Regional Disparities in Cognitive Functioning of Rural and Urban Older Adults in Costa Rica

Abstract

Prior research examining health disparities by region (urban vs. rural) on dementia and cognition have been studied using screening tools mostly, with conflicting results. Some studies support a rural health disadvantage, while other consider that urban dwellers are at greater risk of dementia and cognitive impairment. Latin American (LA) countries are underrepresented in these studies. Full neuropsychological assessment batteries have been administered in a limited number of studies, without addressing measurement equivalence of the tests across regions. The present study situates within a larger research project called EDAD (Epidemiology and Development of Alzheimer’s Disease) with Costa Rican older adults. The EDAD included a group of 16 neuropsychological tests among other health-related measurement tools. The purpose of the present study was to (a) identify the cognitive dimensions of the EDAD neuropsychological battery, (b) examine the comparability of the measures and cognitive constructs across the urban and rural sample of EDAD participants from Costa Rica, (c) determine whether group differences exists in the cognitive constructs, and (d) evaluate the contribution of age and education in the group differences. An exploratory/confirmatory factor analytic approach was implemented to identify the baseline model for the EDAD neuropsychological measures. Then, based on multiple-group confirmatory factor analysis, measurement invariance was examined. Once measurement invariance was established, group comparisons of the latent cognitive factors were conducted to explore regional disparities. Three cognitive constructs were identified in the factor model: Verbal Memory, Spatial Reasoning and Cognitive Flexibility. The findings showed that most of the neuropsychological tests in EDAD can be directly compared across the groups, allowing for latent mean comparisons. The rural sample of Costa Rican older adults had a disadvantage in the Spatial Reasoning and Cognitive Flexibility abilities. When age and education were included in the models, no differences between the regions were found. The results of the present study suggested that norms for Costa Rican older adults should consider age and education adjustments. This study contributes to the growing are of measurement invariance in neuropsychological assessment as it highlights the importance of examining the comparability of assessment measures across different cultural groups.