ADAPTATION OF THE MODIFIED MINI-MENTAL STATE (3MS) EXAM, DEVELOPMENT OF A VERSION FOR THE UNDEREDUCATED, AND DETERMINATION OF NORMATIVE VALUES IN THE TURKISH POPULATION

Abstract

No dementia screening tests with a completed standardization is available in Turkey at present. Most tests in use only have certain threshold values derived from clinical settings, not from population-based studies, which restricts their administration among different patient groups. This study aimed to standardize a potentially widely-applicable screening test to be used in the Turkish population. Currently, over 20% of the Turkish elderly have less than 5 years education, therefore development of a separate version for undereducated elderly population was also planned. Since Mini-Mental-State-Examination (MMSE) is widely used in primary care and a version for the undereducated exists, we decided to standardize Modified-Mini-Mental-Test (3MS) which is an expanded and modified version of MMSE. Translation and cultural adaptation process included a preliminary study, which led to the final version of the Turkish-3MS. A population-based study including individuals over the age of 55 was run to determine the normative values in a representative sample in Ankara, Turkey. A sociodemographic form including health status, lifestyle and environmental factors, daily activities of living and 3MS were used for data collection. Previous diagnosis of dementia along with neuropsychiatric disorders that might affect cognition were determined as exclusion criteria. The association of sociodemographic variables with 3MS scores were evaluated. This study was funded by the Scientific and Technological Research Council of Turkey (Grant no: 214S048). A total of 2235 participants were included. After the exclusion, data of 1948 individuals were analyzed for normative study. Of the study sample, 51.3% were female and 41.1% had less than five years of education (grouped as undereducated). Among the sociodemographic variables examined, age, gender, and education accounted for variance in 3MS scores. Younger age, male gender and higher educational attainment were associated with better 3MS performance. Normative values for both undereducated and educated versions of 3MS-Turkish form were determined. A dementia screening test with normative values was developed for the Turkish population. The test will provide the opportunity for health professionals, including primary care workers to evaluate the cognitive performance based on age, gender and education level, in both educated and undereducated elderly. Studies for further psychometric features are ongoing.