Modification of the mini‐mental state examination for use with the elderly in a non‐western society. Part II: Cutoff points and their diagnostic validities

Abstract

SUMMARYDiagnostic power of the Korean version of the Mini-Mental State Examination (MMSE-K) (Park and Kwon, 1990) for DSM-111-R dementia was studied in 406 persons aged 60 years or more from three sources. Psychiatric clinic patients (N= 177) were diagnosed using standard clinical procedures, laboratory tests and psychological tests; in residential home elderly (N= 128) consensus diagnoses were reached by two psychiatrists afterjoint interviews using the CAMDEX (Roth et al., 1988) including physical examinations but without laboratory tests; and members of psychiatric patients' families (N= 101) were diagnosed after a brief psychiatric interview and assessment of activities of daily living by one psychiatrist. At the cutoff point of 24/23 of MMSE-K score, sensitivity was 92.0% and specificity 91.5%. 23.9% of demented people and 39.3% of non-demented obtained similar scores between 20 and 26. With the introduction of the arbitrary criteria of 'questionable dementia' (MMSE-K score 21-24) the false positive rate was reduced to 1% and the false negative rate to 3%. 74% of males with 'questionable dementia' scores were clinically demented while only 12% of females with the same scores were demented.KEY woms-Dementia, aged, diagnosis, sensitivity and specificity.It is not easy to evaluate exactly cognitive dysfunction and its severity in the elderly. Of the many brief tests for cognitive function, the Wechsler Adult Intelligence Scale (Dick e t al., 1984). The scores also have a close relationship to lesions on the brain CT (Tsai and Twang, 1979). For these reasons and its brevity in use, the MMSE was employed in the Diagnostic Interview Schedule (Robins e t al., 1984). Satisfactory diagnostic validity of the MMSE was demonstrated in an Australian epidemiological study (Kay et al., 1985).However, its score is much influenced by the educational level of subjects (Magaziner e t al., 1987; O'Connor e t al., 1989a) and there are many problems in its administration to non-English-speaking populations (Escobar e t al., 1986). We developed the Korean version of the MMSE (MMSE-K) for use with the Korean elderly. Details of the test, including test items, instructions, interrater reliability and how to correct raw into corrected scores were described in the first part of this project (Park

Development of the Korean version of the Geriatric Depression Scale and its short form among elderly psychiatric patients

“…Cognitive function was assessed by the validated Korean version of MMSE (MMSE-K) [26,27]; scores ranged from 0 to 30, with higher scores indicating better cognition, and a score below 24 indicating cognitive impairment. In this study, subjects whose MMSE-K scores were 15 and below were excluded.…”

Associations between head circumference, leg length and dementia in a Korean population

“…For additional analyses, cognitive impairment was defined as an MMSE score of 20 or below (Park et al, 1991). An informant interview for dementia diagnosis and subtype (Dewey and Copeland, 2001) was also administered.…”

Physical health, depression and cognitive function as correlates of disability in an older Korean population

“…MMSE score was divided into three categories for descriptive presentation according to previously recommended cut-offs for this version (Park et al, 1991), but was treated as a continuous variable for principal analyses.…”