Mini Mental State Examination (MMSE): A validation study in Greece

Abstract

Aim of the study: To validate the MMSE in Greece.

Materials and Methods: 151 subjects took part in the study—64 non-demented subjects (42 males and 22 females) and 87 demented patients (44 males and 43 females), suffering from mild to severe dementia of various types (Alzheimer's disease, vascular dementia, and dementia secondary to other causes). The demented patients' age was 68.05 ±.72 years (mean ± standard deviation), their education 5.71 ± 2.95 years. The normal subjects' age was 68.57 ± 10.32 years and education was 6.18 ± 3.20 years. The diagnosis was made according to the DSM-IV and the NINCDS-ADRDA diagnostic criteria.

Results: MMSE appeared to be valid during test and retest with a Spearman's coefficient p = 0.98 (p < 0.001). At the score level of 23/24, sensitivity is 90.80, specificity 90.62 and positive predictive value (PPV) of 92.94.

Conclusion: The present study confirms the MMSE score 23/24 as a valid cutoff level for the diagnosis of dementia in Greece.

Keywords

MMSE validation neuropsychological assessment dementia cognitive function Greek population

References

1. Levin HS . Benton AL , Fletcher JM , Satz P : Neuropsychological and Intellectual Assessment of Adults. In Kaplan HI , Sadock BI (eds.): Comprehensive Textbook of Psychiatry, Vol. V, 1989.

2. Lezak MD : Neuropsychological Assessment. 2nd Ed. New York: Oxford University Press, 1983.

3. Folstein MF , Folstein SE , McHugh PR : MMSE: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12: 189-198.

4. Roth M , Huppert FA , Tym E , Mountjoy CQ : CAMDEX—The Cambridge Examination for Mental Disorders of the Elderly. London: Cambridge University Press, 1988.

5. Anthony JC , Le Reshe LA , Niar V , et al.: Limits of the MMSE as a screening test for dementia and delirium among hospital patients. Psychol Med. 1982; 12: 397-408.

6. American Psychiatric Association : Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. (DSM-IV) Washington, DC: Division of Public Affairs, American Psychiatric Association, 1994: 123-163.

7. Report of the NINCDS-ADRDA Work Group : Clinical diagnosis of Alzheimer's disease. Neurology. 1984; 34: 939-944.

8. Hachinski VV , Iliff LD , Zihkla E , et al.: Cerebral blood flow in dementia. Archives of Neurology. 1975; 32: 632-637.

9. Hughes CP , Berg L , Danziger WL , et al.: A new clinical scale for the staging of dementia. Brit J Psychiat. 1982; 140: 566-572.

10.

10. Strub RL , Black FW : The Mental Status Examination in Neurology, 2nd Ed. Los Angeles: F.A Davis Company,1989.

11.

11. Mazzoni M , Ferroni L , Lombardi L , et al.: The MMSE: Sensitivity in an Italian sample of patients with dementia. Ital J Neurol Sci. 1992; 13: 323-329.

12.

12. Commenges D , Gagnon M , et al.: Statistical description of the MMSE for French elderly community residents: Paquid Study Group. J Nerv Ment Dis. 1992; 180: 28-32.

13.

13. Mitrushina M , Satz P : Reliability and validity of the MMSE in neurologically intact elderly. J Clin Psychol. 1991; 47: 537-543.

14.

14. Braekhus A , Laake K , Engedal K : The MMSE: Identifying the most efficient variables for detecting cognitive impairment in the elderly. J Am Geriatr Soc. 1992; 40: 1139-1145.

15.

15. Grum RM , Anthony JC , Bassett SS , Folstein MF : Population based norms for the MMSE by age and educational level. JAMA. 1993; 269: 2386-2391.

16.

16. Kokmen E , Naessens JM , Offord KP : A short test of mental status: Description and preliminary results. Mayo Clin Proc. 1987; 62: 281-288.

17.

17. Frolich L , Dierks T , Martin EM , Maurer K : Differential validity of psychometric tests in dementia of the Alzheimer's type. Psychiatry Res. 1992; 44: 93-106.

18.

18. Jagger C , Clarke M , Anderson J , Battcock T : Misclassification of dementia by the MMSE-Are education and social class the only factors? Age-Ageing. 1992; 21: 404-411.

19.

19. Tombaugh TN , McIntyre NJ : The MMSE: A comprehensive review. JAm Geriatr Soc. 1992; 40: 922-935.

20.

20. Grut M , Fratiglioni L , Vitanen M , Winblad B : Accuracy of the MMSE as a screening test for dementia in a Swedish elderly population. Acta Neurol Scand. 1993; 87: 312-317.

21.

21. Resultats du Recensement de la Population et des Habitations, Effectue le 5 Avril 1981; V(2): 24. Republique Hellenique, Office National de Statistique de GCrece, Athenes [National Office of Statistics, Athens, Greece, 1989].