SUMMARYThis study was undertaken to investigate whether it was possible to identify a 'cutoff' score on the Mini-Mental State Examination (MMSE) below which further cognitive assessment would be of little benefit for research or diagnostic purposes. Evaluation of cognitive assessments in 467 subjects, aged 31-92 (mean 71.4 years), in whom an MMSE score was also available revealed, for those patients scoring 6 out of 30, that the majority of a further battery of tasks testing amnesia, aphasia, visuospatial ability and intellectual processing were too difficult. Half of the subjects were too severely impaired to complete 16 of the 17 tasks. When the MMSE score was 8 out of 30 or less, there were eight tasks where a minimum of 50% of patients were untestable. In summary, subjects scoring 8 or less on the MMSE are unlikely to be able to cooperate meaningfully with further cognitive assessment, using psychometric test batteries such as that currently in use in our clinic, and similar batteries.
Beardsall & Brayne (1990) have introduced a method for estimating full-length National Adult Reading Test (NART) scores using the scores on the first half of the test only. They suggest that this is appropriate for subjects who are of low reading ability and might otherwise find testing distressing. Crawford, Parker, Allan, Jack & Morrison (1991) have subsequently explored the accuracy with which Short NART predicted full NART scores and in addition WAIS IQ scores in a large cross-validation sample. They concluded that the Short NART could be used with modest confidence when estimating premorbid IQ. However, when applied to 202 consecutive referrals to this Memory Disorders Clinic, the accuracy with which the Short NART predicted full NART error scores was less satisfactory. Results indicated that discrepancies between Short NART and full NART error scores were outside the bounds of both clinical and statistical acceptability. Examination of these results revealed that one possible source of difficulty lay in variation in the accuracy with which words are pronounced. It is concluded that, despite the appeal of a shortened version of the NART to estimate premorbid IQ, without further modification its use in clinical practice cannot be recommended.
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