Object and praxis in dementia screening: Experiences from urban India
Paper short abstract:
Based on ethnographic data from urban India, I examine how context influences the interpretations and use of the Mini Mental State Examination (MMSE), a popular screening instrument for dementia. I will focus on the interpretations and use of the Mini Mental State Examination (MMSE) by clinicians in Delhi when used to screen for dementia. My analysis is framed in two ways: object – the Mini Mental State Examination is understood by Indian clinicians; and praxis – how is the scale used. I demonstrate how the MMSE, while appearing to adhere to universal diagnostic principles, in practice validates time-efficient techniques rather than reliably screening for cognitive impairment.
Paper long abstract:
"Alzheimer's at a moderate stage," is a diagnosis that can have a lasting impact on individuals, families, and health systems. The power of such a diagnosis is based in a biomedical ontology wherein neuropsychological screening, clinical tests, and observable symptoms are assumed to be universally applicable. However screening and diagnostic tools are created and administered within specific political, cultural and clinical contexts that problematise their supposed universality. Based on ethnographic data from urban India, I examine how context influences the interpretations and use of the Mini Mental State Examination (MMSE), a popular screening instrument for dementia. My analysis draws on Bruno Latour's ideas of 'science in the making,' and is framed through object: how the MMSE is immutable and mobile with cognition presumed to be uniform across time and space; and praxis: how the MMSE's routine application reinforces local power structures rather than accurate screening of cognitive impairment. Subsequently there is a need to rethink how dementia screenings are undertaken accounting for cultural and structural variances as false-negative or even false-positive screening has implications for service delivery and quality of care.
Ethnographic perspectives on 'global mental health'