Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-19T00:43:34.707Z Has data issue: false hasContentIssue false
  • English
  • Français

Cross-cultural comparisons of the Mini-mental State Examination between Japanese and U.S. cohorts

Published online by Cambridge University Press:  17 October 2008

Hiroko H. Dodge ,
Kenichi Meguro ,
Hiroshi Ishii ,
Satoshi Yamaguchi ,
Judith A. Saxton  and
Mary Ganguli
Hiroko H. Dodge*
Affiliation:
Department of Public Health, College of Health and Human Sciences, Oregon State University, U.S.A. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, U.S.A. Department of Neurology, Oregon Health and Science University, U.S.A.
Kenichi Meguro
Affiliation:
Tohoku University Graduate School of Medicine, Sendai, Japan
Hiroshi Ishii
Affiliation:
Tohoku University Graduate School of Medicine, Sendai, Japan
Satoshi Yamaguchi
Affiliation:
The Osaki-Tajiri SKIP Center, Tajiri, Japan
Judith A. Saxton
Affiliation:
Department of Neurology, University of Pittsburgh School of Medicine, U.S.A.
Mary Ganguli
Affiliation:
Department of Psychiatry, Department of Epidemiology, University of Pittsburgh School of Medicine, U.S.A.
*
Correspondence should be addressed to: Dr. Hiroko Dodge. 260 Waldo Hall, Department of Public Health, Oregon State University, Corvallis, OR 97401, U.S.A. Phone: +1 541-737-2686; Fax: +1 541-737-4001. Email: [email protected].
Get access

Abstract

Background: The Mini-mental State Examination (MMSE) is widely used in Japan and the U.S.A. for cognitive screening in the clinical setting and in epidemiological studies. A previous Japanese community study reported distributions of the MMSE total score very similar to that of the U.S.A.

Methods: Data were obtained from the Monongahela Valley Independent Elder's Study (MoVIES), a representative sample of community-dwelling elderly people aged 65 and older living near Pittsburgh, U.S.A., and from the Tajiri Project, with similar aims in Tajiri, Japan. We examined item-by-item distributions of the MMSE between two cohorts, comparing (1) percentage of correct answers for each item within each cohort, and (2) relative difficulty of each item measured by Item Characteristic Curve analysis (ICC), which estimates log odds of obtaining a correct answer adjusted for the remaining MMSE items, demographic variables (age, gender, education) and interactions of demographic variables and cohort.

Results: Median MMSE scores were very similar between the two samples within the same education groups. However, the relative difficulty of each item differed substantially between the two cohorts. Specifically, recall and auditory comprehension were easier for the Tajiri group, but reading comprehension and sentence construction were easier for the MoVIES group.

Conclusions: Our results reaffirm the importance of validation and examination of thresholds in each cohort to be studied when a common instrument is used as a dementia screening tool or for defining cognitive impairment.

Keywords

MMSEcross-cultural comparisoncommunity-based study
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 1 , February 2009 , pp. 113 - 122
Copyright
Copyright © International Psychogeriatric Association 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akanuma, K., Meguro, K., Hashimoto, R. and Ishii, H. (2004). Spontaneous writing in very mild Alzheimer's disease: analysis of MMSE by older residents in a community. Higher Brain Research, 24, 360–367 (in Japanese).Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Bond, G. E., Burr, R. L., McCurry, S. M., Rice, M. M., Borenstein, A. R. and Larson, E. B. (2005). Alcohol and cognitive performance: a longitudinal study of older Japanese Americans. The Kame Project. International Psychogeriatrics, 17, 653–668.Google Scholar
Crane, P. K., van Belle, G. and Larson, E. B. (2004). Test bias in a cognitive test: differential item functioning in the CASI. Statistics in Medicine, 23, 241–256.CrossRefGoogle Scholar
Crane, P. K. et al. (2006). Differential item functioning related to education and age in the Italian version of the Mini-mental State Examination. International Psychogeriatrics, 18, 505–515.CrossRefGoogle ScholarPubMed
Croisile, B., Brabant, M. J., Carmoi, T., Lepage, Y., Aimard, G. and Trillet, M. (1996). Comparison between oral and written spelling in Alzheimer's disease. Brain and Language, 54, 361–387.Google Scholar
de Silva, H. A. and Gunatilake, S. B. (2002). Mini-mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka. International Journal of Geriatric Psychiatry, 17, 134–139.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
Ganguli, M. et al. (1993). Sensitivity and specificity for dementia of population-based criteria for cognitive impairment: the MoVIES project. Journal of Gerontology, Series A: Biological Sciences and Medical Sciences, 48, M152–161.Google Scholar
Ganguli, M. et al. (1995). A Hindi version of the MMSE: the development of a cognitive screening instrument for a largely illiterate rural elderly population in India. International Journal of Geriatric Psychiatry, 10, 367–377.Google Scholar
Ganguli, M., Dodge, H. H., Chen, P., Belle, S. and DeKosky, S. T. (2000). Ten-year incidence of dementia in a rural elderly US community population: the MoVIES Project. Neurology, 54, 1109–1116.Google Scholar
Gibbons, L. E. et al. (2002). Cross-cultural comparison of the Mini-mental State Examination in United Kingdom and United States participants with Alzheimer's disease. International Journal of Geriatric Psychiatry, 17, 723–728.Google Scholar
Graves, A. B., Rajaram, L., Bowen, J. D., McCormick, W. C., McCurry, S. M. and Larson, E. B. (1999). Cognitive decline and Japanese culture in a cohort of older Japanese Americans in King County, WA: the Kame Project. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 54, S154–161.Google Scholar
Hambleton, R. K., Swaminathan, H. and Rogers, H. J. (1991). Fundamentals of Item Reponse Theory. Newbury Park, CA: Sage Publications.Google Scholar
Inzelberg, R. et al. (2007). Education effects on cognitive function in a healthy aged Arab population. International Psychogeriatrics, 19, 593–603.Google Scholar
Ishizaki, J. et al. (1998). A normative, community-based study of Mini-mental State in elderly adults: the effect of age and educational level. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 53, P359–363.Google Scholar
Jones, R. N. (2006). Identification of measurement differences between English and Spanish language versions of the Mini-mental State Examination: detecting differential item functioning using MIMIC modeling. Medical Care, 44, S124–133.Google Scholar
Kohn, R., Vicente, B., Rioseco, P., Saldivia, S. and Torres, S. (2008). The Mini-mental State Examination: age and education distribution for a Latin American population. Aging and Mental Health, 12, 66–71.CrossRefGoogle ScholarPubMed
Meguro, K. et al. (2002). Prevalence of dementia and dementing diseases in Japan: the Tajiri Project. Alzheimer Disease and Associated Disorders, 16, 261–269.Google Scholar
Meguro, K. et al. (2007). Incidence of dementia and associated risk factors in Japan: the Osaki-Tajiri Project. Journal of the Neurological Sciences, 260, 175–182.CrossRefGoogle ScholarPubMed
Morales, L. S., Flowers, C., Gutierrez, P., Kleinman, M. and Teresi, J. A. (2006). Item and scale differential functioning of the Mini-mental State Exam assessed using the Differential Item and Test Functioning (DFIT) framework. Medical Care, 44, S143–151.Google Scholar
Mungas, D., Reed, B. R., Marshall, S. C. and Gonzalez, H. M. (2000). Development of psychometrically matched English and Spanish language neuropsychological tests for older persons. Neuropsychology, 14, 209–223.Google Scholar
Neils, J., Roeltgen, D. P. and Greer, A. (1995). Spelling and attention in early Alzheimer's disease: evidence for impairment of the graphemic buffer. Brain and Language, 49, 241–262.Google Scholar
Ng, T. P., Niti, M., Chiam, P. C. and Kua, E. H. (2007). Ethnic and educational differences in cognitive test performance on Mini-mental State Examination in Asians. American Journal of Geriatric Psychiatry, 15, 130–139.CrossRefGoogle ScholarPubMed
Platel, H. et al. (1993). Characteristics and evolution of writing impairment in Alzheimer's disease. Neuropsychologia, 31, 1147–1158.Google Scholar
Ramirez, M., Teresi, J. A., Holmes, D., Gurland, B. and Lantigua, R. (2006). Differential item functioning (DIF) and the Mini-mental State Examination (MMSE): overview, sample, and issues of translation. Medical Care, 44, S95–S106.Google Scholar
Stewart, R., Johnson, J., Richards, M., Brayne, C. and Mann, A. (2002). The distribution of Mini-mental State Examination scores in an older UK African-Caribbean population compared to MRC CFA study norms. International Journal of Geriatric Psychiatry, 17, 745–751.Google Scholar
Teng, E. L. et al. (1994). The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. International Psychogeriatrics, 6, 45–58; discussion 62.CrossRefGoogle Scholar
Yamada, M. et al. (1999). Prevalence and risks of dementia in the Japanese population: RERF's adult health study Hiroshima subjects. Radiation Effects Research Foundation. Journal of the American Geriatrics Society, 47, 189–195.Google Scholar