BRIEF COMMUNICATION Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory RICARDO NITRINI, 1 PAULO CARAMELLI, 1 EMÍLIO HERRERA, JR., 2 CLÁUDIA SELLITTO PORTO, 1 HELENICE CHARCHAT-FICHMAN, 1 MARIA TERESA CARTHERY, 1 LEONEL TADAO TAKADA, 1 and EDSON PEREIRA LIMA 1 1 Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo School of Medicine, Brazil 2 Catanduva School of Medicine, Catanduva, Brazil (Received May 28, 2003; Revised October 9, 2003; Accepted November 19, 2003) Abstract Cognitive evaluation in developing countries is a difficult undertaking due to low levels of schooling and particularly the illiteracy still frequent in the elderly. This study was part of the epidemiologic evaluation of dementia in Catanduva, Brazil, and had the objective of comparing the performance of illiterate and literate nondemented elderly individuals in 2 tests of long-term memory—the delayed recall of a word list from the CERAD and the delayed recall of common objects presented as simple drawings from the Brief Cognitive Screening Battery (BCSB). Fifty-one elderly subjects (23 illiterates) were evaluated, and the performance of the illiterates and literates differed in the CERAD memory test, but not in the BCSB memory test. This test may be more suitable for the assessment of long-term memory in populations with a high frequency of illiterates, and therefore might prove to be a useful screening tool for the diagnosis of dementia. ( JINS, 2004, 10, 634–638.) Keywords: Neuropsychological evaluation, Illiteracy, Education, CERAD, Dementia INTRODUCTION One of the difficulties in the diagnosis of dementia, espe- cially in epidemiological studies, is related to the differ- ences in the performance of subjects in neuropsychological tests due to educational and cultural factors (Manly et al., 1999; Ostrosky-Solis et al., 1998). Tests that evaluate long- term memory are considered to present the highest sensi- tivity for the neuropsychological diagnosis of dementia (Bondi et al., 1994), but might also be influenced by the factors mentioned previously. One neuropsychological bat- tery that has been recommended for the diagnosis of Alz- heimer’s disease (AD), is that proposed by the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD; Morris et al., 1989), in which the long-term memory test (delayed recall of a word list) is the one which presents the best diagnostic accuracy (Bertolucci et al., 2001; Welsh et al., 1991). In recent years, we have developed and employed some tests for the diagnosis of dementia in low educated sub- jects, both for epidemiological and clinical purposes. One of these tests, the delayed recall of 10 common objects presented as simple drawings, part of the Brief Cognitive Screening Battery (BCSB), has shown a high accuracy for the diagnosis of dementia in case–control studies (Nitrini et al., 1994; 1999). The goal of the present study is to compare the perfor- mance of elderly individuals, with no memory complaints and without dementia, in two tests of long-term memory— the one from the CERAD battery and the one from the BCSB—and to verify the impact of illiteracy on each of these tests. POPULATION AND METHODS As part of the population-based study that we have been performing in the city of Catanduva, São Paulo State, Bra- zil (Herrera et al., 2002), we evaluated 1,119 individuals to investigate the incidence of dementia using a general ques- tionnaire covering health and cognitive status, the Mini- Reprint requests to: Ricardo Nitrini, Rua Bartolomeu Feio, 560, 04580- 001 São Paulo–SP, Brazil. E-mail: rnitrini@uol.com.br Journal of the International Neuropsychological Society (2004), 10, 634–638. Copyright © 2004 INS. Published by Cambridge University Press. Printed in the USA. DOI: 10.10170S1355617704104062 634