Mini-Mental Status Examination: a short form of MMSE was as accurate as the original MMSE in predicting dementia.

OBJECTIVES This study assesses the properties of the Mini-Mental State Examination (MMSE) with the purpose of improving the efficiencies of the methods of screening for cognitive impairment and dementia. A specific purpose was to determine whether an abbreviated version would be as accurate as the original MMSE in predicting dementia. STUDY DESIGN AND SETTING A population-based post hoc examination of the performance characteristics of the MMSE for detecting dementia in an existing data set of 243 elderly persons. RESULTS Sensitivity, specificity, and predictive values were computed for the original MMSE as well as new MMSE scale models derived from a Rasch model item analysis. The optimal threshold for the original MMSE screen yielded sensitivity and specificity estimates of 72.5% and 91.3%, respectively. The use of a subscale resulted in a slightly lower sensitivity (71.0%), specificity (88.4%), and positive predictive value (71.0%) but equal area under the receiver operating characteristic curve. Cross-validation on follow-up data confirmed the results. CONCLUSION A short, valid MMSE, which is as sensitive and specific as the original MMSE for the screening of cognitive impairments and dementia is attractive for research and clinical practice, particularly if predictive power can be enhanced by combining the short MMSE with neuropsychological tests or informant reports.

[1]  Helena C. Kraemer,et al.  Assessment of 2 × 2 Associations: Generalization of Signal-Detection Methodology , 1988 .

[2]  B. Agrell,et al.  Mini Mental State Examination in geriatric stroke patients. Validity, differences between subgroups of patients, and relationships to somatic and mental variables , 2000, Aging.

[3]  Matthias von Davier,et al.  Mixture Distribution Rasch Models , 1995 .

[4]  D Commenges,et al.  A cognitive screening battery for dementia in the elderly. , 2000, Journal of clinical epidemiology.

[5]  I McDowell,et al.  Prediction of probable Alzheimer disease in patients with symptoms suggestive of memory impairment. Value of the Mini-Mental State Examination. , 2000, Archives of family medicine.

[6]  H. Spinnler,et al.  Comparison of two scoring systems of the Mini-Mental State Examination as a screening test for dementia. , 1997, Journal of clinical epidemiology.

[7]  I McDowell,et al.  Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. , 1997, Journal of clinical epidemiology.

[8]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[9]  L L Thompson,et al.  Three-word recall as a measure of memory. , 1993, Journal of clinical and experimental neuropsychology.

[10]  A. Monsch,et al.  Improving the diagnostic accuracy of the Mini‐Mental State Examination , 1995, Acta neurologica Scandinavica.

[11]  B. Lebowitz,et al.  Norms for the Mini-Mental State Examination in a healthy population , 1999, Neurology.

[12]  D. Loewenstein,et al.  Utility of a modified mini‐mental state examination with extended delayed recall in screening for mild cognitive impairment and dementia among community dwelling elders , 2000, International journal of geriatric psychiatry.

[13]  Kjeld Andersen,et al.  Prævalens og incidens af demens i Danmark , 2000 .

[14]  Richard N. Jones,et al.  Education and sex differences in the mini-mental state examination: effects of differential item functioning. , 2002, The journals of gerontology. Series B, Psychological sciences and social sciences.

[15]  Shyu Yi,et al.  Factor structure and explanatory variables of the Mini-Mental State Examination (MMSE) for elderly persons in Taiwan. , 2001 .

[16]  E B Larson,et al.  The Mini-Mental State Examination score and the clinical diagnosis of dementia. , 1994, Journal of Clinical Epidemiology.

[17]  C. Brayne,et al.  The association of education and socioeconomic status with the Mini Mental State Examination and the clinical diagnosis of dementia in elderly people. , 1990, Age and ageing.

[18]  N. Lassen,et al.  Cognitive profiles and regional cerebral blood flow patterns in dementia of the Alzheimer type , 1994, European journal of neurology.

[19]  D Commenges,et al.  Validity of the Mini-Mental State examination as a screening instrument for cognitive impairment and dementia in French elderly community residents. , 1990, Neuroepidemiology.

[20]  J. Carlin,et al.  THE PREDICTIVE VALUE OF DEMENTIA SCREENING INSTRUMENTS IN CLINICAL POPULATIONS , 1997, International Journal of Geriatric Psychiatry.

[21]  H. Christensen,et al.  Improving screening accuracy for dementia in a community sample by augmenting cognitive testing with informant report. , 2003, Journal of clinical epidemiology.

[22]  E G Tangalos,et al.  The Mini-Mental State Examination in general medical practice: clinical utility and acceptance. , 1996, Mayo Clinic proceedings.

[23]  E. Zillmer,et al.  Comparison of two cognitive bedside screening instruments in nursing home residents: a factor analytic study. , 1990, Journal of gerontology.

[24]  J. Cummings,et al.  Screening for dementia: comparison of three commonly used instruments. , 1999, Journal of clinical and experimental neuropsychology.

[25]  H. Brodaty,et al.  The GPCOG: A New Screening Test for Dementia Designed for General Practice , 2002, Journal of the American Geriatrics Society.

[26]  Chris Corcoran,et al.  Characteristics of a two-stage screen for incident dementia. , 2003, Journal of clinical epidemiology.

[27]  K. Engedal,et al.  The Mini‐Mental State Examination: Identifying the Most Efficient Variables for Detecting Cognitive Impairment in the Elderly , 1992, Journal of the American Geriatrics Society.

[28]  Gail Kuslansky,et al.  Detecting dementia with the Hopkins Verbal Learning Test and the Mini-Mental State Examination. , 2004, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[29]  K. Ritchie,et al.  A comparative study of the performance of screening tests for senile dementia using receiver operating characteristics analysis. , 1992, Journal of clinical epidemiology.

[30]  M. Folstein,et al.  Univariate and Multivariate Analyses of the Mental Status Examination , 1985 .

[31]  Christopher D. Manning,et al.  Cognitive Screening of Nursing Home Residents: Factor Structures of the Mini‐Mental State Examination , 1994, Journal of The American Geriatrics Society.

[32]  B B Reiss,et al.  The reliability and validity of the Mini-Mental State in a British community survey. , 1989, Journal of psychiatric research.

[33]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease , 1984, Neurology.

[34]  M. Folstein,et al.  Population-based norms for the Mini-Mental State Examination by age and educational level. , 1993, JAMA.

[35]  C Jonker,et al.  LIMITATIONS OF THE MINI‐MENTAL STATE EXAMINATION IN DIAGNOSING DEMENTIA IN GENERAL PRACTICE , 1997, International journal of geriatric psychiatry.

[36]  S. Kreiner,et al.  Mini-Mental Status Examination: mixed Rasch model item analysis derived two different cognitive dimensions of the MMSE. , 2007, Journal of clinical epidemiology.

[37]  J. C. Wells,et al.  Discriminant validity of a reduced set of Mini‐Mental State Examination items for dementia and Alzheimer's disease , 1992, Acta psychiatrica Scandinavica.

[38]  H. Spinnler,et al.  The Milan Overall Dementia Assessment and the Mini‐Mental State Examination compared: an epidemiological investigation of dementia , 1999, European journal of neurology.

[39]  I. W. Molenaar,et al.  Rasch models: foundations, recent developments and applications , 1995 .

[40]  Jürgen Rost,et al.  Rasch Models in Latent Classes: An Integration of Two Approaches to Item Analysis , 1990 .

[41]  R. Roca Bedside cognitive examination , 1987 .

[42]  D P Salmon,et al.  The Mini-Mental State Examination in the early diagnosis of Alzheimer's disease. , 1990, Archives of neurology.

[43]  J. Teresi,et al.  Item bias in cognitive screening measures: comparisons of elderly white, Afro-American, Hispanic and high and low education subgroups. , 1995, Journal of clinical epidemiology.

[44]  D. O'Connor,et al.  The influence of education and social class on the diagnosis of dementia in a community population , 1991, Psychological Medicine.

[45]  C. Brayne,et al.  Population norms for the MMSE in the very old: Estimates based on longitudinal data , 2000, Neurology.

[46]  I. Skoog,et al.  A Longitudinal Population Study of the Mini-Mental State Examination in the Very Old: Relation to Dementia and Education , 2000, Dementia and Geriatric Cognitive Disorders.

[47]  S. Bassett,et al.  Predicting Performance on the Mini‐Mental State Examination , 1987, Journal of the American Geriatrics Society.

[48]  Minh Quach,et al.  Screening for mild cognitive impairment (MCI) utilizing combined mini‐mental‐cognitive capacity examinations for identifying dementia prodromes , 2002, International journal of geriatric psychiatry.

[49]  M. Folstein,et al.  Limits of the ‘Mini-Mental State’ as a screening test for dementia and delirium among hospital patients , 1982, Psychological Medicine.

[50]  The limited utility of the Mini-Mental State Examination in screening people over the age of 75 years for dementia in primary care. , 2002, The British journal of general practice : the journal of the Royal College of General Practitioners.

[51]  A. Papassotiropoulos,et al.  The validity of psychometric instruments for detection of dementia in the elderly general population , 1998, International journal of geriatric psychiatry.

[52]  R. Hu Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) , 2003 .

[53]  W E Wilkinson,et al.  Comparison of two screening tests in Alzheimer's disease. The correlation and reliability of the Mini-Mental State Examination and the modified Blessed test. , 1987, Archives of neurology.

[54]  A. Mackinnon,et al.  A comparison of alternative methods of screening for dementia in clinical settings. , 1996, Archives of neurology.

[55]  R D Hill,et al.  The relationship between the mini-mental state examination and cognitive functioning in normal elderly adults: a componential analysis. , 1995, Age and ageing.

[56]  L. Frölich,et al.  Psychometric properties of Clock Drawing Test and MMSE or Short Performance Test (SKT) in dementia screening in a memory clinic population , 2002, International journal of geriatric psychiatry.

[57]  S. Bassuk,et al.  Characteristics of the Modified Mini-Mental State Exam among elderly persons. , 2003, Journal of clinical epidemiology.