Alzheimer's, Dementia & Mental Health
Tweaking Score on Dementia Test Improves Risk
Assessment for Educated Senior Citizens
Mini-mental state examination cut score of 27 changed
the sensitivity to 89%, specificity to 78%, correctly classifying
90 percent of the participants
July 14, 2008 – Changing the score necessary to be
found at high risk of dementia on the most commonly administered
screening test of cognitive function, known as the mini-mental state
examination (MMSE), may improve the effectiveness when testing highly
educated older adults, according to a report in the July issue of
Archives of Neurology, one of the JAMA/Archives journals.
“The MMSE is used to screen patients for cognitive
impairment, track changes in cognitive functioning over time and often
to assess the effects of therapeutic agents on cognitive function,” the
authors write.
“Performance on the MMSE is moderated by
demographic variables, with scores decreasing with advanced age and less
education.”
The maximum MMSE score is 30. A score of 24 or less
is typically used to detect individuals with cognitive dysfunction
(thinking, learning and memory).
Sid E. O’Bryant, Ph.D., of the Texas Tech
University Health Sciences Center, and colleagues reviewed the MMSE
scores of 1,141 participants (93 percent white, average age 75.9 years)
in the Mayo Clinic Alzheimer Disease Research Center and Alzheimer
Disease Patient Registry who reported having 16 or more years of
education.
These included 307 patients with dementia, 176
patients with mild cognitive impairment and 658 control patients without
dementia.
With the traditional cut score of 24 on the MMSE,
89 percent of the participants were accurately classified by dementia
status.
This score had a sensitivity of 66 percent and a
specificity of 99 percent for the detection of dementia, meaning that an
individual with a score of 23 or lower would be correctly identified as
having dementia 66 percent of the time and an individual with score of
24 or higher would be correctly diagnosed as not having dementia 99
percent of the time.
Raising the cut score to 27 changed the sensitivity
to 89 percent and the specificity to 78 percent, correctly classifying
90 percent of the participants.
“The current findings are not intended to encourage
the diagnosis of cognitive impairment or dementia based on total MMSE
scores alone,” the authors write.
“Instead, these results provide practitioners with
revised criteria for appropriate management of highly educated older
white patients. Specifically, older patients who present with memory
complaints (reported by themselves or others) who have attained a
college degree or higher level of education and who score below 27 on
the MMSE are at increased risk of cognitive dysfunction and dementia and
should be referred for a comprehensive evaluation, including formal
neuropsychological studies.”
The authors suggest that use of this new cut point
may help facilitate early detection of dementia in highly educated
individuals. Timely treatment may be particularly important in this
population, since individuals with more education tend to decline and
die more quickly after they are diagnosed with Alzheimer’s disease, the
authors note.
Editor's Note: This study was supported by grants
from the National Institute on Aging, and by the Robert and Clarice
Smith and Abigail Van Buren Alzheimer’s Disease Research Program.
