Steven M. Albert
MMSE 2.0: A New Approach to an Old Measure
University of Pittsburgh
minimental state examination mmse industry standard brief cognitive assessments older adults meant practical method grading cognitive state patients clinician title original paper states 1 commonly used epidemiologic cohorts identify incident dementia cognitive decline 11 questions assess 5 cognitive domains orientation registration attention calculation recall language scores range 0 30 score 23 lower indicating possible cognitive impairment need assessment measure used thousands published studies authorized translations 70 languages shortened expanded 2 normed different age education race groups 3 subjected extensive psychometric investigation validation efforts 4regressionbased tscores mmse performance developed help mitigate confounding associated literacy education challenge neuropsychological assessment yet kinds adjustments go far help floor ceiling effects differential sensitivity cognitive change upper lower ranges mmse scores variation sensitivity change seen different clinical meaning 1point mmse change depending persons initial score initial high score 2730 1point decline may clinically meaningful however 1point decline people scoring intermediate range scores 1020 indicate substantial declines cognitive ability metrological psychometric properties compromise value measure epidemiologic study lead false inferences cognitive change without sophisticated statistical modelingphilipps et al 5 addressed problem normalizing transformation mmse scores estimated scores validated using two populationbased studies paquid threecity study southwestern france 20year followup estimate cognitive change cohorts heterogeneous include normal pathological aging well samples including participants meeting criteria dementiathe normalizing transformation corrects curvilinearity mmse performance relative true change underlying cognitive status normalizing transformation scaled 0 100 converts crude scores 20 24 28 example 3737 5144 7461 respectively showing 4point difference crude mmse scores represents actual difference roughly 14 points mmse scores 20 24 23 points mmse scores 24 28this approach mmse likely great value normalizing transformation conveniently presented lookup table figure 3 paper makes possible use standard statistical methods study mmse scores dependent variable changing interval two successive values counteract metrological problems mmse provide score uses information mmse corrected intervals successive scoresthe value transformation seen effect education estimates cognitive decline phillipss simulations show raw score analyses underestimate effect educational level mmse performance baseline overestimate effect education change leading incorrect conclusions regarding el educational level risk factor cognitive declinethis last point go unnoticed neuroepidemiologists great deal research cognitive reserve social determinants cognitive status old age demonstrated key role educational attainment early life risk dementia trajectories cognitive decline age role education occupation cognitive engagement cognitive outcomes widely reported finding limited mmse cognitive outcome could effect education dementia risk actually partly artifact measurement properties mmse normalizing transformation proposed phillips et al 5 suggests minimum studies using raw mmse scores outcomes reexamined reestimated using mmse normalizing transformationanother important use normalizing transformation accurate comparison risk factor effects across different longitudinal studies phillips et al 5 suggest transformation mmse scores apply valid translation mmse even though developed validated frenchlanguage version provide convenient lookup table well r package compute normalized transformation crude mmse scalein short normalizing transformation mmse help improve accuracy studies cognitive change old age first charge investigators determine model predictions change use normalized scores outcomes rather raw scores second charge reexamine education determine much declines cognition old age truly attributed differences education life span much may artifacts curvilinear properties cognitive assessments mmse