Does a Reliable Decline in Mini Mental State Examination Total Score Predict Dementia?

Abstract

Background/Aim: Norms for change in Mini Mental State Examination (MMSE) total score suggest that only a decline of at least 2–4 points indicates a reliable change. However, it is unknown whether change norms (Reliable Change Indices, RCIs) of the MMSE total score are suitable to predict future dementia. Methods: 554 elderly individuals aged 75 and over without dementia at the first 2 visits were tested with the MMSE at a maximum of 6 visits with 1.5-year intervals. Two different RCIs for change in MMSE score (first to second visit) were computed – one RCI which corrects for practice and one RCI which corrects for regression to the mean. The main outcome measure was the diagnosis of dementia. Results: During the study, 88 persons developed dementia. RCIs were significantly associated with future dementia diagnosis. The best cutoff for raw change in MMSE total score to predict dementia was –1 point (sensitivity = 48%, specificity = 67%, relative risk = 1.6). With the RCI + regression to the mean, the diagnostic accuracy was moderate (sensitivity = 61%, specificity = 72%, relative risk = 3.2). Conclusion: A change in MMSE total score is significantly associated with future dementia, but the diagnostic accuracy for dementia prediction is rather low.