Negative Aging Stereotypes Impairs Performance on Predementia Screening Tests

By Will Boggs MD

NEW YORK (Reuters Health) - Negative aging stereotypes can lead to worse performance on brief cognitive tests used to screen for predementia, researchers from France report.

"We were really surprised that negative age-related stereotypes were powerful enough to result in 50% of our participants meeting the MCI clinical criteria on the Montréal Cognitive Assessment (MoCA) test (one of the most sensitive tests to screen for Mild Cognitive Impairment)," said Dr. Marie Mazerolle from the University of Poitiers.

"But interestingly our results also suggest that age-related stereotypes' effects can be quite easily removed using simple interventions about stereotypes or reducing evaluative pressure on tests," she told Reuters Health by email.

Research suggests that culturally shared beliefs that aging inevitably results in severe cognitive decline and diseases such as Alzheimer's disease can impair healthy older adults' performance on cognitive tests.

Dr. Mazerolle's team tested the effects of such stereotypes in 80 healthy individuals aged 60 to 93 years with the equivalent of a sixth-grade education on average. The participants completed two well-known short cognitive tests: the classic Mini-Mental State Examination (MMSE) and the MoCA.

Participants randomly assigned to the stereotype (threat) condition were informed that they would perform a memory task and that both younger and older adults would be taking the test. Those randomized to the reduced-stereotype condition received the same instructions and were also told that there is typically no age difference on this task.

Before taking the second test (either the MMSE or the MoCA, depending upon which test was taken first), reduced-stereotype participants were debriefed about stereotypes, and all participants were told that test 2 was under construction to decrease evaluative pressure.

For both tests, performance was worse in the stereotype condition than in the reduced-stereotype condition. Half of the participants fell below the MoCA cutoff score for MCI in the stereotype condition, compared to only 15% in the reduced-stereotype condition (p=0.041).

Similarly, 30% of stereotype participants fell below the MMSE cutoff score, compared to only 5% of reduced-stereotype participants (p=0.038), the researchers report in Journals of Gerontology: Psychological Sciences, online July 27.

After debriefing, no stereotype effects were found for test 2.

"Our results suggest extreme caution when using brief cognitive tests to diagnose cognitive impairments, especially because these tests can be easily biased by the intervention of negative age-related stereotypes," Dr. Mazerolle said. "A more complete examination of cognitive functioning would guarantee a less biased diagnosis, while taking into account the impact of negative age-related stereotypes."

"We hope that our paper will help to highlight the importance of taking into account the social context (evaluative pressure, stereotypes, etc...) when assessing people's abilities, especially when using short tests that can be easily used, but also easily biased by many factors, including age-related stereotypes," she said.

Dr. Sarah J. Barber from San Francisco State University, who has also examined the effect of stereotypes on adults' performance on a variety of tests, told Reuters Health by email, "Older adults are often concerned that 'senior moments' are indicative that they are developing Alzheimer's disease. In clinical testing situations, this can lead older adults to worry that they will 'fail' brief cognitive screenings that assess for dementia (such as the MMSE or MoCA). The most interesting thing about the current research is that these evaluative concerns can have dramatic effects on performance."

"Recent research from the Health and Retirement Study found that 17% of people worry that their doctor is going to negatively judge them based upon one or more aspects of their social identity (i.e., their age, race, gender, etc.)," Dr. Barber said.

"To combat this, physicians should avoid stating that age is the reason for administering the test," she advised. "Physicians should also consider educating older adult patients about stereotype threat and give them an opportunity to discuss their anxiety prior to taking the tests."

SOURCE: https://bit.ly/2b5LMHf

J Gerontol B Psychol Sci Soc Sci 2016.

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