A Preliminary Report on the Discrepancy between Clinical and Test Evaluations of Competence*

This report demonstrates the discrepancy that can occur between clinical and test evaluations of competence. It presents retrospective examination of 35 assessments of competence performed on 24 subjects by a multidisciplinary competency panel. The findings of the panel are compared with the subjects' results on the Cognitive Competency Test and on the Mini-Mental State Examination. The results show that the multidisciplinary competency panel will more often find subjects competent than indicated by their psychometric test scores. A process approach to the use of tests is recommended. Reliance on tests to decide the outcome of difficult cases does not appear to be warranted.

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Why is Mini-Mental state examination performance correlated with estimated premorbid cognitive ability?

Psychological Medicine ◽

10.1017/s0033291716001045 ◽

2016 ◽

Vol 46 (12) ◽

pp. 2647-2654 ◽

Cited By ~ 4

Author(s):

D. Dykiert ◽

G. Der ◽

J. M. Starr ◽

I. J. Deary

Keyword(s):

Cognitive Ability ◽

Mental State ◽

Test Scores ◽

Mini Mental State Examination ◽

Word Reading ◽

Intelligence Test ◽

Reading Tests ◽

Adult Reading ◽

Intelligence Test Scores ◽

State Examination

BackgroundTests requiring the pronunciation of irregular words are used to estimate premorbid cognitive ability in patients with clinical diagnoses, and prior cognitive ability in normal ageing. However, scores on these word-reading tests correlate with scores on the Mini-Mental State Examination (MMSE), a widely used screening test for possible cognitive pathology. This study aimed to test whether the word-reading tests’ correlations with MMSE scores in healthy older people are explained by childhood IQ or education.MethodWechsler Test of Adult Reading (WTAR), National Adult Reading Test (NART), MMSE scores and information about education were obtained from 1024 70-year-olds, for whom childhood intelligence test scores were available.ResultsWTAR and NART were positively correlated with the MMSE (r ≈ 0.40, p < 0.001). The shared variance of WTAR and NART with MMSE was significantly attenuated by ~70% after controlling for childhood intelligence test scores. Education explained little additional variance in the association between the reading tests and the MMSE.ConclusionsMMSE, which is often used to index cognitive impairment, is associated with prior cognitive ability. MMSE score is related to scores on WTAR and NART largely due to their shared association with prior ability. Obtained MMSE scores should be interpreted in the context of prior ability (or WTAR/NART score as its proxy).

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Tracking Cognitive Decline in Amnestic Mild Cognitive Impairment and Early-Stage Alzheimer Dementia: Mini-Mental State Examination versus Neuropsychological Battery

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000478520 ◽

2017 ◽

Vol 44 (1-2) ◽

pp. 105-117 ◽

Cited By ~ 9

Author(s):

Joonho Kim ◽

Han Kyu Na ◽

Justin Byun ◽

Jiwon Shin ◽

Sungsoo Kim ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Disease Progression ◽

Mental State ◽

Test Scores ◽

Mini Mental State Examination ◽

Magnetic Resonance Images ◽

Amnestic Mild Cognitive Impairment ◽

Neuropsychological Battery ◽

State Examination

Background/Aims: Although the Mini-Mental State Examination (MMSE), Clinical Dementia Rating-Sum of Boxes (CDR-SOB), and neuropsychological batteries are widely used for evaluating cognitive function, it remains elusive which instrument best reflects the longitudinal disease progression in amnestic mild cognitive impairment (aMCI) and probable Alzheimer disease (AD). We investigated whether changes in these three instruments over time correlate with loss of cortical gray matter volume (cGMV). Methods: We retrospectively investigated 204 patients (aMCI, n = 114; AD, n = 90) who had undergone MMSE, CDR-SOB, the dementia version of the Seoul Neuropsychological Screening Battery (SNSB-D), and 3-dimensional T1-weighted magnetic resonance images at least twice. We investigated the partial correlation between annual decline in test scores and percent change of cGMV. Results: In aMCI patients, changes in the SNSB-D total score (r = 0.340, p < 0.001) and CDR-SOB (r = 0.222, p = 0.020), but not MMSE, showed a correlation with cGMV loss, with the SNSB-D total score showing the strongest correlation. In AD patients, decline in all three test scores correlated significantly with cGMV loss, with MMSE exhibiting the strongest correlation (r = 0.464, p < 0.001). Conclusion: In aMCI patients, neuropsychological battery, though time-consuming, was the most adequate tool in tracking disease progression. In AD patients, however, MMSE may be the most effective longitudinal monitoring tool when considering cost-effectiveness.

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Use of rating scales by consultant psychiatrists

Psychiatric Bulletin ◽

10.1192/pb.16.6.329 ◽

1992 ◽

Vol 16 (6) ◽

pp. 329-330 ◽

Cited By ~ 2

Author(s):

Karl Rice ◽

Peter Donnelly

Keyword(s):

Mental State ◽

Rating Scales ◽

Mini Mental State Examination ◽

Rating Scale ◽

Mental Test ◽

Psychiatric Status ◽

Abbreviated Mental Test ◽

Learning Test ◽

State Examination ◽

Difficult Cases

The number and diversity of rating scales and tests of psychiatric status has increased dramatically in the last 20 to 30 years. Tests are in screening, e.g. for dementia the Mini Mental State Examination and the Abbreviated Mental Test; to aid clarification of the diagnosis in difficult cases, e.g. Walton-Black New Word Learning Test, to differentiate between depression and dementia; and in assessing severity of symptoms, e.g. Hamilton Depression Rating Scale.

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Brief cognitive screening of the elderly: a comparison of the Mini-Mental State Examination (MMSE), Abbreviated Mental Test (AMT) and Mental Status Questionnaire (MSQ)

Psychological Medicine ◽

10.1017/s0033291700034826 ◽

1996 ◽

Vol 26 (2) ◽

pp. 427-430 ◽

Cited By ~ 80

Author(s):

D. M. MacKenzie ◽

P. Copp ◽

R. J. Shaw ◽

G. M. Goodwin

Keyword(s):

Mental Status ◽

Mental State ◽

Test Scores ◽

Mini Mental State Examination ◽

Cognitive Test ◽

Full Time ◽

Cognitive Screening ◽

Mental Test ◽

Abbreviated Mental Test ◽

State Examination

SynopsisOne hundred and fifty unselected elderly community subjects were assessed by Mini Mental State Examination (MMSE), Abbreviated Mental Test (AMT) and Mental Status Questionnaire (MSQ). The effects on cognitive test scores of potential confounding (non-cognitive) variables were evaluated. Sensitivities and specificities were: MMSE 80% and 98%; AMT 77% and 90%; and MSQ 70% and 89%. The MMSE identified significantly fewer false positives than the AMT and MSQ. The major effect of intelligence on cognitive test scores has previously been underestimated. Age, social class, sensitivity of hearing and history of stroke were also significantly correlated with cognitive test scores. Years of full time education and depression only affected the longer MMSE and CAMCOG. The MMSE (cut-off 20/21) can be recommended for routine screening. However, as scores are affected by variables other than cognitive function, particularly intelligence, further assessment of identified cases may fail to reveal significant functional impairment.

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Mini-Mental-State

Zeitschrift für Gerontopsychologie & -psychiatrie ◽

10.1024/1011-6877.22.1.11 ◽

2009 ◽

Vol 22 (1) ◽

pp. 11-16 ◽

Cited By ~ 5

Author(s):

Andreas Kaiser ◽

Renate Gusner-Pfeiffer ◽

Hermann Griessenberger ◽

Bernhard Iglseder

Keyword(s):

Mental State ◽

Mini Mental State Examination ◽

Oder Nicht ◽

State Examination

Im folgenden Artikel werden fünf verschiedene Versionen der Mini-Mental-State-Examination dargestellt, die alle auf der Grundlage des Originals von Folstein erstellt wurden, sich jedoch deutlich voneinander unterscheiden und zu unterschiedlichen Ergebnissen kommen, unabhängig davon, ob das Screening von erfahrenen Untersuchern durchgeführt wird oder nicht. Besonders auffällig ist, dass Frauen die Aufgaben «Wort rückwärts» hoch signifikant besser lösten als das «Reihenrechnen». An Hand von Beispielen werden Punkteunterschiede aufgezeigt.

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Zur Anwendung der CES-D bei älteren Menschen: Dimensionsstruktur und Meßartefakte

Diagnostica ◽

10.1026//0012-1924.46.1.29 ◽

2000 ◽

Vol 46 (1) ◽

pp. 29-37 ◽

Cited By ~ 7

Author(s):

Herbert Matschinger ◽

Astrid Schork ◽

Steffi G. Riedel-Heller ◽

Matthias C. Angermeyer

Keyword(s):

Mental State ◽

Latent Class ◽

Mini Mental State Examination ◽

Depression Scale ◽

Epidemiological Studies ◽

Partial Credit ◽

Examination Score ◽

State Examination

Zusammenfassung. Beim Einsatz der Center for Epidemiological Studies Depression Scale (CES-D) stellt sich das Problem der Dimensionalität des Instruments, dessen Lösung durch die Konfundierung eines Teilkonstruktes (“Wohlbefinden”) mit Besonderheiten der Itemformulierung Schwierigkeiten bereitet, da Antwortartefakte zu erwarten sind. Dimensionsstruktur und Eignung der CES-D zur Erfassung der Depression bei älteren Menschen wurden an einer Stichprobe von 663 über 75-jährigen Teilnehmern der “Leipziger Langzeitstudie in der Altenbevölkerung” untersucht. Da sich die Annahme der Gültigkeit eines partial-credit-Rasch-Modells sowohl für die Gesamtstichprobe als auch für eine Teilpopulation als zu restriktiv erwies, wurde ein 3- bzw. 4-Klassen-latent-class-Modell für geordnete Kategorien berechnet und die 4-Klassen-Lösung als den Daten angemessen interpretiert: Drei Klassen zeigten sich im Sinne des Konstrukts “Depression” geordnet, eine Klasse enthielt jene Respondenten, deren Antwortmuster auf ein Antwortartefakt hinwiesen. In dieser Befragtenklasse wird der Depressionsgrad offensichtlich überschätzt. Zusammenhänge mit Alter und Mini-Mental-State-Examination-Score werden dargestellt. Nach unseren Ergebnissen muß die CES-D in einer Altenbevölkerung mit Vorsicht eingesetzt werden, der Summenscore sollte nicht verwendet werden.

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Prediction of Probable Alzheimer Disease in Patients With Symptoms Suggestive of Memory Impairment: Value of the Mini-Mental State Examination

Archives of Family Medicine ◽

10.1001/archfami.9.6.527 ◽

2000 ◽

Vol 9 (6) ◽

pp. 527-532 ◽

Cited By ~ 56

Author(s):

M. C. Tierney

Keyword(s):

Alzheimer Disease ◽

Mental State ◽

Memory Impairment ◽

Mini Mental State Examination ◽

State Examination

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Validation of the Hungarian version of Alzheimer’s Disease Assessment Scale – Cognitive Subscale

Orvosi Hetilap ◽

10.1556/oh.2012.29332 ◽

2012 ◽

Vol 153 (12) ◽

pp. 461-466 ◽

Cited By ~ 5

Author(s):

Magdolna Pákáski ◽

Gergely Drótos ◽

Zoltán Janka ◽

János Kálmán

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Mental State ◽

Mini Mental State Examination ◽

Assessment Scale ◽

Disease Assessment ◽

Control Subjects ◽

Cognitive Subscale ◽

State Examination ◽

Hungarian Version

The cognitive subscale of the Alzheimer’s Disease Assessment Scale is the most widely used test in the diagnostic and research work of Alzheimer’s disease. Aims: The aim of this study was to validate and investigate reliability of the Hungarian version of the Alzheimer’s Disease Assessment Scale in patients with Alzheimer’s disease and healthy control subjects. Methods: syxty-six patients with mild and moderate Alzheimer’s disease and 47 non-demented control subjects were recruited for the study. The cognitive status was established by the Hungarian version of the Alzheimer’s Disease Assessment Scale and Mini Mental State Examination. Discriminative validity, the relation between age and education and Alzheimer’s Disease Assessment Scale, and the sensitivity and specificity of the test were determined. Results: Both the Mini Mental State Examination and the Alzheimer’s Disease Assessment Scale had significant potential in differentiating between patients with mild and moderate stages of Alzheimer’s disease and control subjects. A very strong negative correlation was established between the scores of the Mini Mental State Examination and the Alzheimer’s Disease Assessment Scale in the Alzheimer’s disease group. The Alzheimer’s Disease Assessment Scale showed slightly negative relationship between education and cognitive performance, whereas a positive correlation between age and Alzheimer’s Disease Assessment Scale scores was detected only in the control group. According to the analysis of the ROC curve, the values of sensitivity and specificity of the Alzheimer’s Disease Assessment Scale were high. Conclusions: The Hungarian version of the Alzheimer’s Disease Assessment Scale was found to be highly reliable and valid and, therefore, the application of this scale can be recommended for the establishment of the clinical stage and follow-up of patients with Alzheimer’s disease. However, the current Hungarian version of the Alzheimer’s Disease Assessment Scale is not sufficient; the list of words and linguistic elements should be selected according to the Hungarian standard in the future. Orv. Hetil., 2012, 153, 461–466.

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