Mini-Mental State Examination Items Research Articles

Digital quantification of the MMSE interlocking pentagon areas: a three-stage algorithm

The Mini-Mental State Examination (MMSE) is a widely employed screening tool for the severity of cognitive impairment. Among the MMSE items, the pentagon copying test (PCT) requires participants to accurately replicate a sample of two interlocking pentagons. While the PCT is traditionally scored on a binary scale, there have been limited developments of granular scoring scale to assess task performance. In this paper, we present a novel three-stage algorithm, called Quantification of Interlocking Pentagons (QIP) which quantifies PCT performance by computing the areas of individual pentagons and their intersection areas, and a balance ratio between the areas of the two individual pentagons. The three stages of the QIP algorithm include: (1) detection of line segments, (2) unraveling of the interlocking pentagons, and (3) quantification of areas. A set of 497 PCTs from 84 participants including their baseline and follow-up PCTs from the Rush Memory and Aging Project was selected blinded about their cognitive and clinical status. Analysis of the quantified data revealed a significant inverse relationship between age and balance ratio (beta = − 0.49, p = 0.0033), indicating that older age was associated with a smaller balance ratio. In addition, balance ratio was associated with perceptual speed (r = 0.71, p = 0.0135), vascular risk factors (beta = − 3.96, p = 0.0269), and medical conditions (beta = − 2.78, p = 0.0389). The QIP algorithm can serve as a useful tool for enhancing the scoring of performance in the PCT.

A cross-sectional study of the major risk factor at different levels of cognitive performance within Chinese-origin middle-aged and elderly individuals

ObjectiveSenior citizens suffering from cognitive impairment (CI) are on the East Asia rise. Multiple variables could lead to inter-/intra-individual cognition effectiveness variations, though previous research efforts did not consider weighting issues. MethodsThis study scrutinized 5639 participants meeting required inclusion criteria by the CHARLS. Cognitive capacity was evaluated through Mini-Mental State Examination (MMSE). Considering that MMSE scorings were not following normal distribution, a non-parametric test and multiple linear regression were performed to screen candidate variables linked to cognitive capacity. Such applicability of candidate factors in the cumulative effect and the weighting of the impact on cognitive performance were evaluated by random forest (RF) algorithm. ResultsAge, gender, education, marital status, residence, the type of residence, exercise, socialization level and drinking were correlated to MMSE scorings (p < 0.05). Among them, age, education, gender and sociality were correlated to individual MMSE items (p < 0.05). Regardless of MMSE scores and several MMSE items, age is always a prime factor. However, in the attention and computation item, education is better than age and ranks first. ConclusionsThis preliminary study prompted age, education, gender, and sociality with varying weightings to be linked to cognitive capacity within a Chinese cohort by differing cognitive aspects. At different levels of cognitive performance, the main risk factors are basically similar, but there are still some differences.

Prevalence and associated factors of mild cognitive impairment among middle-aged and older adults: Results of the first phase of Ardakan Cohort Study on Aging.

Data on mild cognitive impairment (MCI) in low- to middle-income countries are still being determined, despite the fact that most future older adults are expected to reside in these regions. This study aimed to investigate the prevalence and associated factors of MCI in Iran. A cross-sectional study was conducted on 4938 community-dwelling subjects aged 50 years or above in the first wave of the Ardakan Cohort Study on Aging. MCI was evaluated using the Mini-Mental State Examination (MMSE) and the Abbreviated Mental Test Score (AMTS) in literate and illiterate individuals. The relationship between factors associated with the odds of MCI was assessed through logistic regression. The prevalence of MCI among all participants, the literates and illiterates, was 15.8%, 6.3%, and 36.4%, respectively. It was found that failure to accomplish any of the MMSE or AMTS items was significantly related to MCI (p < 0.001). Age ([odds ratio (OR): 1.05; p < 0.001 in the literates], [OR: 1.06; p < 0.001 in the illiterates]), sex (OR: 0.13; p < 0.001 in the illiterates), history of stroke ([OR: 2.86; p = 0.006 in the literates], [OR: 2.04; p = 0.045 in the illiterates]), and depression ([OR: 1.87; p < 0.001 in the literates], [OR: 1.41; p = 0.008 in the illiterates]) were significantly associated with MCI. This study highlights the significant associations between age, education, depression, stroke, and MCI in Iranian participants. These findings emphasize the need for targeted interventions in low-literacy populations, mental health screening, and stroke prevention strategies to mitigate the burden of MCI and enhance cognitive health.

THE MINI-MENTAL STATE EXAMINATION IN A CHINESE POPULATION: RELIABILITY, VALIDITY, AND MEASUREMENT INVARIANCE

Abstract The Mini-Mental State Examination (MMSE) is a widely used screening tool for cognitive impairment and dementia in many cultures and regions. However, the properties of the MMSE in the Chinese context have not been evaluated with large population-representative samples. It is also unclear whether item properties of the MMSE differ across age and education subgroups. We study the psychometric properties of the MMSE using data from 8974 respondents aged 60 years or older in the 2018 Chinese Health and Retirement Longitudinal Study (CHARLS). Using item response theory (IRT) for the ordinal data, we confirm a three-dimensional factor structure for the MMSE in CHARLS in accordance with the underlying theoretical framework and establish acceptable model-data fit (SRMSR = 0.036). Total scores and subscale scores of the MMSE correlated positively with each other and correlated negatively with ADL (r = -0.19), IADL (-0.30), and CESD scores (-0.25). The reliability of the total MMSE scores was estimated at 0.78, indicating moderate measurement precision in the study population. Multiple group IRT analysis found that item characteristics and item functioning of 5 items differed by age group and 14 items differed by educational level. This analysis provided evidence on violations to measurement invariance of MMSE items, pointing to a need to account for item-level differences in measurement properties primarily with respect to education level when using the MMSE in CHARLS and, more generally, in Chinese populations. In addition, revised cognitive measures are advised to be used in CHARLS to improve the precision of measurement.

Utility of Mini‐Mental State Examination items to detect objective memory impairment in mild cognitive impairment

AbstractBackgroundAlzheimer’s disease (AD) is the main cause of cognitive impairment in late‐life, and the typical early presentation of AD in older adults is amnestic cognitive impairment. Mini‐Mental State Examination (MMSE) is widely used in screening cognitive impairment in elderly. The aim of this study was to examine which MMSE items would be more associated with the verbal memory impairment in individuals with mild cognitive impairment (MCI).Method249 MCI subjects (mean age: 73.67 ± 6.79 years) were included in this study. The participants underwent clinical assessments and completed detailed neuropsychological tests. The participants were divided into two groups according to Seoul Verbal Learning Test Delayed Recall (SVLT DR) scores: normal verbal memory performance (SVLT DR &gt; = ‐1.5 SD) vs low verbal memory performance (SVLT DR &lt; ‐1.5 SD) groups. Group comparisons between normal and low verbal memory performance were performed. In addition, associations between verbal memory performance and MMSE items were analysed.ResultLow verbal memory performance group (n = 91) had more males and a tendency to be older and more educated than normal verbal memory performance group (n = 158). For MMSE items, low verbal memory performance group had lower MMSE time orientation and lower MMSE recall subscores, and a tendency of higher MMSE copy score than normal verbal memory performance group. Multivariable analyses showed that male sex, MMSE time orientation and MMSE recall scores were associated with lower verbal memory performance.ConclusionIn MCI individuals, male sex, and MMSE time orientation and recall subscores among demographics and MMSE items were associated with low verbral memory performance. These results suggest that more consideration for MMSE sub‐items would be helpful for the clinical evaluation of individuals with MCI at first step.

Geo‐Cultural Influence on Change in CDR and MMSE Scores

AbstractBackgroundAlzheimer’s disease (AD) clinical trials are increasingly global. Most measures used were validated and standardized with North American, White, English‐speaking populations with limited consideration of cultural nuance. Prior research suggests that both the Clinical Dementia Rating (CDR) and Mini Mental State Examination (MMSE) are not free from cultural and linguistic influence. It is important to understand how geo‐cultural factors influence longitudinal change in scores on these measures, which is often used as the primary endpoint for study efficacy. In this study, we examined whether change in CDR and MMSE scores over one‐year follow‐up varied across geo‐cultural regions.MethodThis study included electronic CDR (eCDR) and electronic MMSE (eMMSE) data from four multi‐national AD clinical trials of subjects with prodromal to mild AD. Data were collected at screening and one‐year follow‐up from seven geo‐cultural regions: East Asia (n = 138); Eastern Europe (n = 170); Western Europe (n = 484); North America (n = 496); South America (n = 55); Middle East/Africa (n = 26); and Oceania (n = 26).ResultThe Kruskal–Wallis test found statistically significant variance in CDR‐Sum of Box (CDR‐SB) scores across geo‐cultural regions (p &lt;0.0001). Results of the Dunn’s test indicated mean change in CDR‐SB scores for South America was significantly lower than those for North America, Eastern Europe, Western Europe, and Mideast/Africa. Additionally, mean change in CDR‐SB scores for East Asia was significantly lower than those for Western and Eastern Europe. Change in MMSE total scores did not vary across geo‐cultural regions.ConclusionOur study found average change in CDR‐SB but not MMSE total scores differed significantly across geo‐cultural regions. CDR‐SB scores were relatively more stable in South America compared to most other regions, and in East Asia compared to Western/Eastern Europe. The CDR may be more susceptible to cultural factors due to its reliance on subjective information from caregivers, in contrast with the MMSE, a standardized, objective measure. Different social norms and expectations for aging, functional independence, and trial participation in these regions may have contributed to the variance. Future studies should examine if specific CDR or MMSE items are more contextually dependent on the local culture.

Relationship between Cognitive Performance and Depressive Symptoms in Chinese Older Adults: The China Health and Retirement Longitudinal Study (CHARLS)

BackgroundIn China, an increasing number of people are aging; therefore, attention should be paid to age-related cognitive impairment. With the increasing attention given to geriatric depression in recent years, we focused our investigation on the relationship between depression in the elderly and cognitive decline in a large Chinese community study. MethodsWe screened 4,771 subjects that met the inclusion criteria from the China Health and Retirement Longitudinal Study database. Depressive symptoms and cognitive performance were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and Mini-Mental State Examination (MMSE), respectively. ResultsWe found that 4.46% of the elderly have depression and 35.19% have depressive symptoms. Lower education, higher CESD-10 score, increased age, and more negative marital status were associated with poor cognitive performance in the Chinese elderly. CESD-10 is negatively correlated with each MMSE item, including orientation, memory, attention and computation, and language. LimitationsIt was difficult to draw conclusions about causation since there was no follow-up data, and high CESD-10 scores do not represent the population study finally diagnosed with depression. Finally, it is not clear whether the decline in cognitive function had an impact on participants’ understanding of the problems in the CESD-10. ConclusionsThis study preliminary prompted severe depressive symptoms associated with worse cognitive performance in a Chinese elderly community population.

Mini-Mental State Examination in Brazil: An Item Response Theory Analysis

Abstract The Mini-Mental State Examination (MMSE) is currently used to the track cognitive status of older adults in Brazil. Studies on its psychometric properties are lacking, especially ones that use Item Response Theory. The objective was to assess the difficulty of the items in a Brazilian version of MMSE using the Rasch model and to identify possible differential item functioning (DIF), considering schooling, age and sex of the sample of Brazilian older adults. This study used the answers of 2.734 older adults to the 30 items of MMSE. It was found that four items in the seven series were the most difficult, and items nine, 13, 22 and 23 were the easiest. The skill of respondents was higher than the items’ difficulty level. DIF was observed for schooling, sex and age in, respectively, 27, 18 and 16 items. It is concluded that the use of MMSE in Brazilian older adults should be cautious due to the large number of biased items, mainly due to schooling.

Cross-cultural adaptation and psychometric properties of the MMSE and MoCA questionnaires in Tanzanian Swahili for a traumatic brain injury population

BackgroundTraumatic Brain Injury (TBI) is the most common cause of injury-related death and disability globally, and a common sequelae is cognitive impairment. Addressing post-TBI cognitive deficits is crucial because they affect rehabilitation outcomes, but doing this requires valid and reliable cognitive assessment measures. However, no such instrument has been validated in Tanzania’s TBI population. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are two commonly used instruments to measure cognitive impairment, and there have been a few studies reporting their use in post-TBI cognitive assessment. Our aim was to report the psychometric properties of the Swahili version of both scales amongst the TBI population in Tanzania.MethodsA cross-cultural adaptation committee participated in the translation and content validation process for both questionnaires. Our patient sample consisted of 192 adults with TBI who were admitted to Kilimanjaro Christian Medical Center (KCMC) in Tanzania. Confirmatory factor analysis, reliability and external validity were evaluated.ResultsMoCA showed adequate factor loadings (values > 0.50 for all items except items 7 & 10) and adequate reliability (values > 0.70). Factor loadings for most of the MMSE items were below 0.5 and internal consistency was medium (< 0.7). Polychoric correlation between MMSE and MoCA was strong, positive and statistically significant (r = 0.68, p = 0.001); correlation with the cognitive subscale of FIM indicated moderately positive relationships - MMSE (r = 0.35, p = 0.001) and MoCA (r = 0.43, p = 0.001).ConclusionsWith the exception of the language and memory items, MoCA is a valid and reliable instrument for cognitive impairment screening in Tanzania’s adult TBI population. On the other hand, MMSE does not appear to be an appropriate tool in this patient group, but its positive correlations with MoCA and cFIM indicate similar theoretical concepts. Both instruments require further validation studies to prove their predictive ability for screening cognitive impairment before they are considered suitable for clinical use.

Anew scoring system for increasing the sensitivity of the MMSE.

The mini mental state examination (MMSE) has been criticized for its lack of sensitivity, especially in mild cases of dementia. There have been several attempts to increase the sensitivity by adding or deleting items, which never became accepted in clinical practice. In the current study anew scoring system for improving the sensitivity of the MMSE is proposed, which preserves the original items and the total score of 30points. Instead of changing the number of items or the total score of 30points, the weighting of the different items in the total score of 30points was changed. Neuropsychological test data of 765 patients were retrospectively included in the study to determine the difficulty of each MMSE item. Multiple scoring systems for the MMSE were developed by inclusion of the item difficulty and clinical relevance. The sensitivity of the new scoring system was compared to the original scoring system by using the DemTect as an established measure. The results showed that an increase of 24.3% in sensitivity was statistically significant. Within the mild cognitive impairment subgroup, the sensitivity of the new scoring system was twice as high in comparison to the original MMSE and within the dementia group the sensitivity was increased by 8.2%. Anew scoring system with ahigher sensitivity than the original MMSE was developed, which can easily be administered in clinical practice because it preserves all items and the total score of 30points.

Tooth Loss-associated Cognitive Impairment in the Elderly: A Community-based Study in Japan.

Objective Dementia is a major cause of disruption for a healthy life expectancy in Japan. It has been suggested that the number of teeth is a modifiable risk factor for cognitive impairment and dementia. We therefore examined the possible association between the cognitive function and the number of natural and artificial teeth in community-dwelling Japanese elderly individuals. Methods Among the participants in our prospective, community-based study, 210 elderly individuals (103 men and 107 women; 78.1±4.9 years; mean age±standard deviation) underwent both dental examinations and a Mini-Mental State Examination (MMSE), as well as various medical checkups, in 2016 and 2017. Results The number of natural teeth was significantly associated with an individual's MMSE score. The percentage of cognitively normal subjects (MMSE scores: 27-30) decreased significantly with a decrease in the number of natural teeth. Among the MMSE items, the calculation ability was significantly and independently associated with the number of natural teeth. Regression was calculated as the predicted score of MMSE =21+0.3×(years of schooling)+0.1×(number of natural teeth). Among individuals with 19 or fewer natural teeth, those who had a total of 20 teeth or more, including both natural and artificial teeth, had significantly higher MMSE scores than those who had 19 or fewer natural and artificial teeth combined. Conclusion The number of natural teeth was significantly associated with the cognitive function, especially the calculation ability, and the use of artificial teeth was associated with the preservation of the cognitive function in community-dwelling elderly individuals.

Interpreting Mini-Mental State Examination Performance in Highly Proficient Bilingual Spanish-English and Asian Indian-English Speakers: Demographic Adjustments, Item Analyses, and Supplemental Measures.

Performance on the Mini-Mental State Examination (MMSE), among the most widely used global screens of adult cognitive status, is affected by demographic variables including age, education, and ethnicity. This study extends prior research by examining the specific effects of bilingualism on MMSE performance. Sixty independent community-dwelling monolingual and bilingual adults were recruited from eastern and western regions of the United States in this cross-sectional group study. Independent sample t tests were used to compare 2 bilingual groups (Spanish-English and Asian Indian-English) with matched monolingual speakers on the MMSE, demographically adjusted MMSE scores, MMSE item scores, and a nonverbal cognitive measure. Regression analyses were also performed to determine whether language proficiency predicted MMSE performance in both groups of bilingual speakers. Group differences were evident on the MMSE, on demographically adjusted MMSE scores, and on a small subset of individual MMSE items. Scores on a standardized screen of language proficiency predicted a significant proportion of the variance in the MMSE scores of both bilingual groups. Bilingual speakers demonstrated distinct performance profiles on the MMSE. Results suggest that supplementing the MMSE with a language screen, administering a nonverbal measure, and/or evaluating item-based patterns of performance may assist with test interpretation for this population.

ADCOMS: a composite clinical outcome for prodromal Alzheimer's disease trials

BackgroundDevelopment of new therapies for Alzheimer's disease (AD) is increasingly focused on more mildly affected populations, and requires new assessment and outcome strategies. Patients in early stages of AD have...

MMSE items that predict incident delirium and hypoactive subtype in older medical inpatients

Because hypoactive delirium is especially under-recognized, we analyzed which Mini-Mental State Examination (MMSE) items predicted incident delirium and its hypoactive motor presentation. Over a 1-year period, older medical inpatients (n=291) were consecutively screened on admission with the Confusion Assessment Method-Spanish (CAM-S) to exclude prevalent delirium. Nondelirious patients were evaluated the same day with the MMSE, followed by daily ratings with the CAM-S. Those who became CAM-S positive were rated using the Delirium Rating Scale—Revised-98 to assess severity and motor subtype. Disorientation to time (OR 4.4, 95% CI 1.7–11.1) and place (OR 3.8, 95% CI 1.7–8.2) at admission were risk factors for delirium at follow-up and together correctly classified 88.3% of subjects as to delirium status. Disorientation to time and place, and visuoconstructional impairment were each associated with either hypoactive or mixed subtype (p<0.05 χ2 test). Simple bedside evaluation of cognitive function in nondelirious patients revealed deficits that detected patients at risk for developing incident delirium at follow-up (especially hypoactive or mixed). We recommend patients with orientation deficits be monitored closely for emergence of delirium. A separate evaluation for possible dementia or other causes of cognitive impairment at admission should be considered too.

Covert Hepatic Encephalopathy: Does the Mini-Mental State Examination Help?

The Mini-Mental State Examination (MMSE) has been utilized for the diagnosis of hepatic encephalopathy (HE). However, its threshold of abnormality has not been formally tested in patients with cirrhosis and its diagnostic/prognostic validity remains unknown. The aim of this study was to assess it in a large group of well-characterized outpatients with cirrhosis and no overt HE. One-hundred-and-ninety-one patients underwent clinical assessment, MMSE, electroencephalography (EEG) and paper-and-pencil psychometry (PHES); 117 were followed up for 8±5 months in relation to the occurrence of HE-related hospitalizations. On the day of study, 81 patients (42%) had abnormal EEG and 67 (35%) abnormal PHES; 103 (60%) had a history of HE. Average MMSE was 26.6±3.5; 22 (19%) patients had abnormal MMSE based on the standard threshold of 24. Patients with abnormal EEG/PHES/history of HE had worse MMSE performance than their counterparts with normal tests/negative history (25.7±4.2 vs. 27.3±2.7; P<0.01; 25.5±3.2 vs. 27.9±1.8, P<0.0001; 26.3±3.7 vs. 27.4±2.6, P<0.05, respectively). Based on the above results, MMSE thresholds of 26 and 27 were tested against abnormalities in clinical/EEG/PHES indices and significant associations were observed. An MMSE threshold of 26 was also a predictor of HE-related hospitalization (Cox-Mantel: P=0.001); patients with MMSE<26 were significantly older than those with MMSE≥26 but comparable in terms of liver dysfunction and ammonia levels. When MMSE items were considered separately, those which correlated most significantly with standard HE indices where spatial orientation and writing. In conclusion, an MMSE<26 identifies older patients with cirrhosis who are more prone to manifest HE signs.

Relevance between Alzheimer’s Disease Patients and Normal Subjects Using Go/No-Go Tasks and Alzheimer Assessment Scores

It is a well-known fact that Alzheimer increases with aging. Early detection of Alzheimer has emerged as an important, because it can prevent of further deterioration of the disease. However, early detection is not always easy because of the lack of good methods to identify the early stage of Alzheimer. The screening tests of Alzheimer used around the world. These tests are relatively time-consuming, difficult and distressing for Alzheimer patients. We consider whether go/no-go task can become the screening test of the Alzheimer patient in future. This study compared results of the Mini Mental State Examination (MMSE) and the go/no-go task for between Alzheimer disease patients and normal subjects. The average reaction time and number of total error of go/no-go task that Alzheimer patients were significantly higher than among the normal subjects. About correlation with MMSE and the go/no-go task, 6 items of MMSE had correlations of 4 or more test results concerning response time, forgets and mistakes of go/no-go tasks. These characteristics suggest that there is a possibility that go/no-go tasks could be applied as a measuring method when screening for early signs of Alzheimer.

Predictability of Various Serial Subtractions on Global Deterioration Scale According to Education Level

BackgroundThe serial 100-7s subtraction, an item on the Mini-Mental State Examination (MMSE), is well known for being difficult for uneducated people. Therefore, we investigated into alternative serial subtractions for serial 100-7s subtraction in uneducated people.MethodsOne hundred sixty-nine subjects were enrolled by neurologic or neuropsychiatric out-patient clinics in 4 university medical centers. The subjects were divided into two groups: an uneducated group and an educated group (at least primary schooling) by questionnaire. We investigated the correlation between incorrect number of serial subtractions and Global Deterioration Scale (GDS) score in both groups and undertook receiver operating characteristic (ROC) curve analysis. MMSE including serial 40-4s subtraction, serial 20-2s subtraction, and serial 10-1s subtraction instead of serial 100-7s subtraction were arbitrally named MMSE4, MMSE2, and MMSE1.ResultsIn the educated group, serial 100-7s subtraction showed the highest correlation with GDS score (correlation coefficient, 0.465; P < 0.001). In the uneducated group, serial 40-4s subtraction showed the highest correlation with GDS score (correlation coefficient, 0.608; P < 0.001), and serial 100-7s indicated the lowest correlation (correlation coefficient, 0.378; P = 0.023). In ROC curve analysis for MMSE, MMSE4, MMSE2, and MMSE1 to assess the presence of dementia (GDS score ≥ 3) in uneducated subjects, the area under the curve (AUC) was 0.648, 0.770, 0.758, and 0.711, respectively, and in educated subjects, AUC for MMSE, MMSE4, MMSE2, and MMSE1 was 0.729, 0.719, 0.716, and 0.714, respectively.ConclusionOut of MMSE items, serial 100-7s is adequate in the educated elderly, but may be less adequate in the uneducated elderly. Serial 40-4s seems to be more appropriate for MMSE in the uneducated elderly.

Is the Folstein's Mini-Mental Test an Aphasia Test?

The Mini-Mental State Examination (MMSE) is recognized as a valid screening for dementia. It consists of 29 verbal items from a total of 30. The Brief Aphasia Evaluation (BAE) includes 10 aphasia and 12 orientation items, which are similar to most of the MMSE items. It was studied whether those BAE items (MMSE-like): (a) correlate with the rest of the BAE items (BAE-rest), and (b) differentiate patients with left cerebral lesions (LC) from both patients with right cerebral lesions (RC) and healthy participants (HP). A sample of 109 right-handed volunteers (38 HP, 37 LC, and 34 RC) was studied. The three groups were matched according to gender, age, and education. Patients were similar in multiple variables. The correlation between MMSE-like and BAE-rest was .90. MMSE-like showed a sensitivity and specificity of .81 or above to identify the LC from the other two groups. There is a risk for misdiagnosing aphasia as dementia with the MMSE.

Predictors of Future Cognitive Decline in Persons with Mild Cognitive Impairment

This study sought first to identify individual items of the Mini-Mental State Examination (MMSE) and demographic variables at baseline that predicted the trajectories of cognitive change among patients with mild cognitive impairment (MCI), and second to quantify the risk of cognitive decline in such patients based on their pattern of failure of MMSE items. 187 MCI patients were evaluated serially with the MMSE for up to 3.5 years. Patients who followed a declining cognitive trajectory differed from the stable reference group in their baseline profile of MMSE test performance. Patient age and performance on delayed recall, constructional praxis, attention, and orientation to time and floor predicted future cognitive decline with good accuracy (79.9%) and specificity (86.4%), and moderate sensitivity (67.2%). These results are presented in the form of a simple clinical tool for quantifying risk of future cognitive decline in MCI.

Conversion of the Mini-Mental State Examination to the International Classification of Functioning, Disability and Health Terminology and Scoring System

Background: In older patients, evaluation of the cognitive status is crucial. The Mini-Mental State Examination (MMSE) is widely used for screening of cognition, providing fairly high sensitivity, specificity and reproducibility. Recently, a consensus emerged on the necessity of an international and transparent language, as provided by the WHO’s International Classification of Functioning, Disability and Health (ICF). Most assessment tools however are not in accordance with the ICF. Objective: To reformulate the MMSE according to the ICF, both for the individual items and for the scoring system. Method: MMSE data (scores varying from 3 to 30/30) of (1) 217 cognitively healthy elderly, (2) 60 persons with mild cognitive impairment, (3) 60 patients with mild Alzheimer’s disease (AD), and (4) 60 patients with moderate/severe AD were obtained from studies at a university hospital setting. Subjects were aged 65 years or more and recruited either through advertisement (group 1), from the geriatric day hospital (groups 2 and 3), or the geriatric ward (group 4). The allocation to the groups was done after multidisciplinary evaluation. The conversion of the MMSE to ICF-MMSE was done by content comparison and by subsequent translation of the scoring system using automatic algorithms. Results: All MMSE items were converted to the corresponding ICF categories. Three ICF domains were addressed: global and specific mental functions, general tasks and demands, divided over 6 ICF categories (orientation time/place, sustaining attention, memory functions, mental functions of language, undertaking a simple task). Scores on individual items were transformed according to their relative weight on the original MMSE scale, and a total ICF-MMSE score from 0 (no problem) to 100 (complete problem) was generated. Translation was satisfying, as illustrated by a good correlation between MMSE and ICF-MMSE. The diagnostic groups were distributed over the ICF-MMSE scores as expected. For each ICF domain, ICF-MMSE subscores were higher with increasing severity in cognitive decline. There was a higher dispersion, in accordance with the more detailed scoring possibilities of the ICF-MMSE. Conclusions: It is possible to adapt the MMSE to the ICF concept. This adaptation enhances interdisciplinary communication since it provides more clarity in assessment, with better visibility of the areas covered by the instrument.