Abstract
AimMini-Mental State Examination (MMSE) is one of the most used tests for the screening of global cognition in patients with neurological and medical disorders. Norms for the Italian version of the test were published in the 90 s; more recent norms were published in 2020 for Southern Italy only. In the present study, we computed novel adjustment coefficients, equivalent scores and cut-off value for Northern Italy (Lombardia and Veneto) and Italian speaking Switzerland.MethodsWe recruited 361 healthy young and old (range: 20–95 years) individuals of both sexes (men: 156, women: 205) and from different educational levels (range: 4–22 years). Neuropsychiatric disorders and severe medical conditions were excluded with a questionnaire and cognitive deficits and were ruled out with standardized neuropsychological tests assessing the main cognitive domains. We used a slightly modified version of MMSE: the word ‘fiore’ was replaced with ‘pane’ in verbal recalls to reduce the common interference error ‘casa, cane, gatto’. The effect of socio-demographic features on performance at MMSE was assessed via multiple linear regression, with test raw score as dependent variable and sex, logarithm of 101—age and square root of schooling as predictors.ResultsMean raw MMSE score was 28.8 ± 1.7 (range: 23–30). Multiple linear regression showed a significant effect of all socio-demographic variables and reported a value of R2 = 0.26. The new cut off was ≥ 26 /30.ConclusionWe provide here updated norms for a putatively more accurate version of Italian MMSE, produced in a Northern population but potentially valid all over Italy.
Highlights
In 1975, Marshal and Susan Folstein, from the New York Hospital-Cornell Medical Center in NY, USA, published a brief and simple tool for the assessment of ‘mental state’ in patients with dementia or psychiatric disorders, the MiniMental State Examination (MMSE) [10]
The logarithm of 101 years of age and the square root of years of schooling were found to provide the best transformations of age and education. These transformed variables, sex, and their interaction terms were included in a simultaneous multiple linear regression analysis
We report novel norms for Italian MMSE computed via multiple regression analysis in a sample of 361 young and old neurologically healthy and cognitively unimpaired individuals from Northern Italy and Italian speaking Southern Switzerland
Summary
In 1975, Marshal and Susan Folstein, from the New York Hospital-Cornell Medical Center in NY, USA, published a brief and simple tool for the assessment of ‘mental state’ in patients with dementia or psychiatric disorders, the MiniMental State Examination (MMSE) [10]. One point is attributed to each correct response, for a total score of 30. The popularity of MMSE has grown to the point that the term ‘MMSE’ yields nearly 20,000 Pubmed records and has gone from 14 citations in 1975 to more than 1400 in 40 years, in 2015. The test has been used and is still widely used, for the screening of global cognition in a great variety of medical and neurological populations (e.g. patients with stroke [29], Multiple sclerosis [25], hepatic encephalopathy [16] or renal failure [8], just to mention a few), with dementia being its main and most successful area of application [7, 17]
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