Mini-Mental State Examination in Brazil: An Item Response Theory Analysis

Abstract

The Mini-Mental State Examination (MMSE) is currently used to the track cognitive status of older adults in Brazil. Studies on its psychometric properties are lacking, especially ones that use Item Response Theory. The objective was to assess the difficulty of the items in a Brazilian version of MMSE using the Rasch model and to identify possible differential item functioning (DIF), considering schooling, age and sex of the sample of Brazilian older adults. This study used the answers of 2.734 older adults to the 30 items of MMSE. It was found that four items in the seven series were the most difficult, and items nine, 13, 22 and 23 were the easiest. The skill of respondents was higher than the items’ difficulty level. DIF was observed for schooling, sex and age in, respectively, 27, 18 and 16 items. It is concluded that the use of MMSE in Brazilian older adults should be cautious due to the large number of biased items, mainly due to schooling.

Factors associated with oral health-related quality of life of institutionalized elders

“…The presence of neurological and/or cognitive disorders was determined using the Mini Mental State Examination (MMSE). 18,19 This questionnaire assessed orientation; memory; attention; the ability to name, follow verbal and written commands; and the ability to write a sentence and copy a drawing, resulting in a final score (0-30 points). Elderly individuals with an MMSE final score lower than 13 points were excluded from the study.…”

Psychometric Characteristics of the Mini-Mental State Examination among Older Chinese Immigrants

“…[12] For example, when a group of men and women have the same sum score on the MMSE, they should have the same probability of endorsing any specific test item; otherwise, DIF occurs when the parameters of a given item differ across groups, indicative of item bias and lack of validity. [7] Previous studies have documented DIF in the MMSE attributable to educational attainment, sex, age, or language of administration. [7,10,22,23] Overall, IRT approaches are appropriate for identifying and eliminating language-and culture-related biases at both item and test levels, constructing tests with equivalent reliability at all ability levels.…”

“…[20,21] The Rasch or one-parameter model has been applied in the MMSE, assessing and establishing a hierarchy of item difficulty and the extent to which respondents are separated by cognitive ability level. [7] The third objective is to detect possible differential item functioning (DIF) for bias of items across different age, sex, and education groups. DIF is another function provided by IRT, which helps determine the presence of bias in assessment of cognitive abilities across various subgroups when the subgroups have the same scores on the latent trait.…”

“…[5] However, its psychometric properties, particularly its internal structure remains controversial across countries and cultural groups. [6,7] Previous studies using factor analysis procedures have documented two-, three-, or five-factor structure for the MMSE in various study samples. [6,8,9,10] Overall, cognitive abilities or subdomains of orientation, attention, and recall have been commonly found with various item combinations, but registration and language have not been consistently reproduced.…”

Fragilidade física e desempenho cognitivo em populações idosas, parte I: revisão sistemática com metanálise

“…The Mini-Mental State Examination (MMSE) 33 is an instrument composed of 30 questions, which is able to assess the five dimensions of cognitive profile 38 39 . The MMSE is the most used assessment tool of cognitive status in studies of frailty since it is able to assess what it is intended to evaluate 40 .…”