The Mini-Mental State Examination in General Medical Practice: Clinical Utility and Acceptance
Section snippets
Community Sample
The Mayo Clinic and the Olmsted Medical Group are the only multispecialty group practices that provide health-care services to the 67,000 residents of Rochester, Minnesota, and the additional 39,000 residents of the surrounding predominantly agricultural area of Olmsted County. The Division of Community Internal Medicine at the Mayo Clinic specifically serves the primary internal medicine needs of the county. The practice has a much higher percentage of consultations for elderly persons than
Psychometric Properties
Because the MMSE has a “ceiling” effect that restricts variance at the upper end of the scale (that is, the total score cannot exceed 30), linear analyses were performed on scores expressed as a percentage of the maximal possible score (obtained MMSE score/30) and subsequently transformed with the arcsine of the square root of the percentage score. Such a transformation is appropriate for the application of linear models to variables expressed as percentages.
Age, Education, and Sex
Using data from the community sample
DISCUSSION
This examination of MMSE total scores in a large sample of elderly persons suggests that performance on the MMSE is influenced by age and education but not by sex. These results suggest the need to adjust expectations (that is, cutoff scores) on the basis of the age and education of a patient. Scores that are 1 residual SD less than predicted scores from the fitted linear regression of transformed MMSE total scores on age and education, to a minimal value of 23, are shown in Table 3. A sliding
CONCLUSION
The data or opinions presented herein should not be construed to mean that the MMSE has no role in the general assessment of elderly patients. Rather, we believe that the clinical utility and physician acceptance of the MMSE can be improved through (1) awareness of age and education influences on the MMSE and (2) application of the instrument in settings consonant with its original development (populations with high base rates of dementia). The MMSE does not seem to be efficacious or well
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This study was supported in part by Grants ADCC AG 08031 and ADPR AG 06786 from the National Institute on Aging.
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Emeritus staff.