Can we forget the Mini-Mental State Examination? A systematic review of the validity of cognitive screening instruments within one month after stroke

Objective: To develop a cognitive screening instrument suitable for a neuropsychiatric inpatient, outpatient and consultation—liaison population. Methods: A number of cognitive screening instruments used clinically and published in the literature were reviewed. A new tool, the Neuropsychiatry Unit Cognitive Screen (NUCOG), was developed on the basis of this review, and piloted in a diverse population of patients in the unit. Conclusions: The NUCOG demonstrated a high degree of face validity, correlation with the Mini-Mental State Examination, and significant scoring differences between demented and non-demented patients.

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Can MoCA and MMSE Be Interchangeable Cognitive Screening Tools? A Systematic Review

The Gerontologist ◽

10.1093/geront/gny126 ◽

2018 ◽

Vol 59 (6) ◽

pp. e743-e763 ◽

Cited By ~ 10

Author(s):

Glória S A Siqueira ◽

Paula de M S Hagemann ◽

Daniela de S Coelho ◽

Flávia Heloísa Dos Santos ◽

Paulo H F Bertolucci

Keyword(s):

Systematic Review ◽

Mental State ◽

Cognitive Assessment ◽

Mini Mental State Examination ◽

Screening Tools ◽

Montreal Cognitive Assessment ◽

Cognitive Screening ◽

Sensitive Tool ◽

State Examination ◽

Years Of Schooling

Abstract Background and Objectives Cognitive disorders may be an early sign of neuropsychiatric disorders; however, it remains unclear whether the screening measures are interchangeable. The aim of this study was to contrast the most commonly used screening tools—Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)—for early detection of neurocognitive disorder (NCD). Research Design and Methods This study presents a descriptive systematic review and informative literature according to the Cochrane Foundation’s guidelines. The keywords “Mini-Mental State Examination” and “Montreal Cognitive Assessment” were searched in the Web of Science, SciELO, and LILACS databases. Results Fifty-one studies were selected including a total sample of 11,870 participants (8,360 clinical patients and 3,510 healthy controls). Most studies were published in the past 5 years using a cross-sectional design, carried out across the world. They were organized by age ranges (18–69 years and 20–89 years), years of schooling, and mental status (with and without mental and behavior disorders). Sixteen of 18 studies had participants aged 18–69 years, and 21 out of 33 studies within the older set suggested that the MoCA is a more sensitive tool for detecting NCD. Discussion and Implications Thirty-seven studies suggested that the MoCA is a more sensitive tool for NCD detection because it assesses executive function and visuospatial abilities. Some individuals who demonstrated normal cognitive function on the MMSE had lower performance on the MoCA. However, it seems necessary to establish different cutoffs based on years of schooling to avoid false positives. Future studies should contrast MoCA with other screening tools designed for NCD assessment.

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Assessment of Cognitive Decline in the Elderly by Informant Interview

The British Journal of Psychiatry ◽

10.1192/bjp.152.2.209 ◽

1988 ◽

Vol 152 (2) ◽

pp. 209-213 ◽

Cited By ~ 188

Author(s):

A. F. Jorm ◽

A. E. Korten

Keyword(s):

Cognitive Decline ◽

Elderly People ◽

Mental State ◽

Mini Mental State Examination ◽

The Elderly ◽

Screening Instruments ◽

Cognitive Screening ◽

Direct Assessment ◽

State Examination

Cognitive decline in a sample of 64 elderly people was assessed by a standardised informant interview dealing with changes in memory and intelligence which had taken place in the previous 10 years. Scores from the interview were found to correlate (r=0.74) with the Mini-Mental State Examination. Moreover, the informant interview was found to be less affected by pre-morbid ability than the MMSE. Direct assessment of decline by informants may be a solution to the problem of contamination by pre-morbid ability which affects traditional cognitive screening instruments.

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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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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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Dementia screening in Brazil: a systematic review of normative data for the mini-mental state examination

Clinics ◽

10.6061/clinics/2019/e971 ◽

2019 ◽

Vol 74 ◽

Author(s):

Gustavo Santiago-Bravo ◽

Felipe Kenji Sudo ◽

Naima Assunção ◽

Claudia Drummond ◽

Paulo Mattos

Keyword(s):

Systematic Review ◽

Mental State ◽

Normative Data ◽

Mini Mental State Examination ◽

Dementia Screening ◽

State Examination

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Converting from the Montreal Cognitive Assessment to the Mini-Mental State Examination-2

PLoS ONE ◽

10.1371/journal.pone.0254055 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254055

Author(s):

Hwabeen Yang ◽

Daehyuk Yim ◽

Moon Ho Park

Keyword(s):

Mental State ◽

Cognitive Assessment ◽

Mini Mental State Examination ◽

Intraclass Correlation ◽

Montreal Cognitive Assessment ◽

Cognitive Screening ◽

Conversion Table ◽

Linear Smoothing ◽

Log Linear ◽

State Examination

Objective The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination-2 (MMSE-2) are useful psychometric tests for cognitive screening. Many clinicians want to predict the MMSE-2 score based on the MoCA score. To facilitate the transition from the MoCA to the MMSE-2, this study developed a conversion method. Methods This study retrospectively examined the relationship between the MoCA and MMSE-2. Overall, 303 participants were evaluated. We produced a conversion table using the equipercentile equating method with log-linear smoothing. Then, we evaluated the reliability and accuracy of this algorithm to convert the MoCA to the MMSE-2. Results MoCA scores were converted to MMSE-2 scores according to a conversion table that achieved a reliability of 0.961 (intraclass correlation). The accuracy of this algorithm was 84.5% within 3 points difference from the raw score. Conclusions This study reports a reliable and easy conversion algorithm for transforming MoCA scores into converted MMSE-2 scores. This method will greatly enhance the utility of existing cognitive data in clinical and research settings.

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