Coordinated Analysis of Age, Sex, and Education Effects on Change in MMSE Scores

Piccinin, Andrea M.; Muniz‐Terrera, Graciela; Clouston, Sean; Reynolds, Chandra A.; Thorvaldsson, Valgeir; Deary, Ian J.; Deeg, Dorly J. H.; Johansson, Boo; Mackinnon, Andrew; Spiro, Avron; Starr, John M.; Skoog, Ingmar

doi:10.1093/geronb/gbs077

Cited by 107 publications

(89 citation statements)

References 58 publications

(56 reference statements)

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“…While there were only 5 time points where a spline knot could be placed, theoretical reasons to do so at age 60 would be consistent with other longitudinal studies [24], with subsequent confirmation that age 60 emerged through a data-driven process. Several studies consistently report that education leads to increase cognitive capability in adulthood, but how this influences subsequent decline is much less well understood [28, 29]. Mechanisms are difficult to infer, but it should be emphasized in this analysis that the absolute change is modest and our findings merit further follow-up and validation in other samples.…”

Section: Discussionmentioning

confidence: 73%

Decline in Search Speed and Verbal Memory Over 26 Years of Midlife in a British Birth Cohort

et al. 2017

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Background: Cognitive capabilities change in later life, although their onset and rate of decline, and how they are shaped by lifetime socioeconomic position, childhood cognition and adult health status are all unclear. Methods: From the Medical Research Council National Survey of Health and Development, we analysed 3,192 participants undergoing one or more cognitive assessments at ages 43, 53, 60–64 and 69. Linear mixed models described cognitive trajectories, adjusting for factors across the life course. Results: For both search speed and verbal memory, better performance at age 43 (the intercept) was associated with higher paternal and own education, childhood cognition, and adult occupational class. For search speed, the trajectory was best described as a quadratic function (decline of 45.6 letters/5-years + 4.6 letters). Verbal memory showed a linear decline of 0.20 words/5-years between ages 43 and 60 and a steeper linear decline of 0.95 words/5-years between ages 60 and 69. Decline in verbal memory in the latter period was steeper in those with higher educational achievements at age 26 (additional 0.28 words/5-years for highest attainment). Conclusions: Decline in verbal memory and search speed across midlife is evident, though with different non-linear trajectories. By implication, pathways to cognitive impairment and dementia in older age may have their origins in this period.

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Section: Discussionmentioning

confidence: 73%

Decline in Search Speed and Verbal Memory Over 26 Years of Midlife in a British Birth Cohort

et al. 2017

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“…Other research has drawn attention to the limitations of the MMSE including influences of education, culture, and language. [45][46][47] Also, its use for predicting cognitive decline is questionable. 48 At the same time, the MMSE is used extensively in clinical practice to dichotomize the population into probable and not likely dementia.…”

Section: Limitationsmentioning

confidence: 99%

Updating the Cognitive Performance Scale

Morris

Howard

Steel

et al. 2015

J Geriatr Psychiatry Neurol

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This study presents the first update of the Cognitive Performance Scale (CPS) in 20 years. Its goals are 3-fold: extend category options; characterize how the new scale variant tracks with the Mini-Mental State Examination; and present a series of associative findings. Secondary analysis of data from 3733 older adults from 8 countries was completed. Examination of scale dimensions using older and new items was completed using a forward-entry stepwise regression. The revised scale was validated by examining the scale's distribution with a self-reported dementia diagnosis, functional problems, living status, and distress measures. Cognitive Performance Scale 2 extends the measurement metric from a range of 0 to 6 for the original CPS, to 0 to 8. Relating CPS2 to other measures of function, living status, and distress showed that changes in these external measures correspond with increased challenges in cognitive performance. Cognitive Performance Scale 2 enables repeated assessments, sensitive to detect changes particularly in early levels of cognitive decline.

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“…However, such standardization does not correct the ceiling/floor effect or the varying sensitivity to change [14]. Others applied Tobit regressions [15], but they do not correct the tricky varying sensitivity to change. Rarely, a transformation, the square root of the number of errors, was considered, which considerably reduced the biases [9].…”

Section: Discussionmentioning

confidence: 99%

Normalized Mini-Mental State Examination for Assessing Cognitive Change in Population-Based Brain Aging Studies

Philipps

Amieva

Andrieu³

et al. 2014

Neuroepidemiology

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Background: The Mini-Mental State Examination (MMSE) is widely used in population-based longitudinal studies to quantify cognitive change. However, its poor metrological properties, mainly ceiling/floor effects and varying sensitivity to change, have largely restricted its usefulness. We propose a normalizing transformation that corrects these properties, and makes possible the use of standard statistical methods to analyze change in MMSE scores. Methods: The normalizing transformation designed to correct at best the metrological properties of MMSE was estimated and validated on two population-based studies (n = 4,889, 20-year follow-up) by cross-validation. The transformation was also validated on two external studies with heterogeneous samples mixing normal and pathological aging, and samples including only demented subjects. Results: The normalizing transformation provided correct inference in contrast with models analyzing the change in crude MMSE that most often lead to biased estimates of risk factors and incorrect conclusions. Conclusions: Cognitive change can be easily and properly assessed with the normalized MMSE using standard statistical methods such as linear (mixed) models.

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Coordinated Analysis of Age, Sex, and Education Effects on Change in MMSE Scores

Cited by 107 publications

References 58 publications

Decline in Search Speed and Verbal Memory Over 26 Years of Midlife in a British Birth Cohort

Decline in Search Speed and Verbal Memory Over 26 Years of Midlife in a British Birth Cohort

Updating the Cognitive Performance Scale

Normalized Mini-Mental State Examination for Assessing Cognitive Change in Population-Based Brain Aging Studies

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