P3-256: The impact of literacy skills on two brief cognitive screening tests: The mini-mental state examination and the brief cognitive battery unbiased by education (BCB-Edu)

Abstract The Mini-Mental State Examination (MMSE) is one of the most widely used cognitive screening tests in the world. However, its administration and content differs by country and region, precluding direct comparison of scores across different versions. Our objective was to compare 2 methods of deriving comparable scores across versions of the MMSE. Between 1981 and 2012, investigators in the International Neuropsychological Normative Database Initiative collected MMSE scores on 122,512 persons from 47 studies conducted in 35 countries. We used MMSE data from 80,559 adults aged 41–99 years from 22 studies that provided item-level response data. We first equated 14-point, 15-point, 18-point, 19-point, and 23-point versions of the MMSE to the original 30-point version using coarse equipercentile equating methods that preserved differences across continents, age groups, and durations (years) of education. We then derived more precise item response theory–based scores using item-level responses to MMSE component items. We compared the 2 score-equating approaches using correlation and Bland-Altman plots. Both test-equating approaches were highly correlated with each other (r = 0.73) and with raw MMSE point totals. Bland-Altman plots revealed minimal evidence of systematic differences between the approaches. Our findings support the use of equipercentile equating when item-level data are unavailable to facilitate development of international test norms.

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The relationship between common cognitive screening tests (Standardised Mini‐Mental State Examination and Rowland Universal Dementia Assessment Scale) and the Cognitive Functional Independence Measure

Australasian Journal on Ageing ◽

10.1111/ajag.12998 ◽

2021 ◽

Author(s):

Sarah Therese Fox ◽

Leah Elizabeth Thompson ◽

Jeffrey T. J. Rowland

Keyword(s):

Mental State ◽

Mini Mental State Examination ◽

Functional Independence Measure ◽

Functional Independence ◽

Assessment Scale ◽

Screening Tests ◽

Cognitive Screening ◽

The Relationship ◽

State Examination

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Education does not equally influence all the Mini Mental State Examination subscales and items: inferences from a Brazilian community sample

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462010005000009 ◽

2010 ◽

Vol 32 (3) ◽

pp. 223-230 ◽

Cited By ~ 9

Author(s):

Jerson Laks ◽

Evandro Silva Freire Coutinho ◽

Washington Junger ◽

Heitor Silveira ◽

Raphael Mouta ◽

...

Keyword(s):

Mental State ◽

Mini Mental State Examination ◽

Community Sample ◽

Community Dwelling ◽

Delayed Recall ◽

Functional Activities ◽

Key Factor ◽

Z Scores ◽

The Impact ◽

State Examination

OBJECTIVE: Mini-Mental State Examination cutoffs have been presented for schooling levels to screen cognitive impairment. However, items may behave differently with regards to education. The objective of this study was to examine the impact of education on MMSE subscales and items. METHOD: Community-dwelling participants aged 65 years or more (n = 990, females = 637, age = 74.1 years, range 65-108) were stratified as illiterate (n = 373), 1-8 (n = 540), 9-12 (n = 63), and more than 12 years of schooling (n = 14) and were screened with MMSE and Pfeffer Functional Activities Questionnaire. To make the Mini-Mental State Examination items comparable, each item was transformed into z scores. Multiple linear regression was used to estimate the effect of schooling on MMSE subs and items controlling for age, sex, and activities of daily life. RESULTS: Temporal and space orientation, attention/calculation, repetition, reading, writing, and drawing scores improved as education increased, but not memory registration, three step command, and naming. Reading and writing displayed the largest coefficients, whereas education exerted no influence on naming and three step command tasks. CONCLUSION: Education does not exert an important effect on naming, three step command, memory registration, and delayed recall. As memory is a key factor for diagnosing dementia, these items could be considered despite education.

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Random Forest Model in the Diagnosis of Dementia Patients with Normal Mini-Mental State Examination Scores

Journal of Personalized Medicine ◽

10.3390/jpm12010037 ◽

2022 ◽

Vol 12 (1) ◽

pp. 37

Author(s):

Jie Wang ◽

Zhuo Wang ◽

Ning Liu ◽

Caiyan Liu ◽

Chenhui Mao ◽

...

Keyword(s):

Machine Learning ◽

Cognitive Impairment ◽

Random Forest ◽

Mental State ◽

Mini Mental State Examination ◽

Machine Learning Algorithms ◽

Assessment Model ◽

Test Time ◽

Cognitive Screening ◽

State Examination

Background: Mini-Mental State Examination (MMSE) is the most widely used tool in cognitive screening. Some individuals with normal MMSE scores have extensive cognitive impairment. Systematic neuropsychological assessment should be performed in these patients. This study aimed to optimize the systematic neuropsychological test battery (NTB) by machine learning and develop new classification models for distinguishing mild cognitive impairment (MCI) and dementia among individuals with MMSE ≥ 26. Methods: 375 participants with MMSE ≥ 26 were assigned a diagnosis of cognitively unimpaired (CU) (n = 67), MCI (n = 174), or dementia (n = 134). We compared the performance of five machine learning algorithms, including logistic regression, decision tree, SVM, XGBoost, and random forest (RF), in identifying MCI and dementia. Results: RF performed best in identifying MCI and dementia. Six neuropsychological subtests with high-importance features were selected to form a simplified NTB, and the test time was cut in half. The AUC of the RF model was 0.89 for distinguishing MCI from CU, and 0.84 for distinguishing dementia from nondementia. Conclusions: This simplified cognitive assessment model can be useful for the diagnosis of MCI and dementia in patients with normal MMSE. It not only optimizes the content of cognitive evaluation, but also improves diagnosis and reduces missed diagnosis.

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Detection of mild cognitive impairment in middle-aged and older adults with obstructive sleep apnoea

European Respiratory Journal ◽

10.1183/13993003.01137-2018 ◽

2018 ◽

Vol 52 (5) ◽

pp. 1801137 ◽

Cited By ~ 7

Author(s):

Katia Gagnon ◽

Andrée-Ann Baril ◽

Jacques Montplaisir ◽

Julie Carrier ◽

Sirin Chami ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Obstructive Sleep Apnoea ◽

Mental State ◽

Cognitive Assessment ◽

Mini Mental State Examination ◽

Sleep Apnoea ◽

Screening Tests ◽

Obstructive Sleep ◽

State Examination

Obstructive sleep apnoea increases the risk for mild cognitive impairment and dementia. The present study aimed to characterise the ability of two cognitive screening tests, the Mini-Mental State Examination and the Montreal Cognitive Assessment, to detect mild cognitive impairment in adults aged 55–85 years with and without obstructive sleep apnoea.We included 42 subjects with mild and 67 subjects with moderate-to-severe obstructive sleep apnoea. We compared them to 22 control subjects. Mild cognitive impairment was diagnosed by a comprehensive neuropsychological assessment. We used receiver operating characteristic curves to assess the ability of the two screening tests to detect mild cognitive impairment.The two screening tests showed similar discriminative ability in control subjects. However, among the mild and the moderate-to-severe obstructive sleep apnoea groups, the Mini-Mental State Examination was not able to correctly identify subjects with mild cognitive impairment. The Montreal Cognitive Assessment's discriminant ability was acceptable in both sleep apnoea groups and was comparable to what was observed in controls.The Mini-Mental State Examination should not be used to screen for cognitive impairment in patients with obstructive sleep apnoea. The Montreal Cognitive Assessment could be used in clinical settings. However, clinicians should refer patients for neuropsychological assessment when neurodegenerative processes are suspected.

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Comparison of the Mini-Mental State Examination and Computerized Brief Cognitive Screening Test as Cognitive Screening Tools in Patients with Mild Cognitive Impairment

Current Alzheimer Research ◽

10.2174/1567205018666211215151418 ◽

2021 ◽

Vol 18 ◽

Author(s):

Che-Sheng Chu ◽

I-Chen Lee ◽

Chuan-Cheng Hung ◽

I-Ching Lee ◽

Chi-Fa Hung ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Normal Control ◽

Internal Consistency ◽

Mental State ◽

Screening Test ◽

Mini Mental State Examination ◽

Cognitive Screening ◽

Validity And Reliability ◽

State Examination

Background: The aim of this study was to establish the validity and reliability of the Computerized Brief Cognitive Screening Test (CBCog) for early detection of cognitive impairment. Method: One hundred and sixty participants, including community-dwelling and out-patient volunteers (both men and women) aged ≥ 65 years, were enrolled in the study. All participants were screened using the CBCog and Mini-Mental State Examination (MMSE). The internal consistency of the CBCog was analyzed using Cronbach’s α test. Areas under the curves (AUCs) of receiver operating characteristic analyses were used to test the predictive accuracy of the CBCog in detecting mild cognitive impairment (MCI) in order to set an appropriate cutoff point. Results: The CBCog scores were positively correlated with the MMSE scores of patients with MCI-related dementia (r = 0.678, P < .001). The internal consistency of the CBCog (Cronbach’s α) was 0.706. It was found that the CBCog with a cutoff point of 19/20 had a sensitivity of 97.5% and a specificity of 53.7% for the diagnosis of MCI with education level ≥ 6 years. The AUC of the CBCog for discriminating the normal control elderly from patients with MCI (AUC = 0.827, P < 0.001) was larger than that of the MMSE for discriminating the normal control elderly from patients with MCI (AUC= 0.819, P < .001). Conclusion: The CBCog demonstrated to have sufficient validity and reliability to evaluate mild cognitive impairment, especially in highly educated elderly people.

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Mini- Mental State Examination among lower educationl levels and illiterates: transcultural evaluation

Dementia & Neuropsychologia ◽

10.1590/s1980-57642010dn40200008 ◽

2010 ◽

Vol 4 (2) ◽

pp. 120-125 ◽

Cited By ~ 11

Author(s):

Sonia Maria Dozzi Brucki ◽

Ricardo Nitrini

Keyword(s):

Mental State ◽

Mini Mental State Examination ◽

Northern Region ◽

Screening Tests ◽

Temporal Orientation ◽

Cultural Backgrounds ◽

Two Samples ◽

Urban Sample ◽

Rural Sample ◽

State Examination

Abstract Cognitive performance among illiterates and low educational levels is poorer than that observed in individuals with greater schooling. This difference can be a confounding factor in reaching an accurate diagnosis of cognitive impairment. In addition, there is great heterogeneity in performance among illiterates, probably due to different environmental demands and sociocultural backgrounds. Many reports have described the influence of education on neuropsychological measures and screening tests such as the Mini-Mental State Examination (MMSE). Objectives: To analyze performance in two samples with the same educational level, but different social and cultural backgrounds. Methods: Subjects from two different locations in Brazil (rural sample from Northern region and urban sample residing in the largest city of the Southeastern region) were matched for age and education, and submitted to the MMSE. Results: Significant differences between the groups were found in total scores on the MMSE and in temporal orientation and serial-sevens sub-items for which the urban sample performed best but analysis of illiterates alone yielded the same results, except for the copying pentagons task which was performed better by the rural sample. Conclusions: Cultural and social backgrounds, as well as demands from the environment, influence results of screening tests. Factors other than education must be taken into account when analyzing tests.

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Acute Psychogeriatric Inpatient Treatment Improves Neuropsychiatric Symptoms but Impairs the Level of Functioning in Patients with Dementia

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000431087 ◽

2015 ◽

Vol 40 (5-6) ◽

pp. 290-296 ◽

Cited By ~ 4

Author(s):

Hanna-Mari Alanen ◽

Anneli Pitkänen ◽

Kirsti Suontaka-Jamalainen ◽

Olli Kampman ◽

Esa Leinonen

Keyword(s):

Mental State ◽

Daily Living ◽

Mini Mental State Examination ◽

Neuropsychiatric Symptoms ◽

Functional Decline ◽

Neuropsychiatric Inventory ◽

Behavioral Disturbances ◽

Level Of Functioning ◽

The Impact ◽

State Examination

Aims: To explore the impact of hospitalization on neuropsychiatric symptoms (NPS) and the level of functioning in patients with dementia. Our aim was also to study the influence of psychotropic medications. Methods: Behavioral disturbances, cognition and functional status of 89 patients were assessed using the Neuropsychiatric Inventory (NPI), Mini-Mental State Examination, Barthel Index, and Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCSADL). Results: The total NPI score decreased from 34.6 to 19.5 (p < 0.001), and ADL decreased from 32.2 to 21.7 (p < 0.001) during the hospital stay (mean of 44 days). For a change in ADL, only the effect of anxiolytics was significant (p = 0.045). For a change in NPI with antipsychotic and anxiolytic doses and Mini-Mental State Examination as covariates, no significant relationship was found. Conclusion: NPS improved significantly during hospitalization, but neither antipsychotic nor anxiolytic medication use explained this improvement. In patients using anxiolytics, the functional decline was substantial. These results do not support anxiolytic use in demented patients with NPS.

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