Mini mental state examination and the Addenbrooke's cognitive examination: effect of education and norms for a multicultural population.

OBJECTIVE To derive population norms on the Malayalam adaptation of Addenbrooke's Cognitive Examination (M-ACE) and the inclusive Malayalam mini mental state examination (M-MMSE). MATERIALS AND METHODS Education-stratified norms were obtained on randomly selected cognitively unimpaired community elders (n = 519). RESULTS Valid data on norms was available on 488 subjects (age 68.5 +/- 7.1 and education 7.9 +/- 5.4). Education and age, but not gender had a significant effect on both M-ACE and M-MMSE. When compared to the effect of age, the effect of education was sevenfold more on the M-ACE and ninefold more on the M-MMSE. The mean composite score on the M-ACE (and the M-MMSE) was 42.8 +/- 9.8 (14.9 +/- 3.1) for those with 0 (n = 72), 55.9 +/- 12.5 (19.7 +/- 4.1) with 1-4 (n = 96), 62.6 +/- 11.4 (21.9 +/- 3.7) with 5-8 (n = 81), 77 +/- 10.2 (25.7 +/- 2.4) with 9-12 (n = 136) and 83.4 +/- 7.2 (26.7 +/- 1.6) with > 12 (n = 103) years of formal education. CONCLUSIONS Education has the most potent effect on performance on both M-ACE and M-MMSE in the Indian cohort. Education-stratified scores on the M-ACE and the M-MMSE, will provide a more appropriate means of establishing the cognitive status of patients. It is also our feeling that these cut-off scores will be useful across India.

[1]  [Validity of the Spanish version of the Addenbrooke's Cognitive Examination for the diagnosis of dementia and to differentiate Alzheimer's disease and frontotemporal dementia]. , 2005, Revista de neurologia.

[2]  R. Mohs,et al.  Consortium to establish a registry for Alzheimer's disease (CERAD) clinical and neuropsychological assessment of Alzheimer's disease. , 2002, Psychopharmacology bulletin.

[3]  J. Morris,et al.  The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assesment of Alzheimer's disease , 1989, Neurology.

[4]  S. Morrow.  Instrumental Activities of Daily Living Scale , 1999 .

[5]  H. Brodaty,et al.  THE CLOCK DRAWING TEST FOR DEMENTIA OF THE ALZHEIMER'S TYPE: A COMPARISON OF THREE SCORING METHODS IN A MEMORY DISORDERS CLINIC , 1997, International journal of geriatric psychiatry.

[6]  T. Bak,et al.  Adaptation of the ACE for a Malayalam speaking population in southern India , 2004, International journal of geriatric psychiatry.

[7]  M. Ventura,et al.  Is the Addenbrooke’s Cognitive Examination effective to detect frontotemporal dementia? , 2004, Journal of Neurology.

[8]  P. S. Mathuranath,et al.  Instrumental activities of daily living scale for dementia screening in elderly people , 2005, International Psychogeriatrics.

[9]  L. George,et al.  Scoring nonresponse on the Mini-Mental State Examination , 1988, Psychological Medicine.

[10]  P. S. Mathuranath,et al.  A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia , 2000, Neurology.

[11]  G. Ratcliff,et al.  Practical issues in cognitive screening of elderly illiterate populations in developing countries. The Indo-US Cross-National Dementia Epidemiology Study , 1998, Aging.

[12]  John R Hodges,et al.  The Addenbrooke's Cognitive Examination Revised (ACE‐R): a brief cognitive test battery for dementia screening , 2006, International journal of geriatric psychiatry.

[13]  G. Ratcliff,et al.  Cognitive Test Performance in a Community-Based Nondemented Elderly Sample in Rural India: The Indo-U.S. Cross-National Dementia Epidemiology Study , 1996, International Psychogeriatrics.

[14]  H. D. de Silva,et al.  Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka , 2002, International journal of geriatric psychiatry.

[15]  A. Kurz,et al.  Validation of the Addenbrooke’s Cognitive Examination for Detecting Early Alzheimer’s Disease and Mild Vascular Dementia in a German Population , 2006, Dementia and Geriatric Cognitive Disorders.

[16]  Steven H. Belle,et al.  A hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in india , 1995 .