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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Geriatric PsychiatryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Old and dangerous: prison and dementia.J Forensic Leg Med. 2017; 51: 40-44https://doi.org/10.1016/j.jflm.2017.07.004
- Juvenile incarceration and health.Acad Pediatr. 2016; 16https://doi.org/10.1016/j.acap.2015. 09.004
- Improving the health of older prisoners: nutrition and exercise in correctional institutions.J Correct Health Care. 2018; 24https://doi.org/10.1177/1078345818793121
- Mass incarceration, public health, and widening inequality in the USA.Lancet North Am Ed. 2017; 389https://doi.org/10.1016/S0140-6736(17)30259-3
- Older adults in jail: high rates and early onset of geriatric conditions.Health Justice. 2018; 6: 3https://doi.org/10.1186/s40352-018-0062-9
- A commentary on age segregation for older prisoners: philosophical and pragmatic considerations for correctional systems.Crim Justice Rev. 2009; 34: 119-139
- Aging in correctional custody: setting a policy agenda for older prisoner health care.Am J Public Health. 2012; 102: 1475-1481https://doi.org/10.2105/AJPH.2012.300704
- Dementia in the incarcerated elderly adult: Innovative solutions to promote quality care.J Am Assoc Nurse Pract. 2014; 26: 640-648https://doi.org/10.1002/2327-6924.12189
- Cognition and incarceration: cognitive impairment and its associated outcomes in older jail inmates.J Am Geriatr Soc. 2018; 66: 2065-2071
- Acculturation, reading level, and neuropsychological test performance among African American elders.Cultur Diver. 2004; 11: 37-46https://doi.org/10.4324/9780203764497-5
- Demographically corrected norms for African Americans and Caucasians on the Hopkins Verbal Learning Test-Revised, Brief Visuospatial Memory Test-Revised, Stroop Color and Word Test, and Wisconsin Card Sorting Test 64-Card Version.J Clin Exp Neuropsychol. 2011; 33: 793-804https://doi.org/10.1080/13803395.2011.559157
- Optimal cutoffs for the montreal cognitive assessment vary by race and ethnicity.Alzheimer Dementia. 2018; 10: 773-781https://doi.org/10.1016/j.dadm.2018.09.003
- Prisoners in 2019.U.S. Department of Justice, Bureau of Justice Statistics, 2020 (October 2020, NCJ 255115)
- Jail Inmates in 2019.U.S. Department of Justice, Bureau of Justice Statistics, 2021 (March 2021, NCJ 255608.)
- Neuropsychological functioning of inmates referred for psychiatric treatment.Arch Clin Neuropsychol. 1998; 13https://doi.org/10.1016/S0887-6177(97)00032-2
- Assessing risk for sexual recidivism: some proposals on the nature of psychologically meaningful risk factors.Sex Abuse. 2010; 22https://doi.org/10.1177/1079063210366039
- Role of executive dysfunction in predicting frequency and severity of violence.Aggress Behav. 2010; 36: 338-349https://doi.org/10.1002/ab.20353
- Executive cognitive functioning abilities of male first time and return Canadian federal inmates.Canad J Criminol Crim Justice. 2011; 53https://doi.org/10.3138/cjccj.53.4.377
- Functional disability, depression, and suicidal ideation in older prisoners.J Affect Disord. 2020; 266: 366-373https://doi.org/10.1016/j.jad.2020.01.156
- The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment.J Am Geriatr Soc. 2005; 53 (doi:JGS53221 [pii]): 695-699https://doi.org/10.1111/j.1532-5415.2005.53221.x
- The montreal cognitive assessment: validity and utility in a memory clinic setting.Canad J Psychiatry. 2007; 52: 329-332
- Validity of the trail making test as an indicator of organic brain damage.Percept Mot Skills. 1958; 8: 271-276
- Screening for alcohol abuse using the CAGE questionnaire.Am J Med. 1987; 82: 231-235
Connecticut Department of Correction; Available at: https://portal.ct.gov/-/media/DOC/Pdf/MonthlyStat/Stat201801.pdf, Accessed May 2, 2021. Average Confined Inmate Population and Legal Status.; 2017.
- The diagnosis and management of mild cognitive impairment: a clinical review.JAMA. 2014; 312: 2551-2561https://doi.org/10.1001/jama.2014.13806
- Characteristics of resilient youths living in poverty: the role of self-regulatory processes.Dev Psychopathol. 2003; 15: 139-162https://doi.org/10.1017/S0954579403000087
- Understanding associations among race, socioeconomic status, and health: patterns and prospects.Health Psychol. 2016; 35: 407-411https://doi.org/10.1037/hea0000242
- Montreal cognitive assessment performance among community-dwelling African Americans.Arch Clin Neuropsychol. 2017; 32: 238-244https://doi.org/10.1093/arclin/acw095
- Advanced clinical interpretation of the Delis-Kaplan Executive Function System: multivariate base rates of low scores.Clin Neuropsychol. 2018; 32: 42-53https://doi.org/10.1080/13854046.2017.1334828
- Executive decline and dysfunction precedes declines in memory: the Women's Health and Aging Study II.J Gerontol. 2009; 64: 110-117https://doi.org/10.1093/gerona/gln008
- To err is human: “abnormal” Neuropsychological scores and variability are common in healthy adults.Arch Clin Neuropsychol. 2009; 24: 31-46https://doi.org/10.1093/arclin/acn001
- Group differences in normal neuropsychological test performance for older non-Hispanic White and Black/African American adults.Neuropsychology. 2019; 33https://doi.org/10.1037/neu0000579
- Toward a demographic understanding of incarceration disparities: race, ethnicity, and age structure.J Quant Criminol. 2016; 32: 515-530https://doi.org/10.1007/s10940-015-9265-6
- Stability and change in executive function abilities from late adolescence to early adulthood: a longitudinal twin study.Dev Psychol. 2016; 52: 326-340https://doi.org/10.1037/dev0000075
- What is the relationship of traumatic brain injury to dementia?.J Alzheimer Dis. 2017; 57: 667-681https://doi.org/10.3233/JAD-161002
- Risk of being killed by policeuse of force in the United States by age, race–ethnicity, and sex.PNAS. 2019; 116: 16793-16798https://doi.org/10.1073/pnas.1821204116
- Challenges and solutions for conducting research in correctional settings: the U.S. experience.Int J Law Psychiatry. 2013; 36: 304-310https://doi.org/10.1016/j.ijlp.2013.04.002
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.
