Usefulness of repeated presentation of Mini-Mental State Examination as a diagnostic procedure – a population-based study
E.-L. Helkala
Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland,
Search for more papers by this authorM. Kivipelto
Department of Neuroscience and Neurology, University of Kuopio, Kuopio, Finland,
Search for more papers by this authorM. Hallikainen
Department of Neurology, Kuopio University Hospital, Kuopio, Finland,
Search for more papers by this authorH. Heinonen
Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland,
Search for more papers by this authorJ. Tuomilehto
Department of Epidemiology and Health Promotion, National Public Health Institute, Finland,
Helsinki Department of Public Health, University of Helsinki, Helsinki, Finland
Search for more papers by this authorH. Soininen
Department of Neuroscience and Neurology, University of Kuopio, Kuopio, Finland,
Department of Neurology, Kuopio University Hospital, Kuopio, Finland,
Search for more papers by this authorA. Nissinen
Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland,
Search for more papers by this authorE.-L. Helkala
Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland,
Search for more papers by this authorM. Kivipelto
Department of Neuroscience and Neurology, University of Kuopio, Kuopio, Finland,
Search for more papers by this authorM. Hallikainen
Department of Neurology, Kuopio University Hospital, Kuopio, Finland,
Search for more papers by this authorH. Heinonen
Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland,
Search for more papers by this authorJ. Tuomilehto
Department of Epidemiology and Health Promotion, National Public Health Institute, Finland,
Helsinki Department of Public Health, University of Helsinki, Helsinki, Finland
Search for more papers by this authorH. Soininen
Department of Neuroscience and Neurology, University of Kuopio, Kuopio, Finland,
Department of Neurology, Kuopio University Hospital, Kuopio, Finland,
Search for more papers by this authorA. Nissinen
Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland,
Search for more papers by this authorAbstract
Helkala E-L, Kivipelto M, Hallikainen M, Alhainen K, Heinonen H, Tuomilehto J, Soininen H, Nissinen A. Usefulness of repeated presentation of Mini-Mental State Examination as a diagnostic procedure – a population-based study. Acta Neurol Scand 2002: 106: 341–346. © Blackwell Munksgaard 2002.
Material and methods– The 280 subjects who achieved 24 points or less in the Mini-Mental State Examination (MMSE) in the first survey of 1449 subjects were invited for a comprehensive diagnostic examination for dementia including medical history, thorough neurological and cardiovascular examinations and detailed neuropsychological evaluation, magnetic resonance imaging (MRI)-study, cerebrospinal fluid (CSF)-analysis, electrocardiogram (ECG), chest radiograph and blood tests after the first assessment. The MMSE was presented again. Results– Out of 240 persons, 57 subjects were diagnosed as having dementia. When the cut-off point of 24 or less in the second MMSE was used, the sensitivity of the second MMSE was 82% and the specificity was 64%. The positive predictive value of the second MMSE was 42% and negative predictive value 92%. The non-demented subjects improved their MMSE score at the second examination. In contrast, the demented subjects maintained their low MMSE score at the second examination.
References
- 1 FOLSTEIN MF, FOLSTEIN SE, MCHUGH PR. “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.
- 2 O'CONNOR DW, POLLITT PA, HYDE JB et al. The reliability and validity of the Mini-Mental State in a British community survey. J Psychiatr Res 1989; 23: 87–96.
- 3 PONDS RW, VERHEY FR, ROZENDAAL N, JOLLES J, DEELMAN BG. Screening for dementia: validity of the Cognitive Screening Test (CST) and the Mini-Mental State Examination. Tijdschr Gerontol Geriatr 1992; 23: 94–9.
- 4 GIMENEZ-ROLDAN S, NOVILLO MJ, NAVARRO E, DOBATO JL, GIMENEZ-ZUCCARELLI M. Mini-Mental state examination: proposal of protocol to be used. Rev Neurol 1997; 25: 576–8.
- 5 MCDOWELL I, KRISTJANSSON B, HILL GB, HEBERT R. Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. J Clin Epidemiol 1997; 50: 377–83.
- 6 ISHIZAKI J, MEGURO K, AMBO H. A normative, community-based study of Mini-Mental State in elderly adults: the effect of age and educational level. J Gerontol B Psychol Sci Soc Sci 1998; 53: P359–63.
- 7 KURLOWICZ L, WALLACE M. The Mini-Mental State Examination. J Gerontol Nurs 1999; 25: 8–9.
- 8 TOMBAUGH TN, MCINTYRE NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992; 40: 922–35.
- 9 LOMHOLT RK, JURGENSEN KS. The mini-mental state examination in screening of cognitive dysfunction and dementia. Ugeskr Laeger 1998; 7: 7251–4.
- 10
WIND AW,
SCHELLEVIS FG,
VAN STAVEREN G,
SCHOLTEN RP,
JONKER C,
VAN EIJK JT.
Limitations of the Mini-Mental State Examination in diagnosing dementia in general practice.
Int J Geriatr Psychiatry
1997; 12: 101–8.
10.1002/(SICI)1099-1166(199701)12:1<101::AID-GPS469>3.0.CO;2-R CAS PubMed Web of Science® Google Scholar
- 11 COOPER DB, EPKER M, LACRITZ L et al. Effects of practice on category fluency in Alzheimer's disease. Clin Neuropsychol 2001; 15: 125–8.
- 12 KOHLER S. Quantitative characterization of verbal learning deficits in patients with Alzheimer's disease. J Clin Exp Neuropsychol 1994; 16: 749–53.
- 13 WOODARD JL, DUNLOSKY JA, SALTHOUSE TA. Task decomposition analysis of intertrial free recall performance on the Rey Auditory Verbal Learning Test in normal aging and Alzheimer's disease. J Clin Exp Neuropsychol 1999; 21: 666–76.
- 14 ROSEN WG, TERRY RD, FULD PA, KATZMAN R, BECK A. Pathological verification of ischemic score in differentiation of dementias. Ann Neurol 1980; 7: 486–8.
- 15 MCKHANN G, DRACHMAN D, FOLSTEIN M, KATZMAN R, PRICE D, STADLAN EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984; 34: 939–44.
- 16 ROMAN GC, TATEMICHI TK, ERKINJUNTTI T et al. Vascular dementia: diagnostic criteria for research studies. Neurology 1993; 43: 250–60.
- 17 KIVIPELTO M, HELKALA E-L, HÄNNINEN T et al. Midlife vascular risk factors and late-life mild cognitive impairment. A population-based study. Neurology 2000; 26: 1683–9.
- 18 SMITH GE, PETERSEN RC, PARISI JE et al. Definition, course, and outcome of mild cognitive impairment. Aging Neuropsychol Cogn 1996; 3: 141–7.
- 19 PETERSEN RC, SMITH GE, IVNIK RJ et al. Apolipoprotein E status as a predictor of development of Alzheimer's disease in memory-impaired individuals. JAMA 1995; 273: 1274–8.
- 20 CLARK CM, SHEPPARD L, FILLENBAUM GG et al. Variability in annual Mini-Mental State Examination score in patients with probable Alzheimer disease: a clinical perspective of data from the Consortium to Establish a Registry for Alzheimer's Disease. Arch Neurol 1999; 56: 857–62.
- 21 HAN L, COLE M, BELLAVANCE F, MCCUSKER J, PRIMEAU F. Tracking cognitive decline in Alzheimer's disease using the mini-mental state examination: a meta-analysis. Int Psychogeriatr 2000; 12: 231–47.
- 22 AEVARSSON O, SKOOG I. A longitudinal population study of the mini-mental state examination in the very old: relation to dementia and education. Dement Geriatr Cogn Disord 2000; 11: 166–75.
- 23
UNGER JM,
VAN B ELLE G,
HEYMAN A.
Cross-sectional versus longitudinal estimates of cognitive change in nondemented older people: a CERAD study. Consortium to Establish a Registry for Alzheimer's Disease.
J Am Geriatr Soc
1999; 5: 559–63.
10.1111/j.1532-5415.1999.tb02570.x Google Scholar
- 24 GIORDANI B, BOIVIN MJ, HALL AL et al. The utility and generality of Mini-Mental State Examination scores in Alzheimer's disease. Neurology 1990; 40: 1894–6.
- 25 HILL RD, BACKMAN L. The relationship between the mini-mental state examination and cognitive functioning in normal elderly adults: a componential analysis. Age Ageing 1995; 24: 440–6.
- 26 TINKLENBERG J, BROOKS JO 3d, Tanke ED et al. Factor analysis and premilinary validation of mini-mental state examination from a longitudinal perspective. Int Psychogeriatr 1990; 2: 123–34.
- 27
JACQMIN-GADDA H,
FABRIGOULE C,
COMMENGES D,
DARTIGUES JF.
A 5-year longitudinal study of the Mini-Mental State Examination in normal aging.
Am J Epidemiol
1997; 15: 498–506.
10.1093/oxfordjournals.aje.a009137 Google Scholar
- 28
BRAYNE C,
SPIEGELHALTER DJ,
DUFOUIL C et al. Estimating the true extent of cognitive decline in the old old.
J Am Geriatr Soc
1999; 11: 1283–8.
10.1111/j.1532-5415.1999.tb07426.x Google Scholar
- 29
YOUNGJOHN JR,
CROOK TH.
Stability of everyday memory in age-associated memory impairment: a longitudinal study.
Neuropsychology
1993; 7: 406–16.
10.1037/0894-4105.7.3.406 Google Scholar
- 30 HELKALA E-L, KOIVISTO K, HÄNNINEN T et al. Memory functions in human subjects with different apolipoprotein E phenotypes during a 3-year population-based follow-up study. Neurosci Lett 1996; 204: 177–80.
- 31 WHITE H, DAVIS PB. Cognitive screening tests. an aid in the care of elderly outpatients. Journal of General Internal Medicine. J Gen Intern Med 1990; 5: 438–45.
- 32 CRYSTAL HA, DICKENS D, SLIWINSKI M, MASUR D, BLAU A, LIPTON RB. Associations of status and change measures of neuropsychological function with pathologic changes in elderly, originally nondemented subjects. Arch Neurol 1996; 53: 82–7.
- 33 SHAH Y, TANGALOS EG, PETERSEN RC. Mild cognitive impairment. When is it a precursor to Alzheimer's disease? Geriatrics 2000; 55: 65–8.
- 34 BOZOKI A, GIORDANI B, HEIDEBRINK JL, BERENT S, FOSTER NL. Mild cognitive impairments predict dementia in nondemented elderly patients with memory loss. Arch Neurol 2001; 58: 411–6.
- 35 UHLMANN RF, LARSON EB. Effect of education on the mini-mental state examination as a screening test for dementia. J Am Geriatr Soc 1991; 39: 876–80.
- 36 JAGGER C, CLARKE M, ANDERSSON J, BATTCOCK T. Misclassification of dementia by mini-mental state examination – are education and social class the only factors? Age Ageing 1992; 21: 404–11.
- 37 YLIKOSKI R, ERKINJUNTTI T, SULKAVA R, JUVA K, TILVIS R, VALVANNE J. Correction for age, education and other demographic variables in the use of the Mini Mental State Examination in Finland. Acta Neurol Scand 1992; 85: 391–6.
- 38 COSSA FM, DELLA SALA S, MUSICCO M, SPINNLER H, UBEZIO MC. Comparison of two scoring systems of the Mini-Mental State Examination as a screening test for dementia. J Clin Epidemiol 1997; 50: 961–5.
- 39 QUESADA JJ, FERRUCCI L, CALVANI D, VALENTE C, SALANI B, BAVAZZANO A. Formal education as an effect modifier of the relationship between Mini-Mental State Examination score and IADLs disability in the older population. Aging (Milano) 1997; 9: 175–9.
- 40 ALMEIDA OP. Mini mental state examination and the diagnosis of dementia in Brazil. Arq Neuropsiquiatr 1998; 56: 605–12.
- 41 GRIGOLETTO F, ZAPPALA G, ANDERSON DW, LEBOWITZ BD. Norms for the Mini-Mental State Examination in a healthy population. Neurology 1999; 22: 315–20.
- 42 VAN GORP WG, MARCOTTE TD, SULTZER D, HINKIN C, MAHLER M, CUMMINGS JI. Screening for dementia. comparison of three commonly used instruments. J Clin Exp Neuropsychol 1999; 21: 29–38.
- 43 FRATIGLIONI L, JORM AF, GRUT M et al. Predicting dementia from the Mini-Mental State Examination in an elderly population. the role of education. J Clin Epidemiol 1993; 46: 281–7.
