Social Work Today E-Zine

A different cutoff point on an existing mental function assessment may more effectively assess the risk of dementia in highly educated older adults, according to a report in a recent Archives of Neurology.

The most commonly administered screening test of cognitive function is known as the mini-mental state examination (MMSE). “The MMSE is used to screen patients for cognitive impairment, track changes in cognitive functioning over time and often to assess the effects of therapeutic agents on cognitive function,” the authors wrote. The maximum MMSE score is 30; a score of 24 or less is typically used to detect individuals with cognitive dysfunction.

Sid E. O’Bryant, PhD, of the Texas Tech University Health Sciences Center, and colleagues reviewed the MMSE scores of 1,141 participants (93% white, an average age of 75.9) in the Mayo Clinic Alzheimer Disease Research Center and Alzheimer Disease Patient Registry who reported having 16 or more years of education. These included 307 patients with dementia, 176 patients with mild cognitive impairment, and 658 control patients without dementia.

With the traditional cut score of 24 on the MMSE, 89% of the participants were accurately classified by dementia status. This score had a sensitivity of 66% and a specificity of 99% for the detection of dementia, meaning that an individual with a score of 23 or lower would be correctly identified as having dementia 66% of the time and an individual with score of 24 or higher would be correctly diagnosed as not having dementia 99% of the time. Raising the cut score to 27 changed the sensitivity to 89% and the specificity to 78%, correctly classifying 90% of the participants.

“Older patients who present with memory complaints (reported by themselves or others) who have attained a college degree or higher level of education and who score below 27 on the MMSE are at increased risk of cognitive dysfunction and dementia and should be referred for a comprehensive evaluation, including formal neuropsychological studies,” the authors wrote.

— Source: American Medical Association