Differential Item Functioning (DIF) and the Mini-Mental State Examination (MMSE)

Ramírez, Mildred; Teresi, Jeanne A.; Holmes, Douglas; Gurland, Barry J.; Lantigua, Rafael

doi:10.1097/01.mlr.0000245181.96133.db

Cited by 78 publications

(80 citation statements)

References 47 publications

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“…The CAREDIAG has been studied using several advanced psychometric models, including analyses of its relationship to dementia diagnosis 38,39 and performance across ethnically diverse groups. 40,41 The α C for this sample was 0.875. The Observed Total Behavior Disorder Index was also used to measure observed behaviors.…”

Section: Interview Instrumentsmentioning

confidence: 99%

Verbal and Physical Aggression Directed at Nursing Home Staff by Residents

et al. 2012

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CONTEXT: Little research has been conducted on aggression directed at staff by nursing home residents. OBJECTIVE: To estimate the prevalence of resident-tostaff aggression (RSA) over a 2-week period. DESIGN: Prevalent cohort study. SETTING: Large urban nursing homes. PARTICIPANTS: Population-based sample of 1,552 residents (80 % of eligible residents) and 282 certified nursing assistants. MAIN OUTCOME MEASURES: Measures of resident characteristics and staff reports of physical, verbal, or sexual behaviors directed at staff by residents. RESULTS: The staff response rate was 89 %. Staff reported that 15.6 % of residents directed aggressive behaviors toward them (2.8 % physical, 7.5 % verbal, 0.5 % sexual, and 4.8 % both verbal and physical). The most commonly reported type was verbal (12.4 %), particularly screaming at the certified nursing assistant (9.0 % of residents). Overall, physical aggression toward staff was reported for 7.6 % of residents, the most common being hitting (3.9 % of residents). Aggressive behaviors occurred most commonly in resident rooms (77.2 %) and in the morning (84.3 %), typically during the provision of morning care. In a logistic regression model, three clinical factors were significantly associated with resident-to-staff aggression: greater disordered behavior (OR =6.48, 95 % CI: 4.55, 9.21), affective disturbance (OR=2.29, 95 % CI: 1.68, 3.13), and need for activities of daily living morning assistance (OR= 2.16, 95 % CI: 1.53, 3.05). Hispanic (as contrasted with White) residents were less likely to be identified as aggressors toward staff (OR=0.57, 95 % CI: 0.36, 0.91). CONCLUSION: Resident-to-staff aggression in nursing homes is common, particularly during morning care. A variety of demographic and clinical factors was associated with resident-to-staff aggression; this could serve as the basis for evidence-based interventions. Because RSA may negatively affect the quality of care, resident and staff safety, and staff job satisfaction and turnover, further research is needed to understand its causes and consequences and to develop interventions to mitigate its potential impact.KEY WORDS: nursing home; dementia-related behaviors; elder abuse; staff mistreatment.

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Section: Interview Instrumentsmentioning

confidence: 99%

Verbal and Physical Aggression Directed at Nursing Home Staff by Residents

et al. 2012

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“…The total score possible for the test is 30. Ramirez et al 10 found that the Flesch Reading Ease Index was 86. 4 …”

Section: Item Structure Of the Original Mmsementioning

confidence: 99%

“…While Folstein et al 1 suggested that there were 11 categories covered in the MMSE, Tombaugh and McIntyre 7 said that [43][44][45][46] The point here is that the MMSE is not unidimensional, 42 which a total score seems to suggest. Furthermore, Ramirez et al 10 found using a differential item functioning (DIF) analysis that different items performed differently for different groups tested. Lopez et al 42 agreed many items were classified as ''too easy'' in their item analysis.…”

Section: Advantages and Disadvantages Of The Mmsementioning

confidence: 99%

“…52 Indeed, although rare, individuals can score 30/30 on the MMSE and still have been just diagnosed with early-stage dementia. 53 Other factors that might influence scores include vision and hearing impairment, anxiety, depression, musculoskeletal disorders, dysarthria and dysphasia 10,23 and the effects of medication on scores should be considered. For example, cholinesterase inhibitors, used widely in the treatment of early AD, have been found in at least 1 study to stabilize MMSE scores (see 54 for a review).…”

Section: Advantages and Disadvantages Of The Mmsementioning

confidence: 99%

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The Death Knoll for the MMSE: Has It Outlived Its Purpose?

Mark

2010

J Geriatr Psychiatry Neurol

132

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The Mini-Mental State Examination (MMSE) is arguably the best-known cognitive screen in the world. Originally designed to assess cognitive impairment in elderly populations, it has become one of the first steps toward a dementia diagnosis. Routinely used in the clinic and in research internationally, the MMSE, despite its flaws, has managed to retain its popularity for more than 30 years. This review explores when and how the test is used, lists its advantages and disadvantages, and ultimately questions its value. The specific issue that is addressed here is whether the test has outlived its original purpose. The conclusion is that although the MMSE may be a useful tool in many circumstances where a cognitive screen is required, practitioners should be wary of using MMSE total scores as a shortcut toward a dementia diagnosis. The Mini-Mental State Examination (MMSE) first appeared 34 years ago 1 and since then it has become arguably the most well known and used short cognitive screening instrument. 2-4Indeed, development of the MMSE-II is currently underway. A few reviews have appeared over the years assessing the test's merits but most have appeared in other languages than English. 5,6 The best-known English-language review appeared back in 1992, 7 while Mitchell 8 recently conducted a metaanalysis, the first attempt to quantify the test's validity over populations, testers, studies, and settings. The focus of the current review is 3-fold: (a) to examine whether the MMSE has fulfilled its original purpose, (b) to compare its advantages and disadvantages in a clear way, and (c) to stimulate the debate as to whether an MMSE total score should ever be used in the absence of more detailed assessment by clinicians attempting to make a dementia diagnosis.

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“…Education levels significantly influenced the performance on individual MMSE items which confirms earlier research on the differential item performance attributable to education, race, ethnicity and language, and its use in educationally disadvantaged populations has been questioned. 69 Given the significantly poorer performance of participants with lower education levels on the recommended attention/concentration item the alternate item would preferred for local MMSE administration. Performance on the SIS was not significantly associated with education (p=.578) suggesting that this subset of MMSE items are less influenced by education effects and that it could be a useful alternative to the MMSE locally.…”

Section: Influence Of Demographic Variables and Depressionmentioning

confidence: 99%

Screening a heterogeneous elderly South African population for cognitive impairment: the utility and performance of the Mini-Mental State Examination, Six Item Screener, Subjective Memory Rating Scale and Deterioration Cognitive Observee

et al. 2013

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Objective: The aim of this study was to report on the prevalence of cognitive impairment, and to assess the performance and utility of subjective, objective and informant screening tools in a heterogeneous community sample. Method: A sample of 302 elderly participants (>60 years) living in residential homes in a large city in South Africa were screened for the presence of cognitive impairment using objective (Mini-Mental ) screening tools. All tools were compared to the MMSE and the influence of demographic variables on the performance on these tools was considered. Results: Significantly lower MMSE scores were found in participants aged 80-89 years (p=.023) and those who had 8-11 years of education (p=.002). For every one additional year of education, participants were 0.71 times less likely to screen positive on the MMSE. Differential item functioning on various components of the MMSE was demonstrated due to the effects of education, race and gender. There was significant differential performance between the recommended and alternate attention/concentration items (p<.001) with the alternate item favouring better performance. Based on the MMSE cutoff score of < 23, the prevalence of cognitive impairment was 16.9%; the prevalence yielded by the remaining tools ranged from 10.5% using the DECO to 46% as determined by the presence of a SMC. Using the MMSE as the reference standard for the presence of cognitive impairment, the SIS, SMC, SMRS and DECO had sensitivities of 82.3%, 54.6%, 17.0% and 37.5%, and specificities of 71.3%, 57.6%, 87.4% and 96.7% respectively. Age and race influenced performance on the MMSE, SIS and SMRS. Conclusion: Different types of cognitive screening tools yielded varying sensitivities and specificities for identifying cognitive impairment when compared to the MMSE. The influence of race, age and education on test performance highlights the need for suitable, culture-fair screening tools. Locally, the alternate item for attention/concentration should be preferred. However, the serious consequences of population ageing do not appear to be planned for as evidenced by the lack of a national dementia care policy. There is a lack of recent data on morbidity as well as a paucity of research particularly in the areas of cognitive, mental and physical functioning of the elderly. 3 Dementia, a condition largely affecting the aged, requires specialised services, few of which exist either in the public or private health sector in South Africa. The projected increase in the prevalence of Afr J Psychiatry 2013;16:445-455 ORIGINAL

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Differential Item Functioning (DIF) and the Mini-Mental State Examination (MMSE)

Cited by 78 publications

References 47 publications

Verbal and Physical Aggression Directed at Nursing Home Staff by Residents

Verbal and Physical Aggression Directed at Nursing Home Staff by Residents

The Death Knoll for the MMSE: Has It Outlived Its Purpose?

Screening a heterogeneous elderly South African population for cognitive impairment: the utility and performance of the Mini-Mental State Examination, Six Item Screener, Subjective Memory Rating Scale and Deterioration Cognitive Observee

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