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Huan G, Heyong S. Longitudinal Invariance and Construct Validity of the Chinese Version of the Mini-Mental State Examination Across 10 Years in the Elderly Population. J Nurs Meas 2024; 32:4-17. [PMID: 37348896 DOI: 10.1891/jnm-2021-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background and Purpose: In this study, we investigate the longitudinal measurement invariance of the Chinese version of the mini-mental state examination (CMMSE). Methods: The factor structure and longitudinal equivalence of the CMMSE were examined by confirmatory factor analysis. Four CMMSE measurements of 13,132 participants from the China Longitudinal Health and Longevity Study between 2008 and 2018 were included. The nested model of longitudinal invariance proves the existence of strict longitudinal invariance. Results: It showed that the factor structure, factor loadings, intercept error variance, and latent factor means of the CMMSE were invariant across four measurements. Conclusion: These findings indicate that the changes in CMMSE scores can be attributed to real structural change, indicating that the CMMSE is a reliable measurement tool for the study of cognitive aging.
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Affiliation(s)
- Guo Huan
- School of Human Resources, Guangdong University of Finance and Economics, Guangzhou, China
| | - Shen Heyong
- Institute of Analytical Psychology, City University of Macau, Macau, China
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Chiang SK, Jhong JR, Wang CY. Effects of cognitive stimulus therapy on middle-aged and elderly institutionalized patients with chronic schizophrenia with declined cognition. J Formos Med Assoc 2023; 122:853-861. [PMID: 36964101 DOI: 10.1016/j.jfma.2023.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/11/2023] [Accepted: 03/07/2023] [Indexed: 03/26/2023] Open
Abstract
PURPOSE This study investigates whether using group Cognitive Stimulation Therapy (CST) effectively improves functioning among middle-aged and elderly patients with chronic schizophrenia and a below-normal cognitive range. METHODS The study included an experimental group (N = 24), which was divided into two sub-groups to receive group CST, and a control group (N = 24), who received treatment as usual (TAU). We assessed cognitive functions using the Mini-Mental Status Examination (MMSE). We evaluated the emotional status, psychotic symptoms, and quality of life using the Geriatric Depression Scale short-form 15 (GDS-15), the Brief Psychiatric Rating Scale (BPRS), and the Dementia-Quality of Life (D-QoL) instrument. We performed all measures at three-time points: pre-CST, post-CST, and 3-month follow-up. RESULTS We found group CST can significantly improve cognitive performance, especially the ability to use new information, after group CST intervention. However, the experimental group did not maintain this effect at the 3-month follow-up. RESULTS We found group CST can significantly improve cognitive performance, especially the ability to use new information, after group CST intervention. However, the experimental group did not maintain this effect at the 3-month follow-up. CONCLUSION This study supports group CST can delay the degradation of some cognitive functions in long-term hospitalized patients with chronic schizophrenia for the duration of the intervention. This finding has important clinical implications for long-term institutionalized middle-aged and elderly chronic schizophrenic patients with a below-normal cognitive range in an aging society.
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Affiliation(s)
- Shih-Kuang Chiang
- Department of Counselling and Clinical Psychology, National Dong Hwa University, Taiwan.
| | - Jia-Rong Jhong
- Department of Clinical Psychology, Taoyuan Mental Hospital, Taiwan
| | - Chia-Yu Wang
- Department of Clinical Psychology, Yuli Hospital, Taiwan
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Chiang SK, Liu WY, Hu TM. The effect of computerized working memory training on working memory and emotion perception for patients with chronic schizophrenia and normal cognition. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36576049 DOI: 10.1080/23279095.2022.2159825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cognitive impairment and affective symptoms are hallmark features of patients with schizophrenia. This study determines whether a computerized working memory training program improves the patient's working memory and affective perception. METHODS Thirty-nine male patients with schizophrenia, aged 25-65, participated in this study. The study uses a single-blind randomized controlled design. Twenty subjects were assigned to the experimental group and received an eight-week working memory computerized training course comprising four modules of the CogniPlus system. Nineteen subjects were assigned to the control group and received treatment as usual. All subjects received the same assessments twice, including the Mini-Mental Status Examination (MMSE), Working Memory Index (WMI) of Wechsler Adult Intelligence Scale-Third Edition, and the subjective rating of pictures of the International affective picture system by Self-Assessment Manikin (SAM). RESULTS This study shows that computerized working memory training improves WMI and the score for MMSE and produces a significant increase in the pleasure score for S.A.M. for negative pictures, between the pretest and post-test for the experimental group. CONCLUSIONS Working memory training improves working memory and emotion perception for patients with chronic schizophrenia and normal cognition. The limitations of this study and suggestions for future study are also discussed.
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Affiliation(s)
| | - Wan-Yu Liu
- Chung Shan Medical Rehabilitative Hospital, Taichung, Taiwan
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Tu Y, Lin S, Qiao J, Zhuang Y, Zhang P. Alzheimer's disease diagnosis via multimodal feature fusion. Comput Biol Med 2022; 148:105901. [PMID: 35908497 DOI: 10.1016/j.compbiomed.2022.105901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/26/2022] [Accepted: 07/16/2022] [Indexed: 11/19/2022]
Abstract
Alzheimer's disease (AD) is the most common neurodegenerative disorder in the elderly. Early diagnosis of AD plays a vital role in slowing down the progress of AD because there is no effective drug to treat the disease. Some deep learning models have recently been presented for AD diagnosis and have more satisfactory performance than classic machine learning methods. Nevertheless, most of the existing computer-aided diagnostic models used neuroimaging features for diagnosis, ignoring patients' clinical and biological information. This makes the AD diagnosis inaccurate. In this study, we propose a novel multimodal feature transformation and fusion model for AD diagnosis. The feature transformation aims to avoid the difference in feature dimensions between different modal data and further mine the significant features for AD diagnosis. A geometric algebra-based feature extension method is proposed to obtain different levels of high-dimensional features from patients' clinical and personal biological data. Then, an influence degree-based feature filtration algorithm is proposed to filtrate those features that have no apparent guiding significance for AD diagnosis. Finally, an ANN (Artificial Neural Network)-based framework is designed to fuse transformed features with neuroimaging features extracted by CNN (Convolutional Neural Network) for AD diagnosis. The more in-depth feature mining of patients' clinical information and biological information can significantly improve the performance of computer-aided AD diagnosis. The experiments are obtained on the ADNI dataset. Our proposed model can converge faster and achieves 96.2% accuracy in AD diagnostic task and 87.4% accuracy in MCI (Mild Cognitive Impairment) diagnostic task. Compared with other methods, our proposed approach has an excellent performance in AD diagnosis and surpasses SOTA (state-of-the-art) methods. Therefore, our model can provide more reasonable suggestions for clinicians to diagnose and treat disease.
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Affiliation(s)
- Yue Tu
- School of Computer Science and Engineering, Northeastern University, Shenyang, China
| | - Shukuan Lin
- School of Computer Science and Engineering, Northeastern University, Shenyang, China.
| | - Jianzhong Qiao
- School of Computer Science and Engineering, Northeastern University, Shenyang, China.
| | - Yilin Zhuang
- School of Computer Science and Engineering, Northeastern University, Shenyang, China
| | - Peng Zhang
- School of Computer Science and Engineering, Northeastern University, Shenyang, China
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Abstract
OBJECTIVE The Cognitive Abilities Screening Instrument (CASI) is a screening test of global cognitive function used in research and clinical settings. However, the CASI was developed using face validity and has not been investigated via empirical tests such as factor analyses. Thus, we aimed to develop and test a parsimonious conceptualization of the CASI rooted in cognitive aging literature reflective of crystallized and fluid abilities. DESIGN Secondary data analysis implementing confirmatory factor analyses where we tested the proposed two-factor solution, an alternate one-factor solution, and conducted a χ2 difference test to determine which model had a significantly better fit. SETTING N/A. PARTICIPANTS Data came from 3,491 men from the Kuakini Honolulu-Asia Aging Study. MEASUREMENTS The Cognitive Abilities Screening Instrument. RESULTS Findings demonstrated that both models fit the data; however, the two-factor model had a significantly better fit than the one-factor model. Criterion validity tests indicated that participant age was negatively associated with both factors and that education was positively associated with both factors. Further tests demonstrated that fluid abilities were significantly and negatively associated with a later-life dementia diagnosis. CONCLUSIONS We encourage investigators to use the two-factor model of the CASI as it could shed light on underlying cognitive processes, which may be more informative than using a global measure of cognition.
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Aiello EN, Esposito A, Pucci V, Mondini S, Bolognini N, Appollonio I. Italian telephone-based Mini-Mental State Examination (Itel-MMSE): item-level psychometric properties. Aging Clin Exp Res 2022; 34:1259-1265. [PMID: 34997544 PMCID: PMC8741569 DOI: 10.1007/s40520-021-02041-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/20/2021] [Indexed: 12/03/2022]
Abstract
Background The Italian telephone-based Mini-Mental State Examination (Itel-MMSE), despite being psychometrically sound, has shown relevant ceiling effects, which may negatively impact the interpretation of its scores. In address to overcome such an issue, this study aimed at providing item-level insights on the Itel-MMSE through Item Response Theory (IRT) analyses. Methods Five-hundred and sixty-seven healthy Italian adults (227 males, 340 females; mean age: 51 ± 17 years, range 18–96; mean education: 13.31 ± 4.3 years). A two-parameter logistic IRT model was implemented to assess item discrimination and difficulty of the Itel-MMSE. Construct unidimensionality, statistical independence of items, and model and item fit were tested. Informativity levels were also assessed graphically. Results With respect to the Itel-MMSE total score, ceiling effects were found in 92.7% of participants. Unidimensionality was violated; both model and item fit were poor; a few items showed statistical dependence. Both the whole test and its items proved to be scarcely informative, especially for medium-to-high levels of ability, except for attention and spatial orientation subtests, which consistently yielded the highest discriminative capability. Discussion The Itel-MMSE appears to be most informative in low-performing healthy individuals. However, the present findings should not lead practitioners to aprioristically equate ceiling effects/low informativity to clinical uselessness. Items assessing attention and, to a lesser extent, spatial orientation appear to be the most informative. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-02041-4.
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Affiliation(s)
- Edoardo Nicolò Aiello
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | | | - Veronica Pucci
- Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, Padua, Italy
- Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Sara Mondini
- Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, Padua, Italy
- Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Nadia Bolognini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Ildebrando Appollonio
- Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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A network psychometric approach to neurocognition in early Alzheimer's disease. Cortex 2021; 137:61-73. [PMID: 33607345 DOI: 10.1016/j.cortex.2021.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/06/2020] [Accepted: 01/07/2021] [Indexed: 12/27/2022]
Abstract
In a typical pattern of Alzheimer's disease onset, episodic memory decline is predominant while decline in other neurocognitive domains is subsidiary or absent. Such descriptions refer to relationships between neurocognitive domains as well as deficits within domains. However, the former relationships are rarely statistically modelled. This study used psychometric network analysis to model relationships between neurocognitive variables in cognitive normality (CN), amnestic mild cognitive impairment (aMCI), and early Alzheimer's disease (eAD). Gaussian graphical models with extended Bayesian information criterion graphical lasso model selection and regularisation were used to estimate network models of neurocognitive and demographic variables in CN (n = 229), aMCI (n = 395), and eAD (n = 191) groups. The edge density, network strength and structure, centrality, and individual links of the network models were explored. Results indicated that while global strength did not differ, network structures differed across CN and eAD and aMCI and eAD groups, suggesting neurocognitive reorganisation across the eAD continuum. Episodic memory variables were most central (i.e., influential) in the aMCI network model, whereas processing speed and fluency variables were most central in the eAD network model. Additionally, putative clusters of memory, language and semantic variables, and attention, processing speed and working memory variables arose in the models for the clinical groups. This exploratory study shows how psychometric network analysis can be used to model the relationships between neurocognitive variables across the eAD continuum and to generate hypotheses for future (dis)confirmatory research.
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Saito H, Kashiwakura I, Tsushima M, Mariya Y. Association between Regional Cerebral Blood Flow and Mini-Mental State Examination Score in Patients with Alzheimer's Disease. Curr Med Imaging 2021; 16:1290-1299. [PMID: 32107995 DOI: 10.2174/1573405616666200124125130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/04/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND In patients with Alzheimer's disease (AD), cerebral blood flow (CBF) is decreased from the early stages. CBF in AD is currently estimated from Z-scores using statistical analysis. However, the Z-score is not considered the impaired area ratio. METHODS In the present study, a novel indicator, ΣzS, associated with brain surface area and Zscores, is defined and the association with regional CBF has been estimated using Mini-Mental State Examination (MMSE) scores, which indicate the severity of cognitive impairment in patients with AD. RESULTS A negative correlation was detected between ΣzS in the posterior cingulate gyrus and the subset numbers 1, 2, and 5 of the total MMSE scores. Furthermore, a negative correlation was detected between the total MMSE score and ΣzS in Brodmann area 30, which is a subdivided area of the brain. CONCLUSION These results suggest that ΣzS may be a useful indicator of CBF metabolism, and thus may improve the current understanding of cognitive function in patients with AD.
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Affiliation(s)
- Hitoshi Saito
- Department of Radiology, Akita Kousei Medical Center, Akita, Japan
| | - Ikuo Kashiwakura
- Department of Radiological Life Science, Hirosaki University Graduate School of Health Science, Hirosaki, Aomori, Japan
| | - Megumi Tsushima
- Department of Radiological Life Science, Hirosaki University Graduate School of Health Science, Hirosaki, Aomori, Japan
| | - Yasushi Mariya
- Depatrment of Radiology, Mutsu General Hospital, Mutsu, Aomori, Japan
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A Comparison of the Greek ACE-III, M-ACE, ACE-R, MMSE, and ECAS in the Assessment and Identification of Alzheimer's Disease. J Int Neuropsychol Soc 2020; 26:825-834. [PMID: 32312343 DOI: 10.1017/s1355617720000314] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to adapt the Addenbrooke's Cognitive Examination-III (ACE-III) and Mini-Addenbrooke's Cognitive Examination (M-ACE) into Greek and then to examine the convergent validity against their predecessors Addenbrooke's Cognitive Examination-Revised (ACE-R) and Mini-Mental State Examination (MMSE) in a Greek population. Moreover, a primary aim was to appraise the utility of each screen by conducting a comparison of the psychometric properties of ACE-III, M-ACE, ACE-R, MMSE, and the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis (ALS) Screen (ECAS) in detecting Alzheimer's disease (AD). METHODS Forty patients with AD were recruited and matched with 38 controls. Bayesian Pearson's correlation analysis was conducted to examine the convergent validity. Receiver operating characteristic curve analysis was implemented to appraise the sensitivity and specificity of the tests in detecting AD. RESULTS The ACE-III, M-ACE, and the ECAS scores robustly correlated with ACE-R and MMSE. The ACE-III and the ECAS-ALS Non-Specific score were the most sensitive and specific tools in detecting AD, closely followed by ECAS Total score and M-ACE. Only ECAS Total score correlated with the duration of disease. The ECAS scores were more resilient to ceiling effects than the other screens. M-ACE produced fewer ceiling effects than MMSE. CONCLUSION The Greek ACE-III and M-ACE were successfully adapted and showed good convergent validity against their predecessors. They showed very good psychometric properties in detecting AD and may be considered in hectic clinical settings. ECAS Total score and ECAS-ALS Non-Specific showed comparable psychometric properties in the detection of AD and may be considered in polypathological clinics where motor impairments are common.
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Han G, Maruta M, Ikeda Y, Ishikawa T, Tanaka H, Koyama A, Fukuhara R, Boku S, Takebayashi M, Tabira T. Relationship between Performance on the Mini-Mental State Examination Sub-Items and Activities of Daily Living in Patients with Alzheimer's Disease. J Clin Med 2020; 9:E1537. [PMID: 32443659 PMCID: PMC7291070 DOI: 10.3390/jcm9051537] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022] Open
Abstract
Mini-mental state examination (MMSE) subitems provide useful information about the cognitive status of patients with Alzheimer's disease (AD). If the relationship between MMSE subitems and activities of daily living (ADL) can be shown, the performance of sub-items can predict ADL status and may provide useful information for early ADL intervention. Therefore, the purpose of this study was to investigate the relationship between MMSE subitem scores and ADL. The study sample consisted of 718 patients with AD. Logistic regression analysis using the Physical Self-maintenance Scale (PSMS) and Lawton's Instrumental ADL (L-IADL) was performed with each of the subitems as the dependent variables and the MMSE subitem as the independent variable. As a result, the subitems of MMSE, which are strongly related to each item in PSMS differed (e.g., toilet: registration odds ratio 3.00, grooming: naming 3.66). In the case of L-IADL, most items were strongly associated with "writing" (e.g., shopping: odds ratio 4.29, laundry 3.83). In clinical practice, we often focus only on the total MMSE score in patients with AD. However, the relationship between each MMSE subitem and ADL suggested in this study may be useful information that can be linked to ADL care from the performance of the MMSE subitem.
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Affiliation(s)
- Gwanghee Han
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto 860-8556, Japan; (T.I.); (H.T.); (R.F.); (S.B.); (M.T.)
| | - Michio Maruta
- Doctoral Program of Clinical Neuropsychiatry, Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
- Department of Rehabilitation, Medical Corporation Sanshukai, Okatsu Hospital, Kagoshima 890-0067, Japan
| | - Yuriko Ikeda
- Department of Clinical Neuropsychiatry, Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
| | - Tomohisa Ishikawa
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto 860-8556, Japan; (T.I.); (H.T.); (R.F.); (S.B.); (M.T.)
| | - Hibiki Tanaka
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto 860-8556, Japan; (T.I.); (H.T.); (R.F.); (S.B.); (M.T.)
| | - Asuka Koyama
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan;
| | - Ryuji Fukuhara
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto 860-8556, Japan; (T.I.); (H.T.); (R.F.); (S.B.); (M.T.)
| | - Shuken Boku
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto 860-8556, Japan; (T.I.); (H.T.); (R.F.); (S.B.); (M.T.)
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan;
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Kumamoto University Hospital, Kumamoto 860-8556, Japan; (T.I.); (H.T.); (R.F.); (S.B.); (M.T.)
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan;
- Division of Psychiatry and Neuroscience, Institute for Clinical Research, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Hiroshima 737-0023, Japan
| | - Takayuki Tabira
- Department of Clinical Neuropsychiatry, Graduate School of Health Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
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Reliability and Validity Measurement Issues: Nothing New to Clinical Nurse Specialists; But Liability Issues, Too? CLIN NURSE SPEC 2019; 33:203-204. [PMID: 31403995 DOI: 10.1097/nur.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mayo AM, Peavy GM. Associations among Braak stage, Parkinsonian gait, cognition, and functional status in autopsy-confirmed dementia with Lewy bodies. Int J Geriatr Psychiatry 2019; 34:738-744. [PMID: 30729576 PMCID: PMC6461356 DOI: 10.1002/gps.5080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/03/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Compromised functional abilities in older adults with dementia with Lewy bodies (DLB) represent a significant burden to families and frequently lead to institutionalization. Contributing factors to this compromise are poorly understood. METHODS Using data collected at a first study visit, multiple regression modeling was used to examine the associations between Braak staged Alzheimer disease (AD) pathology, Apolipoprotein E (ApoE) status, Parkinsonian gait, cognition, and functional status from a cohort of 102 cases with an autopsy-confirmed diagnosis of dementia stemming from combined Lewy body and AD pathology. RESULTS On average, 60% of functional activities were compromised per case. Worse functional status was associated with older age at first study visit, compromised cognitive status, and Parkinsonian gait after controlling for gender, mental status, and other covariates. Worse cognitive status predicted worse functional status in both the low and high Braak groups. CONCLUSIONS Older persons with DLB presenting with moderately compromised cognition and Parkinsonian gait should be expected to have impaired functional abilities. Providing these patients with supportive environments may help them to remain independent for longer periods of time.
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Affiliation(s)
- Ann M. Mayo
- University of San Diego, Hahn School of Nursing & Health
Science and Beyster Institute of Nursing Research
| | - Guerry M. Peavy
- University of California, San Diego, Shiley-Marcos
Alzheimer’s Disease Research Center
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Takenoshita S, Terada S, Yoshida H, Yamaguchi M, Yabe M, Imai N, Horiuchi M, Miki T, Yokota O, Yamada N. Validation of Addenbrooke's cognitive examination III for detecting mild cognitive impairment and dementia in Japan. BMC Geriatr 2019; 19:123. [PMID: 31035933 PMCID: PMC6489204 DOI: 10.1186/s12877-019-1120-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/27/2019] [Indexed: 11/23/2022] Open
Abstract
Background Early detection of mild cognitive impairment (MCI) and dementia is very important to begin appropriate treatment promptly and to prevent disease exacerbation. We investigated the screening accuracy of the Japanese version of Addenbrooke’s Cognitive Examination III (ACE-III) to diagnose MCI and dementia. Methods The original ACE-III was translated and adapted to Japanese. It was then administered to a Japanese population. The Hasegawa Dementia Scale-revised (HDS-R) and Mini-mental State Examination (MMSE) were also applied to evaluate cognitive dysfunction. In total, 389 subjects (dementia = 178, MCI = 137, controls = 73) took part in our study. Results The optimal ACE-III cut-off scores to detect MCI and dementia were 88/89 (sensitivity 0.77, specificity 0.92) and 75/76 (sensitivity 0.82, specificity 0.90), respectively. ACE-III was superior to HDS-R and MMSE in the detection of MCI or dementia. The internal consistency, test-retest reliability, and inter-rater reliability of ACE-III were excellent. Conclusions ACE-III is a useful cognitive test to detect MCI and dementia. ACE-III may be widely useful in clinical practice.
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Affiliation(s)
- Shintaro Takenoshita
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Seishi Terada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Hidenori Yoshida
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Megumi Yamaguchi
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Mayumi Yabe
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Nao Imai
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Makiko Horiuchi
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Tomoko Miki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Osamu Yokota
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Vissoci JRN, de Oliveira LP, Gafaar T, Haglund MM, Mvungi M, Mmbaga BT, Staton CA. Cross-cultural adaptation and psychometric properties of the MMSE and MoCA questionnaires in Tanzanian Swahili for a traumatic brain injury population. BMC Neurol 2019; 19:57. [PMID: 30961532 PMCID: PMC6454609 DOI: 10.1186/s12883-019-1283-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic Brain Injury (TBI) is the most common cause of injury-related death and disability globally, and a common sequelae is cognitive impairment. Addressing post-TBI cognitive deficits is crucial because they affect rehabilitation outcomes, but doing this requires valid and reliable cognitive assessment measures. However, no such instrument has been validated in Tanzania's TBI population. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are two commonly used instruments to measure cognitive impairment, and there have been a few studies reporting their use in post-TBI cognitive assessment. Our aim was to report the psychometric properties of the Swahili version of both scales amongst the TBI population in Tanzania. METHODS A cross-cultural adaptation committee participated in the translation and content validation process for both questionnaires. Our patient sample consisted of 192 adults with TBI who were admitted to Kilimanjaro Christian Medical Center (KCMC) in Tanzania. Confirmatory factor analysis, reliability and external validity were evaluated. RESULTS MoCA showed adequate factor loadings (values > 0.50 for all items except items 7 & 10) and adequate reliability (values > 0.70). Factor loadings for most of the MMSE items were below 0.5 and internal consistency was medium (< 0.7). Polychoric correlation between MMSE and MoCA was strong, positive and statistically significant (r = 0.68, p = 0.001); correlation with the cognitive subscale of FIM indicated moderately positive relationships - MMSE (r = 0.35, p = 0.001) and MoCA (r = 0.43, p = 0.001). CONCLUSIONS With the exception of the language and memory items, MoCA is a valid and reliable instrument for cognitive impairment screening in Tanzania's adult TBI population. On the other hand, MMSE does not appear to be an appropriate tool in this patient group, but its positive correlations with MoCA and cFIM indicate similar theoretical concepts. Both instruments require further validation studies to prove their predictive ability for screening cognitive impairment before they are considered suitable for clinical use.
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Affiliation(s)
- Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Duke Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, USA.
- Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC, USA.
| | | | - Temitope Gafaar
- Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Michael M Haglund
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC, USA
| | - Mark Mvungi
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Emergency Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
- Division of Global Neurosurgery and Neuroscience, Duke University, Durham, NC, USA
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O'Connor MG, Duncanson H, Hollis AM. Use of the MMSE in the Prediction of Driving Fitness: Relevance of Specific Subtests. J Am Geriatr Soc 2019; 67:790-793. [DOI: 10.1111/jgs.15772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Margaret G. O'Connor
- Cognitive Neurology Unit; Beth Israel Deaconess Medical Center; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
| | - Haley Duncanson
- Harvard Medical School; Boston Massachusetts
- Chelsea Healthcare Center, Massachusetts General Hospital; Chelsea Massachusetts
| | - Ann M. Hollis
- Cognitive Neurology Unit; Beth Israel Deaconess Medical Center; Boston Massachusetts
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Jung HT, Daneault JF, Lee H, Kim K, Kim B, Park S, Ryu T, Kim Y, Ivan Lee S. Remote Assessment of Cognitive Impairment Level Based on Serious Mobile Game Performance: An Initial Proof of Concept. IEEE J Biomed Health Inform 2019; 23:1269-1277. [PMID: 30668485 DOI: 10.1109/jbhi.2019.2893897] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Individuals with cognitive impairments are evaluated using clinically validated cognitive assessment tools, which need to be administered by trained therapists. This serves as a major barrier for frequent and longitudinal monitoring of patients' cognitive impairment level. We introduce Neuro-World, a set of six mobile games designed to challenge visuospatial short-term memory and selective attention, which allows one to self-administer the assessment of his/her cognitive impairment level. Game performance is analyzed to estimate a widely accepted clinical measure, the mini mental state examination (MMSE), which highlights the translational impact of the system in real-world settings. We collected game-specific performance data from 12 post-stroke patients at baseline and a three-month follow-up, which were used to train supervised machine learning models to estimate the corresponding MMSE scores. The results presented herein show that the proposed approach can estimate the MMSE scores with a normalized root mean square error of 5.75%. We also validate the system's responsiveness to longitudinal changes in cognitive impairment level and demonstrate the system's positive usability in cognitively impaired individuals and their willingness to adhere to the longitudinal use. This study demonstrates that Neuro-world has great potential to be used to evaluate the cognitive impairment level and monitor its long-term change. This study enables new clinical and research opportunities for accurate, longitudinal assessment of cognitive function via mobile games.
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Addenbrooke's Cognitive Examination III: Psychometric Characteristics and Relations to Functional Ability in Dementia. J Int Neuropsychol Soc 2018; 24:854-863. [PMID: 30189909 DOI: 10.1017/s1355617718000541] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The Addenbrooke's Cognitive Examination (ACE) is a common cognitive screening test for dementia. Here, we examined the relationship between the most recent version (ACE-III) and its predecessor (ACE-R), determined ACE-III cutoff scores for the detection of dementia, and explored its relationship with functional ability. METHODS Study 1 included 199 dementia patients and 52 healthy controls who completed the ACE-III and ACE-R. ACE-III total and domain scores were regressed on their corresponding ACE-R values to obtain conversion formulae. Study 2 included 331 mixed dementia patients and 87 controls to establish the optimal ACE-III cutoff scores for the detection of dementia using receiver operator curve analysis. Study 3 included 194 dementia patients and their carers to investigate the relationship between ACE-III total score and functional ability. RESULTS Study 1: ACE-III and ACE-R scores differed by ≤1 point overall, the magnitude varying according to dementia type. Study 2: a new lower bound cutoff ACE-III score of 84/100 to detect dementia was identified (compared with 82 for the ACE-R). The upper bound cutoff score of 88/100 was retained. Study 3: ACE-III scores were significantly related to functional ability on the Clinical Dementia Rating Scale across all dementia syndromes, except for semantic dementia. CONCLUSIONS This study represents one of the largest and most clinically diverse investigations of the ACE-III. Our results demonstrate that the ACE-III is an acceptable alternative to the ACE-R. In addition, ACE-III performance has broader clinical implications in that it relates to carer reports of functional impairment in most common dementias. (JINS, 2018, 24, 854-863).
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Schmitt AL, Livingston RB, Goette WF, Galusha-Glasscock JM. Relationship Between the Mini-Mental State Examination and the Repeatable Battery for the Assessment of Neuropsychological Status in Patients Referred for a Dementia Evaluation. Percept Mot Skills 2016; 123:606-623. [DOI: 10.1177/0031512516667674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current study examined the relationship between the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Mini-Mental State Examination (MMSE) in a large, heterogeneous sample of patients referred for dementia assessment ( N = 495; 37% males, 63% females; M age = 76.8 years, SD = 7.0). The MMSE showed a significant moderate correlation with the RBANS Total Scale score ( r = .65). Moderate significant correlations were found between the MMSE and the RBANS indexes ( r = .41 to .49). The MMSE demonstrated moderate correlations with RBANS factor scores of .63 for Factor 1 (memory/learning) and .58 for Factor 2 (visuospatial/attention). These correlations suggest that the MMSE is best considered a measure of global cognitive functioning with the strongest correlations between broader measures.
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Castro-Costa E, Dewey ME, Uchôa E, Firmo JOA, Lima-Costa MF, Stewart R. Construct validity of the mini mental state examination across time in a sample with low-education levels: 10-year follow-up of the Bambuí Cohort Study of Ageing. Int J Geriatr Psychiatry 2014; 29:1294-303. [PMID: 24737496 DOI: 10.1002/gps.4113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The study aims to investigate whether longitudinal data on the structure of the mini mental state examination (MMSE) collected in an older Brazilian cohort support factorial invariance over time. DESIGN Analysis of 10-year data from a community-based cohort study was performed. SETTING The study took place in Bambuí, Brazil. PARTICIPANTS The study sample comprised 1558 (89.4%) of all eligible 1742 elderly residents. MEASUREMENTS A standard Brazilian version of the MMSE was used. RESULTS A five-factor solution (developed on the baseline of the cohort) either with no constraints or with loadings constrained to equality across time provided a reasonable fit for the MMSE. A comparison between both models suggested that the model with no constraints was superior. However, the five absolute goodness-of-fit indices suggest that the fully constrained model was also adequate and did not differ substantively from the model without any restriction. CONCLUSION The structure of the MMSE remained relatively unchanged across the 10 measurement times, thus providing evidence for the good construct validity of the scale across time.
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Affiliation(s)
- Erico Castro-Costa
- René Rachou Research Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil; Institute of Psychiatry, King's College London, London, UK
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Hsieh S, Schubert S, Hoon C, Mioshi E, Hodges JR. Validation of the Addenbrooke's Cognitive Examination III in frontotemporal dementia and Alzheimer's disease. Dement Geriatr Cogn Disord 2014; 36:242-50. [PMID: 23949210 DOI: 10.1159/000351671] [Citation(s) in RCA: 568] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The aims of this study were to validate the newly developed version of the Addenbrooke's Cognitive Examination (ACE-III) against standardised neuropsychological tests and its predecessor (ACE-R) in early dementia. METHODS A total of 61 patients with dementia (frontotemporal dementia, FTD, n = 33, and Alzheimer's disease, AD, n = 28) and 25 controls were included in the study. RESULTS ACE-III cognitive domains correlated significantly with standardised neuropsychological tests used in the assessment of attention, language, verbal memory and visuospatial function. The ACE-III also compared very favourably with its predecessor, the ACE-R, with similar levels of sensitivity and specificity. CONCLUSION The results of this study provide objective validation of the ACE-III as a screening tool for cognitive deficits in FTD and AD.
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Affiliation(s)
- Sharpley Hsieh
- Neuroscience Research Australia, Sydney, N.S.W., Australia
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22
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de Boer C, Mattace-Raso F, van der Steen J, Pel JJM. Mini-Mental State Examination subscores indicate visuomotor deficits in Alzheimer's disease patients: A cross-sectional study in a Dutch population. Geriatr Gerontol Int 2013; 14:880-5. [PMID: 24237759 DOI: 10.1111/ggi.12183] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2013] [Indexed: 01/03/2023]
Abstract
AIM In diagnostics of Alzheimer's disease (AD), the Mini-Mental State Examination (MMSE) questionnaire is frequently used to test cognitive decline. The final subtest of the MMSE, in which patients have to copy two interlocking pentagons, tests a variety of visuomotor functions. Recent imaging studies suggest that visuomotor function could decline in early stage AD, as a result of degeneration of the brain networks involved. The goal of the present study was to compare memory and visuomotor function in AD patients, reflected by the MMSE subscores for orientation, recall and interlocking pentagons. METHODS The MMSE subscores for orientation, recall and interlocking pentagons of 125 AD patients was extracted from their medical history. Patients were divided into three groups based on disease duration. Using related-samples Wilcoxon signed-rank tests, the performance between subtests using normalized subscores was compared within each group. RESULTS In all three groups, the subscores of recall and interlocking pentagons were significantly lower than orientation. No differences were found between the subscores of recall and interlocking pentagons. CONCLUSIONS The presented data suggest that memory function and visuomotor function are equally impaired in the present study population. This could indicate that visuomotor dysfunction might be a more important clinical feature of AD than is currently assumed. This knowledge can be used to develop new tests and markers for AD reflecting deficits in visuomotor functions, such as quantification of eye and hand movements.
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Affiliation(s)
- Casper de Boer
- Erasmus MC Department of Neuroscience, Vestibular and Ocular Motor Research Group, Rotterdam, the Netherlands
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Monroe T, Carter M. Using the Folstein Mini Mental State Exam (MMSE) to explore methodological issues in cognitive aging research. Eur J Ageing 2012; 9:265-274. [PMID: 28804426 PMCID: PMC5547414 DOI: 10.1007/s10433-012-0234-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cognitive scales are used frequently in geriatric research and practice. These instruments are constructed with underlying assumptions that are a part of their validation process. A common measurement scale used in older adults is the Folstein Mini Mental State Exam (MMSE). The MMSE was designed to screen for cognitive impairment and is used often in geriatric research. This paper has three aims. Aim one was to explore four potential threats to validity in the use of the MMSE: (1) administering the exam without meeting the underlying assumptions, (2) not reporting that the underlying assumptions were assessed prior to test administration, (3) use of variable and inconsistent cut-off scores for the determination of presence of cognitive impairment, and (4) failure to adjust the scores based on the demographic characteristics of the tested subject. Aim two was to conduct a literature search to determine if the assumptions of (1) education level assessment, (2) sensory assessment, and (3) language fluency were being met and clearly reported in published research using the MMSE. Aim three was to provide recommendations to minimalize threats to validity in research studies that use cognitive scales, such as the MMSE. We found inconsistencies in published work in reporting whether or not subjects meet the assumptions that underlie a reliable and valid MMSE score. These inconsistencies can pose threats to the reliability of exam results. Fourteen of the 50 studies reviewed reported inclusion of all three of these assumptions. Inconsistencies in reporting the inclusion of the underlying assumptions for a reliable score could mean that subjects were not appropriate to be tested by use of the MMSE or that an appropriate test administration of the MMSE was not clearly reported. Thus, the research literature could have threats to both validity and reliability based on misuse of or improper reported use of the MMSE. Six recommendations are provided to minimalize these threats in future research.
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Affiliation(s)
- Todd Monroe
- John A. Hartford Foundation & Atlantic Philanthropies Claire M. Fagin Fellow, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240 USA
| | - Michael Carter
- The University of Tennessee Health Science Center, Memphis, TN USA
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Monroe T, Carter M. Using the Folstein Mini Mental State Exam (MMSE) to explore methodological issues in cognitive aging research. Eur J Ageing 2012. [PMID: 28804426 DOI: 10.1007/s10433‐012‐0234‐8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cognitive scales are used frequently in geriatric research and practice. These instruments are constructed with underlying assumptions that are a part of their validation process. A common measurement scale used in older adults is the Folstein Mini Mental State Exam (MMSE). The MMSE was designed to screen for cognitive impairment and is used often in geriatric research. This paper has three aims. Aim one was to explore four potential threats to validity in the use of the MMSE: (1) administering the exam without meeting the underlying assumptions, (2) not reporting that the underlying assumptions were assessed prior to test administration, (3) use of variable and inconsistent cut-off scores for the determination of presence of cognitive impairment, and (4) failure to adjust the scores based on the demographic characteristics of the tested subject. Aim two was to conduct a literature search to determine if the assumptions of (1) education level assessment, (2) sensory assessment, and (3) language fluency were being met and clearly reported in published research using the MMSE. Aim three was to provide recommendations to minimalize threats to validity in research studies that use cognitive scales, such as the MMSE. We found inconsistencies in published work in reporting whether or not subjects meet the assumptions that underlie a reliable and valid MMSE score. These inconsistencies can pose threats to the reliability of exam results. Fourteen of the 50 studies reviewed reported inclusion of all three of these assumptions. Inconsistencies in reporting the inclusion of the underlying assumptions for a reliable score could mean that subjects were not appropriate to be tested by use of the MMSE or that an appropriate test administration of the MMSE was not clearly reported. Thus, the research literature could have threats to both validity and reliability based on misuse of or improper reported use of the MMSE. Six recommendations are provided to minimalize these threats in future research.
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Affiliation(s)
- Todd Monroe
- John A. Hartford Foundation & Atlantic Philanthropies Claire M. Fagin Fellow, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240 USA
| | - Michael Carter
- The University of Tennessee Health Science Center, Memphis, TN USA
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Krohne K, Slettebø Å, Bergland A. Cognitive screening tests as experienced by older hospitalised patients: a qualitative study. Scand J Caring Sci 2011; 25:679-87. [DOI: 10.1111/j.1471-6712.2011.00878.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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The factorial structure of the Mini-Mental State Examination (MMSE) in Japanese dementia patients. BMC Geriatr 2010; 10:36. [PMID: 20534132 PMCID: PMC2903593 DOI: 10.1186/1471-2318-10-36] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 06/09/2010] [Indexed: 12/02/2022] Open
Abstract
Background The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments in the evaluation of global cognitive status. Few studies have investigated the relationship among its components in terms of factorial structure in Japanese individuals suffering from dementia. The aims of this study were: 1) to analyze the factorial structure of MMSE in Japanese dementia patients, 2) to clarify the MMSE static structure in identifying different cognitive profiles and understanding how these profiles are related to levels of dysfunction in subsets of dementia patients. Methods 30,895 consecutive outpatients with dementia were evaluated. The 11 subtests composing the MMSE and the global MMSE score were analyzed. Factor analysis based on principal component analysis with Promax rotation was applied to the data representing the frequency of failures in each subtest as identified by the MMSE. Results Factor analysis identified three factors that explained approximately 44.57% of the total variance. The first factor, immediate memory, essentially constituted a simple index of the reading and writing subtests. The second factor, orientation and delayed recall, expressed the ability to handle new information. The third factor, working memory, was most closely related to the severity of dementia at the time of test administration. Conclusions Japanese dementia patients appear to develop difficulty handling new information in the early stages of their disease. This finding, and our finding that there is a factor associated with disease severity, suggest that understanding the specific factors related to subtest items, which underlie the total MMSE score may be useful to clinicians in planning interventions for Japanese patients in the early stages of dementia.
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Laks J, Coutinho ESF, Junger W, Silveira H, Mouta R, Baptista EMR, Contino ALB, Barca ML, Selbaek G, Engedal K, Engelhardt E. Education does not equally influence all the Mini Mental State Examination subscales and items: inferences from a Brazilian community sample. ACTA ACUST UNITED AC 2010; 32:223-30. [PMID: 20949237 DOI: 10.1590/s1516-44462010005000009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 11/16/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Mini-Mental State Examination cutoffs have been presented for schooling levels to screen cognitive impairment. However, items may behave differently with regards to education. The objective of this study was to examine the impact of education on MMSE subscales and items. METHOD Community-dwelling participants aged 65 years or more (n = 990, females = 637, age = 74.1 years, range 65-108) were stratified as illiterate (n = 373), 1-8 (n = 540), 9-12 (n = 63), and more than 12 years of schooling (n = 14) and were screened with MMSE and Pfeffer Functional Activities Questionnaire. To make the Mini-Mental State Examination items comparable, each item was transformed into z scores. Multiple linear regression was used to estimate the effect of schooling on MMSE subs and items controlling for age, sex, and activities of daily life. RESULTS Temporal and space orientation, attention/calculation, repetition, reading, writing, and drawing scores improved as education increased, but not memory registration, three step command, and naming. Reading and writing displayed the largest coefficients, whereas education exerted no influence on naming and three step command tasks. CONCLUSION Education does not exert an important effect on naming, three step command, memory registration, and delayed recall. As memory is a key factor for diagnosing dementia, these items could be considered despite education.
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Affiliation(s)
- Jerson Laks
- Centre for Alzheimer's disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, RJ, Brazil.
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