Practice effect and test-retest reliability of the Mini-Mental State Examination-2 in people with dementia

Abstract

Background The Mini-Mental State Examination-Second Edition (MMSE-2) consists of three visions: a brief version (MMSE-2:BV), a standard version (MMSE-2:SV), and an expanded version (MMSE-2: EV). Each version was equipped with alternate forms (blue and red). There was a lack of evidence on the practice effect and test-retest reliability of the three versions of the MMSE-2, limiting its utility in both clinical and research settings. The purpose of this study was to examine the practice effect and test-retest reliability of the MMSE-2 in people with dementia. Methods One hundred and twenty participants were enrolled, of which 60 were administered with the blue form twice (i.e., the same-form group, [SF group]) and 60 were administered with the blue form first and then the red form (alternate-form group, [AF group]). The practice effect was evaluated using a paired t-test and Cohen’s d. The test-retest reliability was examined using the intraclass correlation coefficient (ICC). Results For the practice effects, in the SF group, no statistically significant differences were found for the MMSE-2:BV and MMSE-2: EV total scores and eight subtests (p = 0.061–1.000), except for the MMSE-2:SV total score (p = 0.029). In the AF group, no statistically significant differences were found for all three versions of the total scores and subtests (p = 0.106–1.000), except for the visual-constructional ability subtest (p = 0.010). Cohen’s d of all three versions’ total scores and subtests were 0.00–0.20 and 0.00–0.26 for SF group and AF group, respectively. For the test-retest reliability, ICC values for all three versions and eight subtests in SF and AF groups were 0.60–0.93 and 0.56–0.93, respectively. Conclusion Our results demonstrated that the practice effect could be minimized when alternate forms of the MMSE-2 were used. The MMSE-2 had good to excellent test-retest reliability, except for three subtests (i.e., visual-constructional ability, registration, and recall). Caution should be taken when interpreting the results of visual-constructional ability, registration, and recall subtests of the MMSE-2.

Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research study

“…This study showed that the short, remote, and digital cognitive M-CogScore test was comparable with both the MMSE-2, which is an updated version of the original and widely administered MMSE cognitive screening test ( 3 ), and the CDR, which is a structured cognitive questionnaire without objective testing. These results are particularly noteworthy because short tests are usually considered to be inadequate to detect MCI ( 12 ).…”

“…While the CDR takes up to 60 min ( 5 , 19 , 30 ), and MMSE-2 takes 10–15 min to complete ( 3 ), the M-CogScore can be completed in less than 5 min ( 23 ). Additionally, although the CDR is used extensively in research trials and epidemiological studies to identify cognitively impaired individuals, it requires the presence of both a trained test-supervisor to administer and score, as well as the presence of a companion ( 31 ), which are not required for the M-CogScore.…”

“…The CDR global score (range 0–3) was calculated, where 0 was normal, and anything over 0 was impaired cognition ( 18 ). All participants also took the 30-item MMSE-2 and were given a score out of 30 ( 3 ).…”

“…Accessing specialised memory units for the screening of cognitive impairment has been increasingly difficult, with the COVID-19 pandemic further impacting access, especially amongst the elderly. Screening tests such as the Mini-Mental State Examination Second Edition Standard Version (MMSE-2) can take 15 min or longer to complete ( 3 , 4 ). The clinical dementia rating scale (CDR) requires the physical presence of a companion that knows the patient well, and can take up to 60 min to complete ( 5 ).…”

Checking the validity and reliability of the Japanese version of the Mini-Cog using a smartphone application

“…In this study, the same test was repeated three times over a certain period, similarly to previous studies. Therefore, the inclusion of learning and order effects may have affected the results [mean (standard deviation)] of the Mini-Cog scores at the time of participation in the study: in the beginning 4.2 (± 1.0); 4 weeks later: 4.8 (± 0.5); 8 weeks later: 4.6 (± 1.0) [ 18 ].…”