Cross-cultural studies using a modified mini mental test for healthy subjects and patients with various forms of vascular dementia

Abstract

Existing neuropsychological tests are often complex and time-consuming. We designed a modified Mini Mental Test (MMT) battery for clinical assessment of the global and regional higher cortical functions of the brain. We tested its applicability in healthy subjects with different ethnic, cultural and educational backgrounds. The usefulness of our MMT as a tool for the clinical evaluation of patients with various forms of vascular dementia was determined. The MMT comprises five subtests, including clinical evaluations of: (A) orientation (6 points); (B) attention, right–left discrimination, speech, and calculation (20); (C) immediate recall, and recent and remote memory retrieval (10); (D) praxis (10); and (E) visuospatial orientation, agnosia, hemianopsia, and visual hemineglect (14). The MMT was administered to 100 healthy subjects from two different ethnic backgrounds (Indonesian and Chinese/Taiwanese) and diverse cultural and educational backgrounds, and to 61 patients with various forms of vascular dementia. MMT scores were significantly lower in healthy subjects with a low level of education regardless of their ethnic background ( p < 0.001). Patients with vascular dementia had much lower MMT scores than did the comparable age-adjusted normal controls ( p < 0.001). Of the patients with vascular dementia, those with Binswanger’s disease had the lowest MMT scores (25.5 ± 28.9), followed by those with large cerebral infarcts (48.0 ± 7.1), cerebral haemorrhage (49.0 ± 8.5), and multiple lacunar infarctions (55.0 ± 0.5) ( P < 0.001). With a cut-off point of 33/55 (partial score/total score), the sensitivity and positive predictive value of the MMT were 0.98 and 0.94, respectively. The MMT is a simple and useful tool for clinical assessment of the cognitive functions of healthy subjects and patients with or without vascular dementia. It can be used for individuals with different ethnic, cultural and educational backgrounds.