Association Between Acculturation and Structural Assimilation and Mini‐Mental State Examination–Assessed Cognitive Impairment in Older Mexican Americans: Findings from the San Antonio Longitudinal Study of Aging

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Abstract
Older Mexican Americans (MAs) have consistently scored lower on the Folstein Mini-Mental State Examination (MMSE) than older European Americans (EAs). These lower scores may arise from factors other than those traditionally posited (age and education). Thus, this study examined the association between acculturation and structural assimilation and MMSE-assessed cognitive impairment, taking into account education, income, and other contextual factors. Subjects were participants in the San Antonio Longitudinal Study of Aging, a community-based study of chronic disease and functional status in 457 older MAs and 376 older EAs. Scales were used to measure two dimensions of acculturation: (family attitude, cultural values) and structural assimilation (functional integration into the broader American society). Logistic regression was used to examine the association between age, sex, acculturation, and structural assimilation and MMSE scores suggestive of cognitive impairment (<24). After adjusting for contextual factors (age, sex, education and household income), diseases (diabetes mellitus, stroke, and hypertension), and sensory impairments (hearing and vision), structural assimilation, but neither dimension of acculturation, was significantly and negatively associated with MMSE-assessed cognitive impairment. Older MAs in the lowest structural assimilation stratum were 1.89 times as likely to have MMSE-assessed cognitive impairment as those in the highest. Age, education, and visual impairment were also independently associated with cognitive impairment. These findings highlight the need for geriatricians to take contextual factors (including age, education, and structural assimilation) into account when interpreting MMSE scores of MA patients.