Skip to main content
Top
Published in: BMC Geriatrics 1/2005

Open Access 01-12-2005 | Research article

Brief cognitive assessment in a UK population sample – distributional properties and the relationship between the MMSE and an extended mental state examination

Authors: Felicia A Huppert, Sara T Cabelli, Fiona E Matthews, the MRC Cognitive Function and Ageing Study (MRC CFAS)

Published in: BMC Geriatrics | Issue 1/2005

Login to get access

Abstract

Background

Despite the MMSE's known flaws, it is still used extensively as both a screening instrument for dementia and a population measure of cognitive ability. The aim of this paper is to provide data on the distribution of MMSE scores in a representative sample from the UK population and to compare it with an extended cognitive assessment (EMSE) which covers a wider range of cognitive domains and provides a wider range of difficulty levels.

Methods

The MMSE and the EMSE were administered to over 12,000 participants at the screening stage of the MRC Cognitive Function and Ageing Study (MRC CFAS). MRC CFAS is a multi-centre population-based study in England and Wales with respondents aged 65 years and older.

Results

Normative values on the MMSE and EMSE are presented by age group, sex and level of education. There are very large differences between age groups, with smaller differences seen between the sexes and by level of education. The EMSE extends the scores at the high end of the ability range, but is no better than the MMSE at differentiating between dementia and non-dementia.

Conclusion

Population-derived norms are valuable for comparing an individual's score to the score that would be expected among the general population, given the individual's specific demographic characteristics.
Appendix
Available only for authorised users
Literature
1.
go back to reference Folstein MF, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 313: 1419-1420. Folstein MF, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 313: 1419-1420.
2.
go back to reference Bleecker ML, Bolla-Wilson K, Kawas C, Agnew J: Age-specific norms for the Mini-Mental State Exam. Neurology. 1988, 38: 1565-1568.CrossRefPubMed Bleecker ML, Bolla-Wilson K, Kawas C, Agnew J: Age-specific norms for the Mini-Mental State Exam. Neurology. 1988, 38: 1565-1568.CrossRefPubMed
3.
go back to reference Bravo G, Hebert R: Age- and Education-Specific Reference Values for the Mini-Mental and Modified Mini-Mental State Examinations Derived from a Non-Demented Elderly Population. Int J Geriatr Psychiatry. 1997, 12: 1008-1018. 10.1002/(SICI)1099-1166(199710)12:10<1008::AID-GPS676>3.0.CO;2-A.CrossRefPubMed Bravo G, Hebert R: Age- and Education-Specific Reference Values for the Mini-Mental and Modified Mini-Mental State Examinations Derived from a Non-Demented Elderly Population. Int J Geriatr Psychiatry. 1997, 12: 1008-1018. 10.1002/(SICI)1099-1166(199710)12:10<1008::AID-GPS676>3.0.CO;2-A.CrossRefPubMed
4.
go back to reference Teng EL, Chui HC: The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry. 1987, 48: 314-318.PubMed Teng EL, Chui HC: The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry. 1987, 48: 314-318.PubMed
5.
go back to reference Tombaugh TN, McIntyre NJ: The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992, 40: 922-935.CrossRefPubMed Tombaugh TN, McIntyre NJ: The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992, 40: 922-935.CrossRefPubMed
6.
go back to reference Huppert FA, Brayne C, Gill C, Paykel ES, Beardsall L: CAMCOG--a concise neuropsychological test to assist dementia diagnosis: socio-demographic determinants in an elderly population sample. Br J Clin Psychol. 1995, 34 ( Pt 4): 529-541.CrossRef Huppert FA, Brayne C, Gill C, Paykel ES, Beardsall L: CAMCOG--a concise neuropsychological test to assist dementia diagnosis: socio-demographic determinants in an elderly population sample. Br J Clin Psychol. 1995, 34 ( Pt 4): 529-541.CrossRef
7.
go back to reference American Psychiatric Association : Diagnostic and Statistical Manual DSM-IV. 1994, Washington, DC, American Psychiatric Association, Edition IV revised American Psychiatric Association : Diagnostic and Statistical Manual DSM-IV. 1994, Washington, DC, American Psychiatric Association, Edition IV revised
8.
go back to reference World Health Organisation : ICD-10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research. 1993, Geneva, World Health Organisation World Health Organisation : ICD-10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research. 1993, Geneva, World Health Organisation
9.
go back to reference McDowell I, Kristjansson B, Hill GB, Hébert R: Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. J Clin Epidemiol. 1997, 50: 377-383. 10.1016/S0895-4356(97)00060-7.CrossRefPubMed McDowell I, Kristjansson B, Hill GB, Hébert R: Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. J Clin Epidemiol. 1997, 50: 377-383. 10.1016/S0895-4356(97)00060-7.CrossRefPubMed
10.
go back to reference Folstein M, Anthony JC, Parhad I, Duffy B, Gruenberg EM: The meaning of cognitive impairment in the elderly. J Am Geriatr Soc. 1985, 33: 228-235.CrossRefPubMed Folstein M, Anthony JC, Parhad I, Duffy B, Gruenberg EM: The meaning of cognitive impairment in the elderly. J Am Geriatr Soc. 1985, 33: 228-235.CrossRefPubMed
11.
go back to reference Medical Research Council : Report form the MRC Alzheimer's Disease Workshop. 1987, Medical Research Council Medical Research Council : Report form the MRC Alzheimer's Disease Workshop. 1987, Medical Research Council
12.
go back to reference MRC CFAS : Cognitive function and dementia in six areas of England and Wales: the distribution of MMSE and prevalence of GMS organicity level in the MRC CFA Study. The Medical Research Council Cognitive Function and Ageing Study (MRC CFAS). Psychol Med. 1998, 28: 319-335. 10.1017/S0033291797006272.CrossRef MRC CFAS : Cognitive function and dementia in six areas of England and Wales: the distribution of MMSE and prevalence of GMS organicity level in the MRC CFA Study. The Medical Research Council Cognitive Function and Ageing Study (MRC CFAS). Psychol Med. 1998, 28: 319-335. 10.1017/S0033291797006272.CrossRef
13.
go back to reference Huppert FA, Johnson AL, Nickson J, MRC CFAS : High Prevalence of Prospective Memory Impairment in the Elderly and in Early-stage Dementia: Findings from a Population-based Study. Applied Cognitive Psychology. 2000, 14: S63-S81-10.1002/acp.771.CrossRef Huppert FA, Johnson AL, Nickson J, MRC CFAS : High Prevalence of Prospective Memory Impairment in the Elderly and in Early-stage Dementia: Findings from a Population-based Study. Applied Cognitive Psychology. 2000, 14: S63-S81-10.1002/acp.771.CrossRef
14.
go back to reference Copeland JR, Dewey ME, Griffiths-Jones HM: A computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT. Psychol Med. 1986, 16: 89-99.CrossRefPubMed Copeland JR, Dewey ME, Griffiths-Jones HM: A computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT. Psychol Med. 1986, 16: 89-99.CrossRefPubMed
15.
go back to reference Roth M, Tym E, Mountjoy CQ, Huppert FA, Hendrie H, Verma S, Goddard R: CAMDEX. A standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry. 1986, 149: 698-709.CrossRefPubMed Roth M, Tym E, Mountjoy CQ, Huppert FA, Hendrie H, Verma S, Goddard R: CAMDEX. A standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry. 1986, 149: 698-709.CrossRefPubMed
16.
go back to reference Roth M, Huppert FA, Tym E, Mountjoy CQ: CAMDEX: The Cambridge Examination for Mental Disoders of the Elderly. 1988, Cambridge, Cambridge University Press Roth M, Huppert FA, Tym E, Mountjoy CQ: CAMDEX: The Cambridge Examination for Mental Disoders of the Elderly. 1988, Cambridge, Cambridge University Press
17.
go back to reference Roth M, Huppert FA, Mountjoy CQ, Tym E: CAMDEX-R: The Cambridge examination for mental disorders of the elderly - Revised. 1999, Cambridge, Cambridge University Press Roth M, Huppert FA, Mountjoy CQ, Tym E: CAMDEX-R: The Cambridge examination for mental disorders of the elderly - Revised. 1999, Cambridge, Cambridge University Press
18.
go back to reference Townsend P: Poverty in the United Kingdom. 1979, UK, Pelican Townsend P: Poverty in the United Kingdom. 1979, UK, Pelican
19.
go back to reference Rose GA: The Diagnosis of Ischaemic Heart Pain and Intermittent Claudication in Field Surveys. Bulletin of the World Health Organisation. 1962, 27: 645-658. Rose GA: The Diagnosis of Ischaemic Heart Pain and Intermittent Claudication in Field Surveys. Bulletin of the World Health Organisation. 1962, 27: 645-658.
20.
go back to reference Statacorp : Stata Statistical Software: Release 8.2. 2003, College Station, Tx. Statacorp : Stata Statistical Software: Release 8.2. 2003, College Station, Tx.
21.
go back to reference Grigoletto F, Zappala G, Anderson DW, Lebowitz BD: Norms for the Mini-Mental State Examination in a healthy population. Neurology. 1999, 53: 315-320. 10.1159/000006604.CrossRefPubMed Grigoletto F, Zappala G, Anderson DW, Lebowitz BD: Norms for the Mini-Mental State Examination in a healthy population. Neurology. 1999, 53: 315-320. 10.1159/000006604.CrossRefPubMed
22.
go back to reference Crum RM, Anthony JC, Bassett SS, Folstein MF: Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993, 269: 2386-2391. 10.1001/jama.269.18.2386.CrossRefPubMed Crum RM, Anthony JC, Bassett SS, Folstein MF: Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993, 269: 2386-2391. 10.1001/jama.269.18.2386.CrossRefPubMed
23.
go back to reference Kucukdeveci AA, Kutlay S, Elhan AH, Tennant A: Preliminary study to evaluate the validity of the mini-mental state examination in a normal population in Turkey. Int J Rehabil Res. 2005, 28: 77-79. 10.1097/00004356-200503000-00011.CrossRefPubMed Kucukdeveci AA, Kutlay S, Elhan AH, Tennant A: Preliminary study to evaluate the validity of the mini-mental state examination in a normal population in Turkey. Int J Rehabil Res. 2005, 28: 77-79. 10.1097/00004356-200503000-00011.CrossRefPubMed
24.
go back to reference Lechevallier-Michel N, Fabrigoule C, Lafont S, Letenneur L, Dartigues JF: [Normative data for the MMSE, the Benton visual retention test, the Isaacs's set test, the digit symbol substitution test and the Zazzo's cancellation task in subjects over the age 70: results from the PAQUID Study]. Rev Neurol (Paris). 2004, 160: 1059-1070.CrossRef Lechevallier-Michel N, Fabrigoule C, Lafont S, Letenneur L, Dartigues JF: [Normative data for the MMSE, the Benton visual retention test, the Isaacs's set test, the digit symbol substitution test and the Zazzo's cancellation task in subjects over the age 70: results from the PAQUID Study]. Rev Neurol (Paris). 2004, 160: 1059-1070.CrossRef
25.
go back to reference Tombaugh TN, McDowell I, Kristjansson B, Hubley AM: Mini-Mental State Examination (MMSE) and the Modified MMSE (3MS): A psychometric comparison and normative data. 1996, US, American Psychological Assn. Tombaugh TN, McDowell I, Kristjansson B, Hubley AM: Mini-Mental State Examination (MMSE) and the Modified MMSE (3MS): A psychometric comparison and normative data. 1996, US, American Psychological Assn.
26.
go back to reference Jones RN, Gallo JJ: Education bias in the mini-mental state examination. Int Psychogeriatr. 2001, 13: 299-310. 10.1017/S1041610201007694.CrossRefPubMed Jones RN, Gallo JJ: Education bias in the mini-mental state examination. Int Psychogeriatr. 2001, 13: 299-310. 10.1017/S1041610201007694.CrossRefPubMed
27.
go back to reference O'Connell ME, Tuokko H, Graves RE, Kadlec H: Correcting the 3MS for bias does not improve accuracy when screening for cognitive impairment or dementia. J Clin Exp Neuropsychol. 2004, 26: 970-980.CrossRefPubMed O'Connell ME, Tuokko H, Graves RE, Kadlec H: Correcting the 3MS for bias does not improve accuracy when screening for cognitive impairment or dementia. J Clin Exp Neuropsychol. 2004, 26: 970-980.CrossRefPubMed
28.
go back to reference Uhlmann RF, Larson EB: Effect of education on the mini-mental state examination as a screening test for dementia. J Am Geriatr Soc. 1991, 39: 876-880.CrossRefPubMed Uhlmann RF, Larson EB: Effect of education on the mini-mental state examination as a screening test for dementia. J Am Geriatr Soc. 1991, 39: 876-880.CrossRefPubMed
29.
go back to reference Schmand B, Lindeboom J, Hooijer C, Jonker C: Relation between education and dementia: the role of test bias revisited. J Neurol Neurosurg Psychiatry. 1995, 59: 170-174.CrossRefPubMedPubMedCentral Schmand B, Lindeboom J, Hooijer C, Jonker C: Relation between education and dementia: the role of test bias revisited. J Neurol Neurosurg Psychiatry. 1995, 59: 170-174.CrossRefPubMedPubMedCentral
30.
go back to reference Busse A, Sonntag A, Bischkopf J, Matschinger H, Angermeyer MC: Adaptation of dementia screening for vision-impaired older persons: administration of the Mini-Mental State Examination (MMSE). J Clin Epidemiol. 2002, 55: 909-915. 10.1016/S0895-4356(02)00449-3.CrossRefPubMed Busse A, Sonntag A, Bischkopf J, Matschinger H, Angermeyer MC: Adaptation of dementia screening for vision-impaired older persons: administration of the Mini-Mental State Examination (MMSE). J Clin Epidemiol. 2002, 55: 909-915. 10.1016/S0895-4356(02)00449-3.CrossRefPubMed
31.
go back to reference Brayne C, Gill C, Paykel ES, Huppert F, O'Connor DW: Cognitive decline in an elderly population--a two wave study of change. Psychol Med. 1995, 25: 673-683.CrossRefPubMed Brayne C, Gill C, Paykel ES, Huppert F, O'Connor DW: Cognitive decline in an elderly population--a two wave study of change. Psychol Med. 1995, 25: 673-683.CrossRefPubMed
32.
go back to reference de Jager CA, Budge MM, Clarke R: Utility of TICS-M for the assessment of cognitive function in older adults. Int J Geriatr Psychiatry. 2003, 18: 318-324. 10.1002/gps.830.CrossRefPubMed de Jager CA, Budge MM, Clarke R: Utility of TICS-M for the assessment of cognitive function in older adults. Int J Geriatr Psychiatry. 2003, 18: 318-324. 10.1002/gps.830.CrossRefPubMed
33.
go back to reference Hogervorst E, Combrinck M, Lapuerta P, Rue J, Swales K, Budge M: The Hopkins Verbal Learning Test and screening for dementia. Dement Geriatr Cogn Disord. 2002, 13: 13-20. 10.1159/000048628.CrossRefPubMed Hogervorst E, Combrinck M, Lapuerta P, Rue J, Swales K, Budge M: The Hopkins Verbal Learning Test and screening for dementia. Dement Geriatr Cogn Disord. 2002, 13: 13-20. 10.1159/000048628.CrossRefPubMed
Metadata
Title
Brief cognitive assessment in a UK population sample – distributional properties and the relationship between the MMSE and an extended mental state examination
Authors
Felicia A Huppert
Sara T Cabelli
Fiona E Matthews
the MRC Cognitive Function and Ageing Study (MRC CFAS)
Publication date
01-12-2005
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2005
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/1471-2318-5-7

Other articles of this Issue 1/2005

BMC Geriatrics 1/2005 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine