Mini-Mental State Examination norms in a community-dwelling sample of elderly with low schooling in Brazil

Abstract

The objective of this study was to assess Mini-Mental State Examination norms of a functionally normal sample of community-dwelling elderly. Illiterate and low-educated subjects who scored less than 5 on the Pfeffer Functional Activities Questionnaire (PFAQ) [n = 397; female = 269; mean age = 72.15 (SD = 7.24) years] had the 5th, 25th, 50th, and 75th percentiles calculated according to age (65-74; 75-84 years). Overall MMSE score was 21.97 (SD = 4.48). Mean MMSE for illiterate younger individuals was 19.46 (SD = 3.47), and the quartile distribution was 14, 17, 19, and 21. MMSE of subjects with 1-8 years of schooling was 23.90 (3.87), and the distribution was 15, 22, 24, and 27. MMSE of older illiterate subjects was 18.11 (SD = 3.63), and the distribution of scores was 13, 16, 18, and 20, whereas subjects with 1-8 years of schooling scored 23.81 (SD = 4.01) and the distribution was 15, 22, 24, and 27. These MMSE normative data may help improve the detection of cognitive impairment in Brazil, mainly in the primary clinical setting.

The Prevalence of Cognitive Impairment among Older Adults in Jamaica

“…Our findings of variables predicting an association with cognitive impairment build upon previous work among older adults (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). In this study, self-reported hypertension was not a significant predictor of cognitive impairment.…”

“…Scores on MMSE are greatly influenced by age and education level (13)(14)(15). Cognitive impairment and dementia have been associated with rural dwellers (16), increased rates of hospitalization (17,18), increased risk for falls (19,20), increased prevalence of fear of falling (21,22), diabetes mellitus (23,24), depression (17,25), and dependence in activities of daily living [ADL] (26).…”

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

“…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.…”

“…when score distribution is used to establish cut-off points, the most recommended approach is to consider that subjects with scores below the 5 th percentile have a high probability of dementia 13,14 and to use the lower quartile as the cut-off for cognitive screening 9,15 . In Brazil, the 5 th percentile was used to define the cut-off points in a study of patients aged 15 years or more at a general hospital triage 5 .…”

“…In Brazil, the 5 th percentile was used to define the cut-off points in a study of patients aged 15 years or more at a general hospital triage 5 . Another study determined the percentile distribution of MMSE scores of a sample of communitydwelling elders aged 65 to 84 years, with no impairment in activities of daily living 9 . The present study evaluated the MMSE scores of 1558 elderly participants of the Bambuí population-based cohort and had the following objectives: (1) to estimate the prevalence of cognitive impairment, using several cut-off points recommended by Brazilian authors; (2) to estimate the agreement when those cut-off points were used; (3) to examine the percentile distribution of MMSE scores in this population.…”