Schutte Clara M, Tsikane Mukhethwa, Nchoe Keorapetse
Department of Neurology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
S Afr J Psychiatr. 2021 May 27;27:1327. doi: 10.4102/sajpsychiatry.v27i0.1327. eCollection 2021.
The Folstein mini mental state exam (MMSE) is the most commonly administered assessment of cognitive functioning; however, its utility in illiterate individuals is limited. In South Africa, more than eight million adults are considered functionally illiterate and cognitive evaluation using standard scales is inaccurate. Other countries have developed adapted MMSE scales for their local purposes.
The first aim of this study was to develop a South African Brief Cognitive Score (SA BCS) for use in minimally literate or illiterate individuals. The second aim was to test this SA BCS against the original Folstein MMSE in patients with memory problems.
The study was conducted in Tshilamba, Tshiombo, Tshifudi, Dzimauli and Pile in Venda as well as Rethabiseng and Zithobeni in Bronkhorstspruit for the illiterate study group, and Steve Biko Academic Hospital for the literate study groups.
The SA BCS was developed considering our local requirements and substituting questions needing literacy with items that did not. Both the original Folstein MMSE and the SA BCS were administered to groups of literate and illiterate normal individuals. Thereafter, the tests were repeated in groups of literate and illiterate patients with cognitive decline.
Firstly, 33 illiterate and 31 literate subjects were assessed. The average original Folstein score was 29.29/30 for the literate subjects, and for the SA BCS 29.80. For the illiterate subjects, the average score for the original Folstein MMSE was 21.24/30 and for the SA BCS 27.45. Kruskall-Wallis equality of population rank test confirmed a significant improvement in the scores of the SA BCS in the illiterate group when compared to the original Folstein ( = 0.0001). In the second part of the study, 20 literate and 20 illiterate patients were assessed as before. In the literate group, the average original Folstein MMSE score was 20.5, while the average score for the South African BCS was 22.5. In the illiterate group, the average Folstein MMSE was 18.9; and the average score in the South African BCS was 22.8. The Kruskal-Wallis equality of population rank test showed a significant difference ( = 0.008) between the scores of the illiterate versus literate patients when the Folstein MMSE was used to assess cognition. With the SA BCS, no significant difference was found between the groups ( = 0.79).
The SA BCS appears to have potential to be a more reliable scale when assessing cognition in illiterate or minimally literate subjects when compared to the original Folstein MMSE.
福尔斯坦简易精神状态检查表（MMSE）是认知功能评估中最常用的工具；然而，其在文盲个体中的效用有限。在南非，超过800万成年人被认为是功能性文盲，使用标准量表进行认知评估并不准确。其他国家已根据当地需求开发了改编版的MMSE量表。
本研究的首要目的是开发一种南非简易认知评分量表（SA BCS），用于文化程度极低或文盲的个体。第二个目的是在有记忆问题的患者中，将该SA BCS与原始的福尔斯坦MMSE量表进行对比测试。
文盲研究组的研究在文达的奇兰巴、奇翁博、奇富迪、齐马乌利和皮莱以及布隆克霍斯特斯普鲁特的雷塔比森和齐托贝尼进行，识字研究组的研究在史蒂夫·比科学术医院进行。
根据我们当地的需求开发SA BCS，用无需识字的项目替代需要识字的问题。原始的福尔斯坦MMSE量表和SA BCS量表均施用于识字和不识字的正常个体组。此后，对识字和不识字的认知功能衰退患者组重复进行测试。
首先，对33名不识字和31名识字受试者进行了评估。识字受试者的福尔斯坦原始平均得分是29.29/30，SA BCS的平均得分是29.80。对于不识字的受试者，福尔斯坦MMSE的平均得分是21.24/30，SA BCS的平均得分是27.45。克鲁斯卡尔-沃利斯总体秩次平等检验证实，与原始福尔斯坦量表相比，SA BCS在不识字组中的得分有显著提高（P = 0.0001）。在研究的第二部分，如前所述对20名识字和20名不识字患者进行了评估。在识字组中，福尔斯坦MMSE的原始平均得分是20.5，而南非BCS的平均得分是22.5。在不识字组中，福尔斯坦MMSE的平均得分是18.9；南非BCS的平均得分是22.8。当使用福尔斯坦MMSE评估认知时，克鲁斯卡尔-沃利斯总体秩次平等检验显示不识字与识字患者的得分之间存在显著差异（P = 0.
