Preliminary Assessment of an Arabic Version of the Mini-Mental State Examination

Abstract

S Al-Rajeh, A Ogunniyi, A Awada, A Daif, R Zaidan, Preliminary Assessment of an Arabic Version of the MiniMental State Examination. 1999; 19(2): 150-152 The Mini-Mental State Examination (MMSE) is one of the most widely used instruments for quantitative assessment of cognitive functions and for dementia screening.1,2 It assesses many cognitive domains, including orientation, memory, language, calculation and visual construction. The test, however, shows educational as well as cultural bias, and appears to be more suited to Western culture. [2][3][4] The use of the MMSE in other cultures, therefore, entails translation into the specific languages, modification and/or substitution of some of the items with culturally relevant ones, and pilot-testing these for reliability, sensitivity and specificity. There are many versions and translations of the MMSE, including Chinese, German, Spanish and Nigerian, which have been used for studies in the respective cultures. [4][5][6][7] An Arabic version of the MMSE was developed and pilot-tested on Saudi patients. The results are presented in this report. Materials and MethodsThe MMSE was translated into the Arabic language, with many items left unchanged from the original version. The names of the area of the Kingdom and its location were substituted for the name of the country and the particular state, which appear in the original version. Date (a popular palm produce), chair and money, were the three items most often used. We used serial subtraction of 3s from 100 for assessing calculation, attention and concentration. We omitted spelling "world" backwards because the concept appeared difficult in a predominantly illiterate population. The expression "no ifs, ands or buts" was replaced by an Arabic phrase. The Arabic version produced was then translated back into English to ensure consistency of the items. The questionnaire was then administered by the same interviewer to 33 subjects, comprising 27 males and 6 females, who volunteered to take part in the study. The participants were mainly relations of inpatients at the King Khalid University Hospital, Riyadh (KKUH), who had no evidence of central nervous system dysfunction and were not on medications that could depress cognitive function or alertness. The responses were recorded as either correct or incorrect. The educational status of the individuals was obtained at the end of the administration of the questionnaire. Individuals who had not attended school or had spent less than six years in school were regarded as uneducated.Using sequential analysis, the questionnaire was administered by the same interviewer to four clinically diagnosed demented patients (based on DSM-IV criteria) 8 being managed at KKUH, for the determination of its psychometric properties. The dementia diagnoses were vascular (two cases), probable Alzheimer's disease (one case) and dementia associated with meningioma (one case). The patients included three females and one male, with a mean age of 69.8±11.2 years (range, 54-80 years), who were uned...

Cognitive function and its association with level of education and work status in adults in Saudi Arabia: a cross-sectional study

“…This is in agreement with other published studies in Saudi Arabia and the Arab world. 5,6 On average, males of our sample scored 3 points higher than females. The difference between the two genders in MMSE scores was previously attributed to sociocultural factors regarding female education and employment.…”

“…4 As predicted, and reported by numerous other researches, education has the largest effect on cognitive function as scored by the MMSE. [2][3][4][5][6] Subjects who obtained no education scored several points less than those who did. And there was a gradual increase in the mean score of subjects belonging to progressively higher levels of education, with those who went to college/university scoring, on average, 8 points more than uneducated subjects.…”

“…4 This is reflected in cognitive function scores of individuals with varying levels of education. 5,6 Cognitive function can be scored in various ways; one of the most widely used methods is known as the Mini Mental State Examination (MMSE). It was introduced in 1975 to thoroughly but routinely investigate the cognitive realm.…”

“…6 International studies have shown that cognitive changes with age can be reduced, proving that cognitive impairment is not an inevitable result of aging. [7][8][9] Studies suggest that continuous learning and mental exercise may be crucial interventional factors in preserving cognitive health throughout aging.…”

“…However, this cut-off value has a low specificity of 51.5%, with sensitivity of 100% for the diagnosis of dementia according to Al-Rajeh Both of these studies showed that the mean MMSE of males was higher than that of their female counterparts. 6 This may be due to cultural and societal influences on the previous generations regarding female education and employment.…”