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Effects of education and culture on the validity of the Geriatric Mental State and its AGECAT algorithm

Institute of Psychiatry, King’s College, London, UK

Daisy Acosta

Universidad Nacional Pedro Henriquez Ureña (UNPHU), Santo Domingo, Dominican Republic

Helen Chiu

Chinese University of Hong Kong, Hong Kong, SAR

John Copeland

University of Liverpool, Liverpool, UK

Michael Dewey

Institute of Psychiatry, King’s College, London, UK

Marcia Scazufca

University of São Paulo, São Paulo, Brazil

Mathew Varghese

National Institute of Mental Health and Neurological Sciences, Bangalore, India

the 10/66 Dementia Research Group

Correspondence: Professor Martin Prince, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel: +44 20 7848 0136; fax: +44 20 7277 0283; e-mail: m.prince{at}iop.kcl.ac.uk

Declaration of interest None.

Background The Geriatric Mental State (GMS) is the most widely used psychiatric research assessment for older persons. Evidence for validity comes from the developed world.

Aims To assess the validity of GMS/AGECAT organicity and depression diagnoses in 26 centres in India, China, Latin America and Africa.

Method We studied 2941 persons aged 60 years and over: 742 people with dementia and three groups free of dementia (697 with depression, 719 with high and 783 with low levels of education). Local clinicians diagnosed dementia (DSM–IV) and depression (Montgomery–Åsberg Depression Rating Scale score 18).

Results For dementia diagnosis GMS/AGECAT performed well in many centres but educational bias was evident. Specificity was poor in India and sensitivity sub-optimal in Latin America. A predictive algorithm excluding certain orientation items but including interviewer judgements improved upon the AGECAT algorithm. For depression, sensitivity was high. The EURO–D depression scale, derived from GMS items using European data, has a similar factor structure in Latin America, India and, to a lesser extent, China.

Conclusions Valid, comprehensive mental status assessment across cultures seems achievable in principle.

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