***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To determine whether a cognitive test package can predict the onset of dementia up to 11 years later , and the extent to which this prediction is independent of that provided by APOE genotype . Methods : Prospect i ve cohort study based on 54 general practice s in the UK ; 657 survivors of the 1088 participants in the MRC treatment trial of hypertension in older adults were followed for up to 11 years ; 370 participants ( 57 % of survivors ) were traced , screened for dementia , and genotyped for APOE in 1994 . Baseline assessment s included  trail making test A , paired associated learning test , Raven ’s progressive matrices , and national adult reading test .  At follow up , both mini-mental state examination and CAMCOG  were used . Outcome measures were DSM-IIIR dementia and NINCDS-ADRDA possible and probable Alzheimer ’s disease . Results : All the cognitive tests completed in 1983 predicted onset of dementia and Alzheimer ’s disease up to 11 years later , as did APOE genotype . Cognitive test performance was not associated with APOE genotype . Addition of cognitive tests increased the area under the ROC curve for the prediction of Alzheimer ’s disease provided by age , family history , and APOE genotype ( 0.81 v 0.69 , p = 0.048 ) ; addition of APOE genotype did not increase the area under the ROC curve for the prediction provided by age , family history , and cognitive tests ( 0.81 v 0.77 , p = 0.28 ) . Conclusions : Simple tests of cognitive ability provide useful predictive information up to a decade before the onset of dementia . The predictive information provided is independent of , but not enhanced by , the addition of APOE genotype We developed a modified trail-making test using a PC and touch panel and compared it with the mini mental state examination ( MMSE ) . The test consisted of a series of numbers from 1 to 36 , r and omly arranged across the display . The object of the test was for the subject to touch the numbers in order , beginning with 1 and ending with 36 , in as little time as possible . The system consisted of a PC and a liquid crystal display ( LCD ) touch-panel screen .  One hundred and thirty-four patients with dementia performed the test . Sixty of the 134 patients ( 15 male , 45 female ; average age , 81.1plusmn7 years ) were diagnosed as having Alzheimer 's disease and the others had cerebrovascular dementia . Sixty-two of 134 patients ( 23 male , 39 female ; average age , 77.6plusmn8 years ; MMSE score , 21.5plusmn5.6 points ) completed the test . The correlation coefficient between test performance time and MMSE score was -0.534 . This test may also be a useful indicator of focal frontal lesions and can be used as an early screening test for Alzheimer 's In the community at large , many older adults with minimal cognitive and functional impairment remain stable or improve over time , unlike patients in clinical research setting s , who typically progress to dementia . Within a prospect i ve population -based study , we identified neuropsychological tests predicting improvement or worsening over 1 year in cognitively driven everyday functioning as measured by Clinical Dementia Rating ( CDR ) .  Participants were 1682 adults aged 65 + and dementia-free at baseline .  CDR change was modeled as a function of baseline test scores , adjusting for demographics . Among those with baseline CDR = 0.5 , 29.8 % improved to CDR = 0 ; they had significantly better baseline scores on most tests . In a stepwise multiple logistic regression model , tests which remained independently associated with subsequent CDR improvement were Category Fluency , a modified Token Test , and the sum of learning trials on Object Memory Evaluation . In contrast , only 7.1 % with baseline CDR = 0 worsened to CDR = 0.5 . They had significantly lower baseline scores on most tests . In multiple regression analyses , only the Mini-Mental State Examination , delayed memory for visual reproduction , and recall susceptible to proactive interference , were independently associated with CDR worsening . At the population level , changes in both directions are observable in functional status , with different neuropsychological measures predicting the direction of change The project Epidemiology Research on Dementia in Antwerp ( ERDA ) estimated the prevalence of dementia in a r and om , population -based sample , stratified for age and sex . The sample of 1,736 elderly was screened at home with the Mini-Mental State Examination .  All elderly under the cutoff of 23 - 24/30 got a diagnostic examination with the Cambridge Mental Disorders of the Elderly Examination and the DSM-IIIR criteria . The prevalence of dementia in the population above 65 years was estimated at 9 % . The following age-specific prevalences of dementia ( included mild dementia ) were found in the age-groups 65 - 69 , 70 - 74 , 75 - 79 , 80 - 84 , 85 + : 0.6 , 5.1 , 7.6 , 16.2 and 33.6 % . The prevalence of at least moderate dementia was 0.3 , 3.9 , 4.0 , 11.2 and 25.0 % , respectively . The prevalence of dementia , vascular dementia and dementia of the Alzheimer type was markedly higher in women than in men Background : Dementia is poorly recognized even by physicians . This study compares three instruments used to assess dementia in a community setting in Sri Lanka . Method : Translated and culturally adapted versions of the Mini Mental State Examination ( MMSE ) , Informant Question naire on Cognitive Decline in the Elderly ( IQCODE ) and Clinical Dementia Rating ( CDR ) were administered to 363 individuals selected by stratified r and om sampling in a periurban community in Sri Lanka . The results on the three instruments were compared with the independent psychiatric evaluation done on a concentrated sample of 37 individuals from the study population . Results : Culturally adapted MMSE , IQCODE and CDR can be used to screen dementia in Sri Lanka . IQCODE is the best among the three instruments with a sensitivity of 71.4 % and a specificity of 82.6 % when 3.5 is the cut-off . In addition , IQCODE is culturally acceptable , easy to administer and can be used in those with a low level of literacy as well as in those with hearing or visual impairment . Conclusion : IQCODE was found to be more effective and culturally acceptable as a screening tool for dementia in Sri Lanka , compared with MMSE and CDR Objective . To design a brief cognitive screener with acceptable sensitivity and specificity for identifying subjects with cognitive impairment Design . Cohort one is assembled from a community-based survey coupled with a second-stage diagnostic evaluation using formal diagnostic criteria for dementia . Cohort two is assembled from referrals to a specialty clinic for dementing disorders that completed the same diagnostic evaluation . Setting . Urban neighborhoods in Indianapolis , Indiana and the Indiana Alzheimer Disease Center . Patients . Cohort one consists of 344 community-dwelling black persons identified from a r and om sample of 2212 black persons aged 65 and older residing in Indianapolis ; cohort two consists of 651 subject referrals to the Alzheimer Disease Center . Measurements . Formal diagnostic clinical assessment s for dementia including scores on the  Mini-mental state examination ( MMSE ) , a six-item screener derived from the MMSE , the Blessed Dementia Rating Scale ( BDRS ) , and the Word List Recall .  Based on clinical evaluations , subjects were categorized as no cognitive impairment , cognitive impairment-not demented , or demented . Results . The mean age of the community-based sample was 74.4 years , 59.4 % of the sample were women , and the mean years of education was 10.1 . The prevalence of dementia in this sample was 4.3 % and the prevalence of cognitive impairment was 24.6 % . Using a cut-off of three or more errors , the sensitivity and specificity of the six-item screener for a diagnosis of dementia was 88.7 and 88.0 , respectively . In the same sample , the corresponding sensitivity and specificity for the MMSE using a cut-off score of 23 was 95.2 and 86.7 . The performance of the two scales was comparable across the two population s studied and using either cognitive impairment or dementia as the gold st and ard . An increasing number of errors on the six-item screener is highly correlated with poorer scores on longer measures of cognitive impairment . Conclusions . The six-item screener is a brief and reliable instrument for identifying subjects with cognitive impairment and its diagnostic properties are comparable to the full MMSE . It can be administered by telephone or face-to-face interview and is easily scored by a simple summation of errors OBJECTIVE To determine the variability in annual  Mini-Mental State Examination scores  of patients with Alzheimer disease enrolled in the Consortium to Establish a Registry for Alzheimer 's Disease ( CERAD ) . PATIENTS A total of 372 patients with probable Alzheimer disease with 1 or more years of follow-up . SETTING Twenty-one CERAD clinical sites throughout the United States . RESULTS An average annual decline of 3.4 points in CERAD patients returning for longitudinal re assessment s was close to the SD of the measurement error of 2.8 points for the Mini-Mental State Examination . There was wide variability in individual rates of decline . Even with 4 years of follow-up , 15.8 % of the patients had no clinical ly meaningful decline in  Mini-Mental State Examination score ( defined as a change in initial score > 3 , ie , 1 SD of measurement error ) . Validity of measurements of the rate of change in Mini-Mental State Examination scores improved with longer observation intervals and was reliable for most patients when observations were separated by 3 or more years . CONCLUSIONS Although the Mini-Mental State Examination is a useful screening instrument to assess level of cognitive function , it has limited value in measuring the progression of Alzheimer disease in individual patients for periods less than 3 years because of a large measurement error and substantial variation in change in annual score OBJECTIVES To determine whether the accuracy of the Mini-Mental State Examination ( MMSE ) in predicting future Alzheimer 's disease ( AD ) could be improved by the addition of patient and informant ratings of cognitive difficulties . DESIGN An inception cohort of nondemented patients followed longitudinally for 2 years . SETTING Patients referred to a university teaching hospital research investigation by their family physicians because of concerns about memory impairment . PARTICIPANTS One hundred sixty-five community-residing patients were included who did not have dementia or any identifiable cause for memory impairment . After 2 years , 29 met criteria for AD , and 95 were not demented . MEASUREMENTS Baseline assessment s included  MMSE , an Informant Rating Scale , and a Patient Rating Scale of cognitive difficulties .  After 2 years , patients were diagnosed following the reference st and ard for probable AD . Diagnosticians were blind to baseline scores . RESULTS Age and education were included in all analyses as covariates . The best logistic regression model included the Informant Rating Scale and the MMSE  ( sensitivity = 83 % , specificity = 79 % ) . An empirically reduced six-item model that included two items each from the MMSE , the Patient Rating Scale , and the Informant Rating Scale produced a significantly better model than the one with the full test scores ( sensitivity = 90 % , specificity = 94 % ) . CONCLUSION Results indicate that inclusion of informant ratings with the MMSE significantly improved its accuracy in the prediction of probable AD . Replication in a new prospect i ve cohort of nondemented patients is necessary to confirm these findings Previous studies have suggested that education and race may affect performance on st and ardized mental status tests . In order to more clearly define these relationships , a prospect i ve longitudinal study was devised to answer two questions : ( 1 ) whether race or level of education affects scores on the  Mini-Mental State ( MMS ) exam  in non-demented people and ( 2 ) what numerical cutpoints maximize the sensitivity and specificity of utilizing the MMS to help diagnose dementia in blacks of varying educational attainment . A total of 100 white and 258 black individuals , recruited from two city hospital primary care geriatric clinics , were evaluated and subsequently followed longitudinally over a 2 1/2 year period in order to assess accurately the presence or absence of dementia . In the non-demented , total MMS scores and performance on each item of the MMS were analyzed , revealing that people with an 8th grade or less education consistently had significantly ( P less than .01 ) worse results than the better educated ( 9th grade or better ) on borough , attention items , recall of table and dog , copying , sentence writing , phrase repeating , and total score . Furthermore , a total of 25 % of the lower education group had an MMS score in the 18 - 23 range , traditionally thought to suggest dementia . There were no consistently significant differences between blacks and whites of equal education . In the better educated groups , using a score of 23 or less to define dementia maximizes the sensitivity and specificity of using the MMS in this diagnosis at 93 % and 100 % , respectively . In the lower education group , using 17 or less to define dementia maximizes sensitivity and specificity at 81 % and 100 % , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS Background and aims 
    Output:
    
The MMSE contributes to a diagnosis of dementia in low prevalence setting s , but should not be used in isolation to confirm or exclude disease .