A New Scoring Method of the Mini-Mental Status Examination to Screen for Dementia

Abstract

Background: Although the Mini-Mental Status Examination (MMSE) is the most widely used screening instrument for dementia, it has several limitations. Methods: We developed and validated a new scoring method of the MMSE, namely the short form of the MMSE (MMSE-S). Results: The MMSE-S was more robust to demographic influences than the MMSE. The influence of education, in particular, was smaller in the MMSE-S compared to the MMSE (p < 0.01). The diagnostic accuracy of the MMSE-S for very mild to mild dementia was also better than that of the original MMSE (p < 0.0001). Its specificity, in particular, was higher than that of the original MMSE. In Korea, we could improve the post-test probability for dementia from 46.88 to 64.76% by employing the MMSE-S instead of the MMSE. We also provided optimal cut-off scores for dementia stratified by age, education, and gender, which may further improve the diagnostic accuracy of the MMSE-S for dementia. Conclusion: Due to its good accuracy and brevity, the MMSE-S may contribute to enhancing the cost-effectiveness of and accessibility to dementia screening as well as early diagnosis and treatment of dementia, particularly in low- and middle-income countries.

The Mini-Mental State Examination: Czech Norms and Cutoffs for Mild Dementia and Mild Cognitive Impairment due to Alzheimer's Disease

“…Our results correspond to findings from other studies that showed the negative impact of age, the positive impact of education, and no impact with regard to gender on MMSE scores [8,21,22,23,24,25]. There was one study that found a significant gender affect [7]. Only one study did not find sociodemographic relationships with MMSE scores [26].…”

“…Our mean score on the MMSE (28 ± 2) in the Czech Republic was similar to those in other elderly Czechs (29 ± 1), in the USA (29 ± 1; 28 ± 2), Canada (27 ± 2), Australia (27 ± 4), Japan (29 ± 2; 28 ± 2), Korea (27 ± 2; 26 ± 3), Singapore (27 ± 3; 28 ± 2), Slovenia (27 ± 2), Croatia (27 ± 3), and Italy (27 ± 2) [4,6,7,21,23,24,25,26,27,28,29,30]. Therefore, performance in NOS appears to be cross-culturally independent and shows a ceiling effect (the test is ‘too easy').…”

“…The MMSE has been modified several times. Most recently, a short form of the MMSE was introduced to achieve better diagnostic accuracy and reduce the influence of demographic variables [7]. …”