Cognitive Impairment in Older Incarcerated Males: Education and Race Considerations.

ABSTRACT Objective Assess cognitive impairment (global cognition and executive functioning) in older incarcerated males overall, and according to education and race. Design Cross-sectional Participants The sample included 239 racially diverse (37.7% White, 41.4% Black, 20.9% Hispanic/Other) incarcerated males age ≥50 (mean age = 56.4 ± 6.1; range 50–79 years). Measurements Global cognitive impairment assessed using the Montreal Cognitive Assessment (MoCA) − standard MoCA scoring (1-point adjustment for ≤12 years education, and score Results Average MoCA score was 24.12 ± 3.38. Overall, 62.8% and 38.5% of participants met criteria for cognitive impairment using standard scoring and education- and race-specific cutpoints, respectively. This difference was largely attributed to the change in proportion of Blacks who met criteria for cognitive impairment after applying education- and race-specific cutpoints (62.6% versus 19.2%). Fewer White inmates were impaired (51.1% versus 36.7%) after applying demographically-adjusted norms; however, the proportion of Hispanics/Others remained largely unchanged (84% versus 80%). A considerable proportion of participants were mildly impaired on TMT-A (18.2% Whites, 7.1% Blacks) and TMT-B (20.5% Whites, 4.1% Blacks). Race differences were observed in missed MoCA items. Conclusions Cognitive impairment is common in older incarcerated persons, despite applying education- and race-specific norms. Notable race differences highlight need for validated assessments for this diverse population.