The role of education in mini-mental state examination: a study in Northeast Brazil

-Functional incapacity and cognitive impairment are conditions related to the process of human aging. Cognitive impairment is considered an important predicitve factor for functional impairment in elderly populations. This cross-sectional study analyzes the association between cognitive performance and functional capacity in an elderly population sample in Natal, Brazil. A total of 213 elderly persons were assessed by the BOAS Multidimensional Questionnaire (Brazil Old Age Schedule) and the Mini-Mental State Examination (MMSE). The results of multivariate analysis and linear regression showed that age and schooling level are factors associated with cognitive performance in the elderly of this study. The final explicative model, elaborated by logistic regression, found that cognitive performance was the only predicitve variable of functional incapacity for the activities of daily living even when adjusted for sociodemographic variables.KEy wOrdS: MMSE, BOAS, elderly, functional status, cognitive impairment. Impacto do desempenho cognitivo na capacidade funcional em uma amostra populacional de idosos do nordeste brasileiroResumo -A incapacidade funcional e o déficit cognitivo são condições relacionadas com o processo de envelhecimento humano. O déficit cognitivo é considerado um importante fator preditor de prejuízos funcionais em populações idosas. Este estudo transversal analisa a associação do desempenho cognitivo na capacidade funcional de uma amostra populacional idosa residente em Natal-rN. Foram avaliados 213 idosos pelo Questionário Multidimensional-BOAS e pelo Mini-Exame do Estado Mental (MEEM). Através de analise multivariada mediante regressão linear, os resultados apontam a idade e o nível de escolaridade como fatores associados ao desempenho cognitivo nos idosos do estudo. O modelo explicativo final elaborado através de regressão logística apresentou o desempenho cognitivo como a única variável preditora de incapacidade funcional para as atividades da vida diária mesmo quando ajustado por variáveis sócio-demográficas. Functional dependence is one of the conditions related to the human aging process, and consequent decrease in the quality of life of elderly populations. Aspects such as advanced age, female sex, low schooling levels and comorbidity are strongly associated with functional dependency 1 . Functional capacity is influenced by demographic, socioeconomic, cultural and psychosocial factors 2 . Owing to the particular nature of detecting important impairments in elderly populations, functional capacity is increasingly seen by professionals as a new paradigm for assessing health in the elderly. Mental disturbances are common in elderly populations. It is estimated that 8% are afflicted by these pathologies 3 . The most important of these are dementias, because of their high frequency and the impact they cause on the health and functional capacity of this population 4 . Mild cognitive impairment is characterized as the transitional state between normal aging and dementia, and is exemplif...

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 89%

Impact of cognitive performance on the functional capacity of an elderly population in Natal, Brazil

Castro

Guerra²

2008

“…According to earlier Brazilian studies, educational levels impact MMSE scoring 10,11 ; therefore, it would be important to evaluate the impact of education over SMMSE scores as well. The aim of this study was to determine objective cognitive responses in moderate and severe AD patients by way of the SMMSE, and to correlate performances with MMSE scores, providing cutoff ranges for accurate assessment and monitoring of these patients.…”

mentioning

confidence: 99%

Educational bias in the assessment of severe dementia: Brazilian cutoffs for severe Mini-Mental State Examination

Wajman

Oliveira

Schultz

et al. 2014

Cognitive assessment in advanced stages of Alzheimer's disease (AD) is limited by the imprecision of most instruments. Objective: To determine objective cognitive responses in moderate and severe AD patients by way of the Severe Mini-Mental State Examination (SMMSE), and to correlate performances with Mini-Mental State Examination (MMSE) scores. Method: Consecutive outpatients in moderate and severe stages of AD (Clinical Dementia Rating 2.0 or 3.0) were evaluated and compared according to MMSE and SMMSE scores. Results: Overall 400 patients were included, 67.5% females, mean age 76.6±6.7 years-old. There was no significant impact of age or gender over MMSE or SMMSE scores. Mean schooling was 4.4±2.5 years, impacting SMMSE scores (p=0.008). Scores on MMSE and SMMSE were significantly correlated (F-ratio=690.6325, p,0.0001). Conclusion: The SMMSE is influenced by schooling, but not by age or gender, and is an accurate test for assessment of moderate and severe AD.

“…Therefore, several strategies have been proposed in order to minimize the effects of schooling level in the interpretation of results, such as: (1) adjustment of cut-off points according to schooling level [5][6][7][8] , (2) the use of cut-off points based on the distribution of MMSE scores in the study population 9 and (3) transcultural adaptation [10][11][12] . In Brazil, the most common approach has been the use of different cut-off points according to schooling level.…”

mentioning

confidence: 99%

Norms for the mini-mental state examination: adjustment of the cut-off point in population-based studies (evidences from the Bambuí health aging study)

Castro-Costa

Fuzikawa

Uchôa

et al. 2008

-Objective: To estimate the prevalence of cognitive impairment in an elderly population-based cohort, using several Mini-Mental State Examination (MMSE) cut-off points recommended by Brazilian authors and to examine the percentile distribution of MMSE scores in the study population. Method: A total of 1558 subjects aged ≥60 years (89.4% of the total), living in the city of Bambuí, MG, completed the MMSE and were included in the present study. Results: The estimated prevalences of cognitive impairment varied from 13.2% to 27.0% depending on the cut-off point and agreement varied widely between them (kappa range: 0.38 to 0.88). Cutoff point 13/14 corresponded to the 5 th percentile and 21/22 corresponded to the lower quartile of the MMSE score distribution. Conclusion: In the absence of comparable cut-off points, percentile distributions are more adequate for population-based studies of elderly with low schooling level.KEy wordS: elderly, cognitive symptoms, epidemiology, Brazil. Normas para o uso do Mini-Exame do Estado Mental: adequação do ponto de corte em estudos populacionais (evidências do Projeto Bambuí)Resumo -Objetivo: Estimar a prevalência de déficit cognitivo em uma base populacional de idosos, utilizando-se os diferentes pontos de corte do Mini-Exame do Estado Mental (MEEM) recomendados por autores brasileiros e verificar a distribuição em percentis da pontuação do MEEM na população estudada. Método: Participaram do estudo 1558 (89,4% do total) indivíduos com idade ≥60 anos residentes na cidade de Bambuí, MG, que foram submetidos ao MEEM. Resultados: A prevalência estimada de déficit cognitivo variou de 13,2% a 27,0%, dependendo do ponto de corte utilizado, observando-se grande variação na sua concordância (índices de kappa entre 0,38 e 0,88). o ponto de corte de 13/14 correspondeu ao 5º percentil e o de 21/22, ao quartil inferior da distribuição dos escores do MEEM. Conclusão: Na ausência de pontos de corte comparáveis, a distribuição em percentis é mais adequada para estudos de base populacional de idosos com baixa escolaridade.