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Alzheimer's Research & Therapy
Published in: Alzheimer's Research & Therapy 1/2016

Open Access 01-12-2016 | Research

Mini Mental State Examination and Logical Memory scores for entry into Alzheimer’s disease trials

Authors: Kimberly R. Chapman, Hanaan Bing-Canar, Michael L. Alosco, Eric G. Steinberg, Brett Martin, Christine Chaisson, Neil Kowall, Yorghos Tripodis, Robert A. Stern

Published in: Alzheimer's Research & Therapy | Issue 1/2016

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Abstract

Background

Specific cutoff scores on the Mini Mental State Examination (MMSE) and the Logical Memory (LM) test are used to determine inclusion in Alzheimer’s disease (AD) clinical trials and diagnostic studies. These screening measures have known psychometric limitations, but no study has examined the diagnostic accuracy of the cutoff scores used to determine entry into AD clinical trials and diagnostic studies.

Methods

ClinicalTrials.gov entries were reviewed for phases II and III active and recruiting AD studies using the MMSE and LM for inclusion. The diagnostic accuracy of MMSE and LM-II cutoffs used in AD trials and diagnostic studies was examined using 23,438 subjects with normal cognition, mild cognitive impairment (MCI), and AD dementia derived from the National Alzheimer’s Coordinating Center database.

Results

MMSE and LM cutoffs used in current AD clinical trials and diagnostic studies had limited diagnostic accuracy, particularly for distinguishing between normal cognition and MCI, and MCI from AD dementia. The MMSE poorly discriminated dementia stage.

Conclusions

The MMSE and LM may result in inappropriate subject enrollment in large-scale, multicenter studies designed to develop therapeutics and diagnostic methods for AD.
Literature
1.
Palmqvist S, Zetterberg H, Mattsson N, Johansson P, Minthon L, Blennow K, et al. Detailed comparison of amyloid PET and CSF biomarkers for identifying early Alzheimer disease. Neurology. 2015;85:1240–9.PubMedCentralCrossRefPubMed
2.
Khan TK, Alkon DL. Alzheimer’s disease cerebrospinal fluid and neuroimaging biomarkers: diagnostic accuracy and relationship to drug efficacy. J Alzheimers Dis. 2015;46:817–36.CrossRefPubMed
3.
Lautner R, Plamqvist S, Mattsson N, Andreasson U, Wallin A, Pålsson E, et al. Apolipoprotein E genotype and the diagnostic accuracy of cerebrospinal fluid biomarkers for Alzheimer disease. JAMA Psychiatry. 2014;71:1183–91.CrossRefPubMed
4.
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;12:189–98.CrossRefPubMed
5.
Wechsler D. WMS-R: Wechsler Memory Scale–Revised. San Antonio, TX: Psychological Corporation; 1987.
6.
Franco-Marina F, García-González JJ, Wagner-Echeagaray F, Gallo J, Ugalde O, Sánchez-García S, et al. The Mini-Mental State Examination revisited: ceiling and floor effects after score adjustment for educational level in an aging Mexican population. Int Psychogeriatr. 2010;22:72–81.CrossRefPubMed
7.
Galasko D, Abramson I, Corey-Bloom J, Thal JL. Repeated exposure to the Mini-Mental State Examination and the Information-Memory-Concentration Test results in a practice effect in Alzheimer’s disease. Neurology. 1993;43:1559–63.CrossRefPubMed
8.
Spencer RJ, Wendell CR, Giggey PP, Katzel LI, Lefkowitz DM, Siegel EL, et al. Psychometric limitations of the Mini-Mental State Examination among nondemented older adults: an evaluation of neurocognitive and magnetic resonance imaging correlates. Exp Aging Res. 2013;39:382–97.CrossRefPubMed
9.
Lonie JA, Tierney KM, Ebmeier KP. Screening for mild cognitive impairment: a systematic review. Int J Geriatr Psychiatry. 2009;24:902–15.CrossRefPubMed
10.
Arevalo‐Rodriguez I, Smailagic N, Roqué i Figuls M, Ciapponi A, Sanchez‐Perez E, Giannakou A, et al. Mini‐Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev. 2015;3:CD010783.PubMed
11.
Mitchell AJ. A meta-analysis of the accuracy of the Mini-Mental State Examination in the detection of dementia and mild cognitive impairment. J Psychiatr Res. 2009;43:411–31.CrossRefPubMed
12.
Perneczky R, Wagenpfeil S, Komossa K, Grimmer T, Diehl J, Kurz A. Mapping scores onto stages: Mini-Mental State Examination and Clinical Dementia Rating. Am J Geriatr Psychiatry. 2006;14:139–44.CrossRefPubMed
13.
Schnabel R. Overcoming the challenge of re-assessing logical memory. Clin Neuropsychol. 2012;26:102–15.CrossRefPubMed
14.
Weintraub S, Salmon D, Mercaldo N, Ferris S, Graff-Radford NR, Chui H, et al. The Alzheimer’s Disease Centers’ Uniform Data Set (UDS): the neuropsychological test battery. Alzheimer Dis Assoc Disord. 2009;23:91–101.PubMedCentralCrossRefPubMed
15.
Derby CA, Burns LC, Wang C, Katz MJ, Zimmerman ME, L’Italien G, et al. Screening for predementia AD time-dependent operating characteristics of episodic memory tests. Neurology. 2013;80:1307–14.PubMedCentralCrossRefPubMed
16.
Johnson DK, Storandt M, Balota DA. Discourse analysis of logical memory recall in normal aging and in dementia of the Alzheimer type. Neuropsychology. 2003;17:82–92.CrossRefPubMed
17.
Tremont D, Halpert S, Javorsky DJ, Stern RA. Differential impact of executive dysfunction on verbal list learning and story recall. Clin Neuropsychol. 2000;14:295–302.CrossRefPubMed
18.
Doody RS, Thomas RG, Farlow M, Iwatsubo T, Vellas B, Joffe S, et al. Phase 3 trials of solanezumab for mild-to-moderate Alzheimer’s disease. N Engl J Med. 2014;370:311–21.CrossRefPubMed
19.
Salloway S, Sperling R, Fox NC, Blennow K, Klunk W, Raskind M, et al. Two phase 3 trials of bapineuzumab in mild-to-moderate Alzheimer’s disease. N Engl J Med. 2014;370:322–33.PubMedCentralCrossRefPubMed
20.
Beekly DL, Ramos EM, van Belle G, Deitrich W, Clark AD, Jacka ME, et al. The National Alzheimer’s Coordinating Center (NACC) database: an Alzheimer disease database. Alzheimer Dis Assoc Disord. 2004;18:270–7.PubMed
21.
Beekly DL, Ramos EM, Lee WW, Deitrich WD, Jacka ME, Wu J, et al. The National Alzheimer’s Coordinating Center (NACC) database: the Uniform Data Set. Alzheimer Dis Assoc Disord. 2007;21:249–58.CrossRefPubMed
22.
Morris JC, Weintraub S, Chui HC, Cummings J, DeCarli C, Ferris S, et al. The Uniform Data Set (UDS): clinical and cognitive variables and descriptive data from Alzheimer Disease Centers. Alzheimer Dis Assoc Disord. 2006;13:210–6.CrossRef
23.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan E. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDS Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology. 1984;34:939–44.CrossRefPubMed
24.
Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, et al. Mild cognitive impairment–beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;256:240–6.CrossRefPubMed
25.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry. 1982;140:566–72.CrossRefPubMed
26.
Morris JC. Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. Int Psychogeriatr. 1997;9:173–6.CrossRefPubMed
27.
Morris JC. The Clinical Dementia Rating: current version and scoring rules. Neurology. 1993;43:2412–4.CrossRefPubMed
28.
Nyunt MS, Chong MS, Lim WS, Lee TS, Yap P, Ng TP. Reliability and validity of the Clinical Dementia Rating for community-living elderly subjects without an informant. Dement Geriatr Cogn Dis Extra. 2013;3:407–16.PubMedCentralCrossRefPubMed
29.
Fan J, Upadhye S, Worster A. Understanding receiver operating characteristic (ROC) curves. CJEM. 2006;8:19–20.PubMed
30.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefPubMed
31.
Spering CC, Hobson V, Lucas JA, Menon CV, Hall JR, O’Bryant SE. Diagnostic accuracy of the MMSE in detecting probable and possible Alzheimer’s disease in ethnically diverse highly educated individuals: an analysis of the NACC database. J Gerontol A Biol Sci Med Sci. 2012;67:890–6.PubMedCentralCrossRefPubMed
32.
Tombaugh TN, McIntyre NJ. The Mini‐Mental State Examination: a comprehensive review. J Am Geriatr Soc. 1992;40:922–35.CrossRefPubMed
33.
Abikoff H, Alvir J, Hong G, Sukoff R, Orazio J, Solomon S, et al. Logical Memory subtest of the Wechsler Memory Scale: age and education norms and alternate-form reliability of two scoring systems. J Clin Exp Neuropsychol. 1987;9:435–48.CrossRefPubMed
34.
Goldberg TE, Harvey PD, Wesnes KA, Snyder PJ, Schneider LS. Practice effects due to serial cognitive assessment: implications for preclinical Alzheimer’s disease randomized controlled trials. Alzheimers Dement (Amst). 2015;1:103–11.
35.
Perneczky R. The appropriateness of short cognitive tests for the identification of mild cognitive impairment and mild dementia [in German]. Aktuelle Neurol. 2003;30:114–7.CrossRef
36.
National Institute for Clinical Excellence (NICE). Guidance on the use of donepezil, rivastigmine and galantamine for the treatment of Alzheimer’s disease [Technology Appraisal Guidance]. London: NICE; 2001.
37.
38.
Callahan BL, Ramirez J, Berezuk C, Duchesne S, Black SE, Alzheimer’s Disease Neuroimaging Initiative. Predicting Alzheimer’s disease development: a comparison of cognitive criteria and associated neuroimaging biomarkers. Alzheimers Res Ther. 2015;7:68.PubMedCentralCrossRefPubMed
39.
Jak AJ, Bondi MW, Delano-Wood L, Wierenga C, Corey-Bloom J, Salmon DP, et al. Quantification of five neuropsychological approaches to defining mild cognitive impairment. Am J Geriatr Psychiatry. 2009;17:368–75.PubMedCentralCrossRefPubMed
40.
Hsu JL, Fan YC, Huan YL, Wang J, Chen WH, Chiu HC, et al. Improved predictive ability of the Montreal Cognitive Assessment for diagnosing dementia in a community-based study. Alzheimers Res Ther. 2015;7:69.PubMedCentralCrossRefPubMed
41.
Trezepacz PT, Hochstetler H, Wang S, Walker B, Saykin; Alzheimer’s Disease Neuroimaging Initiative. Relationship between the Montreal Cognitive Assessment and Mini-Mental State Examination for assessment of mild cognitive impairment in older adults. BMC Geriatr. 2015;15:107.
42.
Gavett BE, Ashendorf L, Gurnani AS. Reliable change on neuropsychological tests in the Uniform Data Set. J Int Neuropsychol Soc. 2015;21:558–67.CrossRefPubMed
Metadata
Title
Mini Mental State Examination and Logical Memory scores for entry into Alzheimer’s disease trials
Authors
Kimberly R. Chapman
Hanaan Bing-Canar
Michael L. Alosco
Eric G. Steinberg
Brett Martin
Christine Chaisson
Neil Kowall
Yorghos Tripodis
Robert A. Stern
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Alzheimer's Research & Therapy / Issue 1/2016
Electronic ISSN: 1758-9193
DOI
https://doi.org/10.1186/s13195-016-0176-z

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