To study the effect of education and language of response at the interview on performance in the Mini-Mental State Examination (MMSE) domains, we studied 2861 Mexican Americans aged 65 and older from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (EPESE) followed from 1993 to 1994 until 2004 to 2005. The MMSE was examined as total score (0-30) or divided into 2 global domains: (1) no-memory (score 0-24): Orientation, attention, and language; and (2) memory (score 0-6): working and delayed memory. Mean age and total MMSE were 72.7 years and 24.6 at baseline, and 81.7 years and 20.5 at 11 years of follow-up. Spanish-speaking participants had less education (4.1 vs 7.4 years, P < .0001), they had significantly higher adjusted mean scores for memory, no-memory, and total MMSE compared with English-speaking participants. In multivariate longitudinal analyses, participants with more years of education performed better than those with less education, especially in total MMSE and no-memory domain. Spanish-speaking participants with 4 to 6 years of education had higher memory scores than those speaking English (estimate 0.40, standard error [SE] = 0.14, P < .001), 7 to 11 (estimate 0.27, standard error = 0.13, P < .01) or 12+ (estimate 0.44, standard error = 0.13, P < .001). Results suggest that cultural factors and variables related to preferred language use determined variations in MMSE performance. Because the memory domain of the MMSE is less affected by education, it may be used along with other cognitive tests for early detection of cognitive decline in older populations with low education.

Background. Melanoma incidence and mortality had a sustained increase in the last 3 decades in the United States, especially among white older men. Little is known about the relationship between marital status and melanoma outcomes in older people. The objective of this study was to determine the association between marital status and stage at diagnosis and survival of older persons with cutaneous melanoma. Methods. Data are from the Surveillance, Epidemiology and End Results (SEER) registries–Medicare–linked database (1991–1999). The sample consisted of 14,630 men and women 65 years old and older. The outcomes were melanoma stage at diagnosis and melanoma specific survival. The main independent variable, marital status, was used in four categories: married, single, separated or divorced, and widowed. Other covariates include sociodemographics, stage at diagnosis, tumor characteristics (body site and histology), and comorbidity index. Logistic regression and survival analyses techniques were used. Results. Multivariate analyses showed that, compared with married persons, widowed persons were more likely to be diagnosed with late-stage (regional or distant) versus early-stage (in situ or localized) melanoma (odds ratio = 1.31, 95% confidence interval [CI], 1.13–1.52). In addition, after controlling for all other variables (sociodemographics, stage at diagnosis, tumor characteristics, and comorbidity), widowed persons were at increased risk of death from melanoma (hazard ratio = 1.23, 95% CI, 1.06–1.44). Conclusion. Older widowed persons were more likely to be diagnosed at late stage and to die from melanoma than were older married persons.