An adaptation of the modified mini-mental state examination

Analysis of demographic influences and normative data. The Cache County Study

JoAnn T. Tschanz, Kathleen A. Welsh-Bohmer, Brenda L. Plassman, Maria C. Norton, Bonita W. Wyse, John C.S. Breitner, James C. Anthony, Erin Bigler, James Burke, Michelle C Carlson, Chris Corcoran, Robert Green, Andrea Hart, Michael Helms, Ara S. Khachaturian, Carol Leslie, Constantine G Lyketsos, Lawrence Mayer, Marion Meyer, Richard Miech & 8 others Russell Ray, Ingmar Skoog, David C. Steffens, Martin I Steinberg, Jeanette J. Townsend, Nancy West, Michael Williams, Peter P Zandi

Research output: Contribution to journalArticle

Abstract

Objectives: To present a new version of the Modified Mini-Mental State Examination (3MS-R), provide normative information extending to individuals in the 10th decade, and examine the effects of demographic variables on test performance. Background: The Modified Mini-Mental State Examination, based originally on the Mini-Mental State Examination, has been used to screen populations for dementia. Providing normative information and an analysis of demographic variables on test performance for this version would support broader use in clinical and other settings. Methods: Two thousand, nine hundred thirteen elderly individuals determined to be free of dementia and other neurologic and psychiatric conditions served as subjects. An analysis of variance was conducted to examine the effects of age, gender, and education on test performance. Descriptive statistics (means, standard deviations, and percentile ranks) were calculated to summarize the range of normal performance. To examine the sensitivity/specificity of the suggested cut-off points at the 7th and 10th percentiles, two subsamples of elderly individuals, on whom clinical dementia assessments were available, were used to classify individuals with regard to dementia status. Results: Lower age, higher education, and female gender were associated with higher 3MS-R scores. Gender effects were among the weakest, but most important at lower levels of education. Education effects were most prominent in the youngest age groups. Selection of a cut-off point at the 7th percentile revealed 69%-70% sensitivity for detecting dementia, and higher sensitivity for individuals in the youngest age groups. Specificity at this cut-off point was 89%. Raising the cut-off point to the 10th percentile improved sensitivity to 73%-76%, but reduced specificity to 85%-86%. Conclusion: We present a version of the Modified Mini-Mental State Examination that has demonstrated utility in screening a population for dementia. An analysis of normative information and the effects of demographic influences suggest that the 7th percentile cut-off point performs very well in detecting dementia in 65-79-year-old individuals but less well for individuals in their 80s and 90s. To increase the sensitivity of the 3MS-R to detect dementia or other forms of cognitive impairment, particularly among the "old-old," the test user may wish to raise the cut-off point for impairment in some demographic groups or to supplement the test with additional cognitive measures.

Original languageEnglish (US)
Pages (from-to)28-38
Number of pages11
JournalNeuropsychiatry, Neuropsychology and Behavioral Neurology
Volume15
Issue number1
StatePublished - 2002
Externally publishedYes

Fingerprint

Dementia
Demography
Education
Age Groups
Nervous System
Population
Psychiatry
Analysis of Variance
Reference Values
Sensitivity and Specificity

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Psychiatry and Mental health
  • Psychology(all)

Cite this

An adaptation of the modified mini-mental state examination : Analysis of demographic influences and normative data. The Cache County Study. / Tschanz, JoAnn T.; Welsh-Bohmer, Kathleen A.; Plassman, Brenda L.; Norton, Maria C.; Wyse, Bonita W.; Breitner, John C.S.; Anthony, James C.; Bigler, Erin; Burke, James; Carlson, Michelle C; Corcoran, Chris; Green, Robert; Hart, Andrea; Helms, Michael; Khachaturian, Ara S.; Leslie, Carol; Lyketsos, Constantine G; Mayer, Lawrence; Meyer, Marion; Miech, Richard; Ray, Russell; Skoog, Ingmar; Steffens, David C.; Steinberg, Martin I; Townsend, Jeanette J.; West, Nancy; Williams, Michael; Zandi, Peter P.

In: Neuropsychiatry, Neuropsychology and Behavioral Neurology, Vol. 15, No. 1, 2002, p. 28-38.

Research output: Contribution to journalArticle

Tschanz, JT, Welsh-Bohmer, KA, Plassman, BL, Norton, MC, Wyse, BW, Breitner, JCS, Anthony, JC, Bigler, E, Burke, J, Carlson, MC, Corcoran, C, Green, R, Hart, A, Helms, M, Khachaturian, AS, Leslie, C, Lyketsos, CG, Mayer, L, Meyer, M, Miech, R, Ray, R, Skoog, I, Steffens, DC, Steinberg, MI, Townsend, JJ, West, N, Williams, M & Zandi, PP 2002, 'An adaptation of the modified mini-mental state examination: Analysis of demographic influences and normative data. The Cache County Study', Neuropsychiatry, Neuropsychology and Behavioral Neurology, vol. 15, no. 1, pp. 28-38.
Tschanz, JoAnn T. ; Welsh-Bohmer, Kathleen A. ; Plassman, Brenda L. ; Norton, Maria C. ; Wyse, Bonita W. ; Breitner, John C.S. ; Anthony, James C. ; Bigler, Erin ; Burke, James ; Carlson, Michelle C ; Corcoran, Chris ; Green, Robert ; Hart, Andrea ; Helms, Michael ; Khachaturian, Ara S. ; Leslie, Carol ; Lyketsos, Constantine G ; Mayer, Lawrence ; Meyer, Marion ; Miech, Richard ; Ray, Russell ; Skoog, Ingmar ; Steffens, David C. ; Steinberg, Martin I ; Townsend, Jeanette J. ; West, Nancy ; Williams, Michael ; Zandi, Peter P. / An adaptation of the modified mini-mental state examination : Analysis of demographic influences and normative data. The Cache County Study. In: Neuropsychiatry, Neuropsychology and Behavioral Neurology. 2002 ; Vol. 15, No. 1. pp. 28-38.
@article{a22dfe5071314c2e815a997da35c5efb,
title = "An adaptation of the modified mini-mental state examination: Analysis of demographic influences and normative data. The Cache County Study",
abstract = "Objectives: To present a new version of the Modified Mini-Mental State Examination (3MS-R), provide normative information extending to individuals in the 10th decade, and examine the effects of demographic variables on test performance. Background: The Modified Mini-Mental State Examination, based originally on the Mini-Mental State Examination, has been used to screen populations for dementia. Providing normative information and an analysis of demographic variables on test performance for this version would support broader use in clinical and other settings. Methods: Two thousand, nine hundred thirteen elderly individuals determined to be free of dementia and other neurologic and psychiatric conditions served as subjects. An analysis of variance was conducted to examine the effects of age, gender, and education on test performance. Descriptive statistics (means, standard deviations, and percentile ranks) were calculated to summarize the range of normal performance. To examine the sensitivity/specificity of the suggested cut-off points at the 7th and 10th percentiles, two subsamples of elderly individuals, on whom clinical dementia assessments were available, were used to classify individuals with regard to dementia status. Results: Lower age, higher education, and female gender were associated with higher 3MS-R scores. Gender effects were among the weakest, but most important at lower levels of education. Education effects were most prominent in the youngest age groups. Selection of a cut-off point at the 7th percentile revealed 69{\%}-70{\%} sensitivity for detecting dementia, and higher sensitivity for individuals in the youngest age groups. Specificity at this cut-off point was 89{\%}. Raising the cut-off point to the 10th percentile improved sensitivity to 73{\%}-76{\%}, but reduced specificity to 85{\%}-86{\%}. Conclusion: We present a version of the Modified Mini-Mental State Examination that has demonstrated utility in screening a population for dementia. An analysis of normative information and the effects of demographic influences suggest that the 7th percentile cut-off point performs very well in detecting dementia in 65-79-year-old individuals but less well for individuals in their 80s and 90s. To increase the sensitivity of the 3MS-R to detect dementia or other forms of cognitive impairment, particularly among the {"}old-old,{"} the test user may wish to raise the cut-off point for impairment in some demographic groups or to supplement the test with additional cognitive measures.",
author = "Tschanz, {JoAnn T.} and Welsh-Bohmer, {Kathleen A.} and Plassman, {Brenda L.} and Norton, {Maria C.} and Wyse, {Bonita W.} and Breitner, {John C.S.} and Anthony, {James C.} and Erin Bigler and James Burke and Carlson, {Michelle C} and Chris Corcoran and Robert Green and Andrea Hart and Michael Helms and Khachaturian, {Ara S.} and Carol Leslie and Lyketsos, {Constantine G} and Lawrence Mayer and Marion Meyer and Richard Miech and Russell Ray and Ingmar Skoog and Steffens, {David C.} and Steinberg, {Martin I} and Townsend, {Jeanette J.} and Nancy West and Michael Williams and Zandi, {Peter P}",
year = "2002",
language = "English (US)",
volume = "15",
pages = "28--38",
journal = "Cognitive and Behavioral Neurology",
issn = "1543-3633",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - An adaptation of the modified mini-mental state examination

T2 - Analysis of demographic influences and normative data. The Cache County Study

AU - Tschanz, JoAnn T.

AU - Welsh-Bohmer, Kathleen A.

AU - Plassman, Brenda L.

AU - Norton, Maria C.

AU - Wyse, Bonita W.

AU - Breitner, John C.S.

AU - Anthony, James C.

AU - Bigler, Erin

AU - Burke, James

AU - Carlson, Michelle C

AU - Corcoran, Chris

AU - Green, Robert

AU - Hart, Andrea

AU - Helms, Michael

AU - Khachaturian, Ara S.

AU - Leslie, Carol

AU - Lyketsos, Constantine G

AU - Mayer, Lawrence

AU - Meyer, Marion

AU - Miech, Richard

AU - Ray, Russell

AU - Skoog, Ingmar

AU - Steffens, David C.

AU - Steinberg, Martin I

AU - Townsend, Jeanette J.

AU - West, Nancy

AU - Williams, Michael

AU - Zandi, Peter P

PY - 2002

Y1 - 2002

N2 - Objectives: To present a new version of the Modified Mini-Mental State Examination (3MS-R), provide normative information extending to individuals in the 10th decade, and examine the effects of demographic variables on test performance. Background: The Modified Mini-Mental State Examination, based originally on the Mini-Mental State Examination, has been used to screen populations for dementia. Providing normative information and an analysis of demographic variables on test performance for this version would support broader use in clinical and other settings. Methods: Two thousand, nine hundred thirteen elderly individuals determined to be free of dementia and other neurologic and psychiatric conditions served as subjects. An analysis of variance was conducted to examine the effects of age, gender, and education on test performance. Descriptive statistics (means, standard deviations, and percentile ranks) were calculated to summarize the range of normal performance. To examine the sensitivity/specificity of the suggested cut-off points at the 7th and 10th percentiles, two subsamples of elderly individuals, on whom clinical dementia assessments were available, were used to classify individuals with regard to dementia status. Results: Lower age, higher education, and female gender were associated with higher 3MS-R scores. Gender effects were among the weakest, but most important at lower levels of education. Education effects were most prominent in the youngest age groups. Selection of a cut-off point at the 7th percentile revealed 69%-70% sensitivity for detecting dementia, and higher sensitivity for individuals in the youngest age groups. Specificity at this cut-off point was 89%. Raising the cut-off point to the 10th percentile improved sensitivity to 73%-76%, but reduced specificity to 85%-86%. Conclusion: We present a version of the Modified Mini-Mental State Examination that has demonstrated utility in screening a population for dementia. An analysis of normative information and the effects of demographic influences suggest that the 7th percentile cut-off point performs very well in detecting dementia in 65-79-year-old individuals but less well for individuals in their 80s and 90s. To increase the sensitivity of the 3MS-R to detect dementia or other forms of cognitive impairment, particularly among the "old-old," the test user may wish to raise the cut-off point for impairment in some demographic groups or to supplement the test with additional cognitive measures.

AB - Objectives: To present a new version of the Modified Mini-Mental State Examination (3MS-R), provide normative information extending to individuals in the 10th decade, and examine the effects of demographic variables on test performance. Background: The Modified Mini-Mental State Examination, based originally on the Mini-Mental State Examination, has been used to screen populations for dementia. Providing normative information and an analysis of demographic variables on test performance for this version would support broader use in clinical and other settings. Methods: Two thousand, nine hundred thirteen elderly individuals determined to be free of dementia and other neurologic and psychiatric conditions served as subjects. An analysis of variance was conducted to examine the effects of age, gender, and education on test performance. Descriptive statistics (means, standard deviations, and percentile ranks) were calculated to summarize the range of normal performance. To examine the sensitivity/specificity of the suggested cut-off points at the 7th and 10th percentiles, two subsamples of elderly individuals, on whom clinical dementia assessments were available, were used to classify individuals with regard to dementia status. Results: Lower age, higher education, and female gender were associated with higher 3MS-R scores. Gender effects were among the weakest, but most important at lower levels of education. Education effects were most prominent in the youngest age groups. Selection of a cut-off point at the 7th percentile revealed 69%-70% sensitivity for detecting dementia, and higher sensitivity for individuals in the youngest age groups. Specificity at this cut-off point was 89%. Raising the cut-off point to the 10th percentile improved sensitivity to 73%-76%, but reduced specificity to 85%-86%. Conclusion: We present a version of the Modified Mini-Mental State Examination that has demonstrated utility in screening a population for dementia. An analysis of normative information and the effects of demographic influences suggest that the 7th percentile cut-off point performs very well in detecting dementia in 65-79-year-old individuals but less well for individuals in their 80s and 90s. To increase the sensitivity of the 3MS-R to detect dementia or other forms of cognitive impairment, particularly among the "old-old," the test user may wish to raise the cut-off point for impairment in some demographic groups or to supplement the test with additional cognitive measures.

UR - http://www.scopus.com/inward/record.url?scp=0036199591&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036199591&partnerID=8YFLogxK

M3 - Article

VL - 15

SP - 28

EP - 38

JO - Cognitive and Behavioral Neurology

JF - Cognitive and Behavioral Neurology

SN - 1543-3633

IS - 1

ER -