Characteristic differences in the mini-mental state examination used in Asian countries

Abstract

Background: The mini-mental state examination (MMSE) was adapted by individual countries according to their languages and cultures, though it has not been systematically compared. The objective of this study was to compare the linguistic and cultural variations of the MMSE used in various Asian countries. With this, we can analyze the strengths and weaknesses of the MMSE and consider using a common version in future international clinical studies in Asia. Methods: We collected the MMSEs used in 11 Asian nations. After translating those into English, we compared them to understand the differences in the questionnaires with regard to cultural aspects. Results: Many items may be applicable or comparable with a little modification, for Asian countries. However, attention and calculation and repetition may be incomparable. There were some differences in the contents and the ways to administer. Conclusions: The lack of consideration of the cultural differences and their influences on the interpretation of the same cognitive test makes cross-cultural studies difficult. Some items of MMSE tasks need readjusting for, if any, multi-national studies. This study might serve as a first step in the development of a standardized cross-cultural cognitive instrument, especially in Asia.

Current approaches to dementia screening and case finding in low‐ and middle‐income countries: Research update and recommendations

“…However, educational biases have been reported in the RUDAS studies conducted in India, Thailand, and Lebanon especially on items assessing drawing and praxis . To overcome bias due to education and literacy, in some instances, and mainly in the MMSE, education and literacy sensitive items have been adapted, simplified, or omitted including (1) substitution of items involving reading with verbal commands, (2) substitution of written language with pictures/figures, (3) substitution of writing a sentence with verbal descriptions, (4) omitting tasks that require writing or phonemic fluency, and (5) simplification of drawing tasks (drawing diamond within a square instead of interlocking pentagons) . Unfortunately, adaptations to address educational bias in cognitive assessment tests can improve the precision of tests but can also result in issues of equivalence with the original test versions.…”

“…Test adaptations can also lead to biases due to language and culture. For example, questions relating to time such as “what is the date or year?” in the MMSE may not be applicable to populations that use a non‐Western calendar, ie, the Lunar or Hindi calendar . Items regrading orientation in places and place naming (eg, in the MMSE or ACE) may be problematic, particularly in settings where there is no numbering or naming of buildings and streets .…”

“…Items regrading orientation in places and place naming (eg, in the MMSE or ACE) may be problematic, particularly in settings where there is no numbering or naming of buildings and streets . Some tests, such as getting the patient to repeat a certain expression, ie, “no ifs, ands, or buts,” or words used in naming tasks, ie, names of animals, may be of little relevance across different cultures or difficult to be meaningfully translated . Also, shape drawing (eg, interlocking pentagons in the MMSE) may be less comprehensible in populations not familiar with geometric representations …”

Comparisons between traditional medicines and pharmacotherapies for Alzheimer disease: A systematic review and meta‐analysis of cognitive outcomes

“…In MMSE, a change of ≥3 points was considered clinically important in AD . However, the meaningfulness of 3‐point changes is likely to vary across populations, age groups, and test versions, and lack of blinding appears to have inflated effect estimates.…”

Association of Cognitive Impairment and Type 2 Diabetes Mellitus: A Case-Control Study

“…6 The MMSE is advantageous as it does not require any specialized equipment or training for its administration, and yet demonstrates validity and reliability in diagnosis and longitudinal assessment of Alzheimer's disease. 7 The ease of application and the short duration of time required to conduct the examination makes it a popular tool for assessment of cognitive function in the clinician's office or even at bedside. The Montreal Cognitive Assessment (MoCA) is a well-Section: Medicine validated, reliable, and easily accessible screening tool for the detection of MCI.…”