Education does not equally influence all the Mini Mental State Examination subscales and items: inferences from a Brazilian community sample

Abstract

OBJECTIVE: Mini-Mental State Examination cutoffs have been presented for schooling levels to screen cognitive impairment. However, items may behave differently with regards to education. The objective of this study was to examine the impact of education on MMSE subscales and items. METHOD: Community-dwelling participants aged 65 years or more (n = 990, females = 637, age = 74.1 years, range 65-108) were stratified as illiterate (n = 373), 1-8 (n = 540), 9-12 (n = 63), and more than 12 years of schooling (n = 14) and were screened with MMSE and Pfeffer Functional Activities Questionnaire. To make the Mini-Mental State Examination items comparable, each item was transformed into z scores. Multiple linear regression was used to estimate the effect of schooling on MMSE subs and items controlling for age, sex, and activities of daily life. RESULTS: Temporal and space orientation, attention/calculation, repetition, reading, writing, and drawing scores improved as education increased, but not memory registration, three step command, and naming. Reading and writing displayed the largest coefficients, whereas education exerted no influence on naming and three step command tasks. CONCLUSION: Education does not exert an important effect on naming, three step command, memory registration, and delayed recall. As memory is a key factor for diagnosing dementia, these items could be considered despite education.

Development, validity, and reliability of the General Activities of Daily Living Scale: a multidimensional measure of activities of daily living for older people

“…The Pfeffer Functional Activities Questionnaire seems to be one of the most commonly used tools for functional assessment aiming at the investigation of IADL performance. [7][8][9][10] One study using the Pfeffer scale 7 found an additive effect between functional scores and the Mini Mental State Examination (MMSE) for the diagnosis of AD. The Disability Assessment for Dementia was also adapted for Brazil 11 and seems to be useful for the characterization of functionality in frontotemporal dementia and AD, assessing both BADLs and IADLs as well as leisure activities, although these two groups do not show differences in functional performance.…”

Psychometric properties of the Brazilian version of Pfeffer's Functional Activities Questionnaire

“…Pfeffer's Functional Assessment Questionnaire (FAQ) is one of the most widely used measures of functional status in research and is often employed in epidemiological studies on dementia (Nitrini et al, 2004; Laks et al, 2005, 2010; Aprahamian et al, 2011). The interest of researchers in different centers on the questionnaire has grown in recent years, especially after its inclusion in the assessment protocol of the Alzheimer's Disease Neuroimaging Initiative (2014).…”

Applicability of the single-case methodology in a patient with dementia with Lewy bodies

“…These results also indicate that some instruments used to evaluate cognitive functions, such as the complex line drawing task 4 and the Mini Mental State Examination pentagons, 5 can be influenced by educational attainment. Clinicians should be aware of this phenomenon.…”