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Comparing the Mini-Mental State Examination and the modified Mini-Mental State Examination in the detection of mild cognitive impairment in older adults

Published online by Cambridge University Press:  19 July 2018

Ryan Van Patten Open the ORCID record for Ryan Van Patten [Opens in a new window] ,
Karysa Britton  and
Geoffrey Tremont
Ryan Van Patten*
Affiliation:
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA Neuropsychology Program, Rhode Island Hospital, Providence, Rhode Island, USA
Karysa Britton
Affiliation:
Neuropsychology Program, Rhode Island Hospital, Providence, Rhode Island, USA
Geoffrey Tremont
Affiliation:
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA Neuropsychology Program, Rhode Island Hospital, Providence, Rhode Island, USA
*
Correspondence should be addressed to: Ryan Van Patten, Neuropsychology Program, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903. Phone: +540-649-4702; Fax: +401-444-6643. Email: [email protected].
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Abstract

Objectives:

To show enhanced psychometric properties and clinical utility of the modified Mini-Mental State Examination (3MS) compared to the Mini-Mental State Examination (MMSE) in mild cognitive impairment (MCI).

Design:

Psychometric and clinical comparison of the 3MS and MMSE.

Setting:

Neuropsychological clinic in the northeastern USA.

Participants:

Older adults referred for cognitive concerns, 87 of whom were cognitively intact (CI) and 206 of whom were diagnosed with MCI.

Measurements:

The MMSE, the 3MS, and comprehensive neuropsychological evaluations.

Results:

Both instruments were significant predictors of diagnostic outcome (CI or MCI), with comparable odds ratios, but the 3MS explained more variance and showed improved classification accuracies relative to the MMSE. The 3MS also demonstrated greater receiver operating characteristic area under the curve values (0.85, SE = 0.02) compared to the MMSE (0.74, SE = 0.03). Scoring lower than 95/100 on the 3MS suggested MCI, while scoring lower than 28/30 on the MMSE suggested MCI. Additionally, compared to the MMSE, the 3MS shared more variance with neuropsychological composite scores in Language and Memory domains but not in Attention, Visuospatial, and Executive domains. Finally, 65.5% MCI patients were classified as impaired (scoring ≤1 SD below the mean) using 3MS normative data, compared to only 11.7% of patients who were classified as impaired using MMSE normative data.

Conclusions:

Broadly speaking, our data strongly favor the widespread substitution of the MMSE with the 3MS in older adults with concerns for cognitive decline.

Keywords

mild cognitive impairmentagingneuropsychological testingcognitive assessment
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 5: Issue Theme: Well-Being in Dementia , May 2019 , pp. 693 - 701
Copyright
© International Psychogeriatric Association 2018 

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References

Barkley, R. A. (2012). Executive Functions: What They Are, How They Work, and Why They Evolved. New York, NY: Guilford Press.Google Scholar
Benedict, R. H., Schretlen, D., Groninger, L., Dobraski, M. and Shpritz, B. (1996). Revision of the brief visuospatial memory test: studies of normal performance, reliability, and validity. Psychological Assessment, 8, 145–153.Google Scholar
Benton, A. L. (1994). Contribution to Neuropsychological Assessment: A Clinical Manual, 2nd edn. New York: Oxford University Press.Google Scholar
Berg, E. A. (1948). A simple objective technique for measuring flexibility in thinking. The Journal of General Psychology, 39, 15–22. doi:10.1080/00221309.1948.9918159.Google Scholar
Brandt, J. and Benedict, R. H. B. (2001). Hopkins Verbal Learning Test-Revised: Professional Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Bravo, G. and Hebert, R. (1997). Age and education specific reference values for the mini-mental and modified mini-mental state examinations derived from a non-demented elderly population. International Journal of Geriatric Psychiatry, 12, 1008–1018. doi:10.1002/(SICI)1099-1166(199710)12:10<1008::AID-GPS676>3.0.CO;2-A3.0.CO;2-A>Google Scholar
Crum, R. M., Anthony, J. C., Bassett, S. S. and Folstein, M. F. (1993). Population-based norms for the mini-mental state examination by age and educational level. Journal of the American Medical Association, 269, 2386–2391. doi:10.1001/jama.1993.03500180078038Google Scholar
Eastwood, R., Nobbs, H., Lindsay, J. and McDowell, I. (1992). Canadian study of health and aging. Dementia and Geriatric Cognitive Disorders, 3, 209–212. doi: 10.1159/000107019Google Scholar
Feng, L., Chong, M. S., Lim, W. S. and Ng, T. P. (2012). The modified mini-mental state examination test: normative data for Singapore Chinese older adults and its performance in detecting early cognitive impairment. Singapore Medical Journal, 53, 458–462.Google Scholar
Field, A. (2009). Discovering Statistics Using SPSS, 3rd edn. Thousand Oaks, CA: Sage Publications.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi: 10.1016/0022-3956(75)90026-6Google Scholar
Gladsjo, J. A., Schuman, C. C., Evans, J. D., Peavy, G. M., Miller, S. W. and Heaton, R. K. (1999). Norms for letter and category fluency: demographic corrections for age, education, and ethnicity. Assessment, 6, 147–178.Google Scholar
Grace, J. et al. (1995). Folstein vs. modified mini-mental state examination in geriatric stroke: stability, validity, and screening utility. Archives of Neurology, 52, 477–484. doi: 10.1001/archneur.1995.00540290067019Google Scholar
Güngen, C., Ertan, T., Eker, E., Yaşar, R. and Engin, F. (2002). Reliability and validity of the standardized mini mental state examination in the diagnosis of mild dementia in Turkish population. Turkish Journal of Psychiatry, 13, 273–281.Google Scholar
Harciarek, M. and Kertesz, A. (2011). Primary progressive aphasias and their contribution to the contemporary knowledge about the brain-language relationship. Neuropsychology Review, 21, 271–287.Google Scholar
Jones, T. G., Schinka, J. A., Vanderploeg, R. D., Small, B. J., Graves, A. B. and Mortimer, J. A. (2002). 3MS normative data for the elderly. Archives of Clinical Neuropsychology, 17, 171–177. doi: 10.1016/S0887-6177(00)00108-6Google Scholar
Jurica, P., Leitten, C. L. and Mattis, S. (2001). Dementia Rating Scale-2. Odessa, FL: Psychological Assessment Resources.Google Scholar
Kaplan, E., Goodglass, H. and Weintraum, S. (1983). The Boston Naming Test. Philadelphia: Lee & Febiger.Google Scholar
Lezak, M., Howieson, D. B., Bigler, E. D. and Tranel, D. (2012). Neuropsychological Assessment, 5th edn. New York: NY: Oxford University Press.Google Scholar
Loewenstein, D. A. et al. (2000). Utility of a modified mini-mental state examination with extended delayed recall in screening for mild cognitive impairment and dementia among community dwelling elders. International Journal of Geriatric Psychiatry, 15, 434–440. doi: 10.1002/(SICI)1099-1166(200005)15:5<434::AID-GPS137>3.0.CO;2-23.0.CO;2-2>Google Scholar
McDowell, I., Kristjansson, B., Hill, G. B. and Hebert, R. (1997). Community screening for dementia: the mini mental state exam (MMSE) and modified mini-mental state exam (3MS) compared. Journal of Clinical Epidemiology, 50, 377–383. doi: 10.1016/S0895-4356(97)00060-7Google Scholar
Measso, G. et al. (1993). The mini-mental state examination: normative study of an Italian random sample. Developmental Neuropsychology, 9, 77–85. doi: 10.1080/87565649109540545Google Scholar
Mitchell, A. J. (2009). A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. Journal of Psychiatric Research, 43, 411–431.Google Scholar
Mitchell, A. J. and Shiri-Feshki, M. (2009). Rate of progression of mild cognitive impairment to dementia–meta-analysis of 41 robust inception cohort studies. Acta Psychiatrica Scandinavica, 119, 252–265. doi: 10.1111/j.1600-0447.2008.01326.xGoogle Scholar
Mitrushina, M. and Satz, P. (1991). Reliability and validity of the mini-mental state exam in neurologically intact elderly. Journal of Clinical Psychology, 47, 537–543. doi: 10.1002/1097-4679(199107)47:4<537::AID-JCLP2270470411>3.0.CO;2-93.0.CO;2-9>Google Scholar
Murray, C. J. et al. (2015). Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. The Lancet, 386, 2145–2191. doi: 10.1016/S0140-6736(15)61340-XGoogle Scholar
Nadler, J. D., Richardson, E. D. and Malloy, P. F. (1994). Detection of Impairment with the mini-mental state examination. Cognitive and Behavioral Neurology, 7, 109–113.Google Scholar
Nazem, S. et al. (2009). Montreal cognitive assessment performance in patients with Parkinson's disease with “normal” global cognition according to mini-mental state examination score. Journal of the American Geriatrics Society, 57, 304–308. doi: 10.1111/j.1532-5415.2008.02096.xGoogle Scholar
O'Bryant, S. E. et al. (2008). Detecting dementia with the mini-mental state examination in highly educated individuals. Archives of Neurology, 65, 963–967. doi:10.1001/archneur.65.7.963Google Scholar
Perlstein, W. M., Carter, C. S., Barch, D. M. and Baird, J. W. (1998). The Stroop task and attention deficits in Schizophrenia: a critical evaluation of card and single-trial Stroop methodologies. Neuropsychology, 12, 414–425.Google Scholar
Perry, R. J. and Hodges, J. R. (1999). Attention and executive deficits in Alzheimer's disease: a critical review. Brain, 122, 383–404. doi: 10.1093/brain/122.3.383Google Scholar
Petersen, R. C. (2004). Mild cognitive impairment as a diagnostic entity. Journal of Internal Medicine, 256, 183–194.Google Scholar
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G. and Kokmen, E. (1999). Mild cognitive impairment: clinical characterization and outcome. Archives of Neurology, 56, 303–308. doi: 10.1001/archneur.56.3.303Google Scholar
Putcha, D. and Tremont, G. (2016). Predictors of independence in instrumental activities of daily living: amnestic versus nonamnestic MCI. Journal of Clinical and Experimental Neuropsychology, 38, 991–1004. doi: 10.1080/13803395.2016.1181716Google Scholar
Reitan, R. M. (1992). Trail making test: Manual for administration and scoring. Reitan Neuropsychology Laboratory, Tucson.Google Scholar
Sinanović, O., Mrkonjić, Z., Zukić, S., Vidović, M. and Imamović, K. (2011). Post-stroke language disorders. Acta Clinica Croatica, 50, 79–94.Google Scholar
Snyder, H. R. (2013). Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: a meta-analysis and review. Psychological Bulletin, 139, 81–132.Google Scholar
Spencer, R. J. et al. (2013). Psychometric limitations of the mini-mental state examination among nondemented older adults: an evaluation of neurocognitive and magnetic resonance imaging correlates. Experimental Aging Research, 39, 382–397. doi: 10.1080/0361073X.2013.808109Google Scholar
Sperling, R. A. et al. (2011). Toward defining the preclinical stages of Alzheimer's disease: recommendations from the national institute on Aging-Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 7, 280–292. doi: 10.1016/j.jalz.2011.03.003Google Scholar
Stern, R. A, Javorsky, D. J., Singer, E. A. and Kaplan, E. (1999). The Boston Qualitative Scoring System for the Rey–Osterrieth Complex Figure: BQSS: Professional Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Stern, R. A. and White, T. (2003). Neuropsychological Assessment Battery: Administration, Scoring, and Interpretation Manual. Lutz, FL: Psychological Assessment Resources.Google Scholar
Strauss, E., Sherman, E. M. and Spreen, O. (2006). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. New York, NY: Oxford University Press.Google Scholar
Tariq, S. H., Tumosa, N., Chibnall, J. T., Perry, M. H. and Morley, J. E. (2006). Comparison of the Saint Louis university mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder – a pilot study. The American Journal of Geriatric Psychiatry, 14, 900–910. doi: 10.1097/01.JGP.0000221510.33817.86Google Scholar
Teng, E. L. and Chui, H. C. (1987). The modified mini-mental state examination (3MS). The Journal of Clinical Psychiatry, 41, 114–121.Google Scholar
Tombaugh, T. N., McDowell, I., Kristjansson, B. and Hubley, A. M. (1996). Mini-mental state examination (MMSE) and the modified MMSE (3MS): a psychometric comparison and normative data. Psychological Assessment, 8, 48–59.Google Scholar
Tombaugh, T. N. and McIntyre, N. J. (1992). The mini-mental state examination: a comprehensive review. Journal of the American Geriatrics Society, 40, 922–935. doi: 10.1111/j.1532-5415.1992.tb01992.xGoogle Scholar
Wechsler, D. (1997). WMS-III: Wechsler Memory Scale Administration and Scoring Manual. San Antonio, TX: The Psychological Corporation.Google Scholar
Wechsler, D. (2008). Wechsler Adult Intelligence Scale–Fourth Edition (WAIS–IV): Administration and scoring manual. San Antonio, TX: NCS Pearson.Google Scholar
Wechsler, D. (2009). Wechsler Memory Scale – Fourth Edition (WMS-IV). San Antonio, TX: Pearson.Google Scholar
Youden, W. J. (1950). Index for rating diagnostic tests. Cancer, 3, 32–35. doi: 10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-33.0.CO;2-3>Google Scholar