race.
Design
Cross-sectional
Participants
The sample included 239 racially diverse (37.7% White, 41.4% Black, 20.9% Hispanic/Other)
incarcerated males age ≥50 (mean age = 56.4 ± 6.1; range 50–79 years).
Measurements
Global cognitive impairment assessed using the Montreal Cognitive Assessment (MoCA) − standard
MoCA scoring (1-point adjustment for ≤12 years education, and score <26 indicating
cognitive impairment) versus education- and race-specific cutpoints. Trail Making
Test (TMT) assessed executive functioning. The relationship between race and cognitive
impairment was evaluated using Chi-Square, One-Way ANOVA, and Tukey's HSD post-hoc
analyses. Chi-Square was also used to evaluate the relationship between race and frequency
of missed MoCA items.
Results
Average MoCA score was 24.12 ± 3.38. Overall, 62.8% and 38.5% of participants met
criteria for cognitive impairment using standard scoring and education- and race-specific
cutpoints, respectively. This difference was largely attributed to the change in proportion
of Blacks who met criteria for cognitive impairment after applying education- and
race-specific cutpoints (62.6% versus 19.2%). Fewer White inmates were impaired (51.1%
versus 36.7%) after applying demographically-adjusted norms; however, the proportion
of Hispanics/Others remained largely unchanged (84% versus 80%). A considerable proportion
of participants were mildly impaired on TMT-A (18.2% Whites, 7.1% Blacks) and TMT-B
(20.5% Whites, 4.1% Blacks). Race differences were observed in missed MoCA items.
Conclusions
Cognitive impairment is common in older incarcerated persons, despite applying education-
and race-specific norms. Notable race differences highlight need for validated assessments
for this diverse population.
Key Words
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Article info
Publication history
Published online: May 27, 2021
Accepted:
May 21,
2021
Received in revised form:
May 14,
2021
Received:
March 16,
2021
Identification
Copyright
© 2021 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.