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Meta-Analysis
. 2016 Jan 13;2016(1):CD011145.
doi: 10.1002/14651858.CD011145.pub2.

Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations

Sam T Creavin  1 , Susanna Wisniewski, Anna H Noel-Storr, Clare M Trevelyan, Thomas Hampton, Dane Rayment, Victoria M Thom, Kirsty J E Nash, Hosam Elhamoui, Rowena Milligan, Anish S Patel, Demitra V Tsivos, Tracey Wing, Emma Phillips, Sophie M Kellman, Hannah L Shackleton, Georgina F Singleton, Bethany E Neale, Martha E Watton, Sarah Cullum
Affiliations
Meta-Analysis

Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations

Sam T Creavin et al. Cochrane Database Syst Rev. .

Abstract

Background: The Mini Mental State Examination (MMSE) is a cognitive test that is commonly used as part of the evaluation for possible dementia.

Objectives: To determine the diagnostic accuracy of the Mini-Mental State Examination (MMSE) at various cut points for dementia in people aged 65 years and over in community and primary care settings who had not undergone prior testing for dementia.

Search methods: We searched the specialised register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), LILACS (BIREME), ALOIS, BIOSIS previews (Thomson Reuters Web of Science), and Web of Science Core Collection, including the Science Citation Index and the Conference Proceedings Citation Index (Thomson Reuters Web of Science). We also searched specialised sources of diagnostic test accuracy studies and reviews: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). We attempted to locate possibly relevant but unpublished data by contacting researchers in this field. We first performed the searches in November 2012 and then fully updated them in May 2014. We did not apply any language or date restrictions to the electronic searches, and we did not use any methodological filters as a method to restrict the search overall.

Selection criteria: We included studies that compared the 11-item (maximum score 30) MMSE test (at any cut point) in people who had not undergone prior testing versus a commonly accepted clinical reference standard for all-cause dementia and subtypes (Alzheimer disease dementia, Lewy body dementia, vascular dementia, frontotemporal dementia). Clinical diagnosis included all-cause (unspecified) dementia, as defined by any version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); International Classification of Diseases (ICD) and the Clinical Dementia Rating.

Data collection and analysis: At least three authors screened all citations.Two authors handled data extraction and quality assessment. We performed meta-analysis using the hierarchical summary receiver-operator curves (HSROC) method and the bivariate method.

Main results: We retrieved 24,310 citations after removal of duplicates. We reviewed the full text of 317 full-text articles and finally included 70 records, referring to 48 studies, in our synthesis. We were able to perform meta-analysis on 28 studies in the community setting (44 articles) and on 6 studies in primary care (8 articles), but we could not extract usable 2 x 2 data for the remaining 14 community studies, which we did not include in the meta-analysis. All of the studies in the community were in asymptomatic people, whereas two of the six studies in primary care were conducted in people who had symptoms of possible dementia. We judged two studies to be at high risk of bias in the patient selection domain, three studies to be at high risk of bias in the index test domain and nine studies to be at high risk of bias regarding flow and timing. We assessed most studies as being applicable to the review question though we had concerns about selection of participants in six studies and target condition in one study.The accuracy of the MMSE for diagnosing dementia was reported at 18 cut points in the community (MMSE score 10, 14-30 inclusive) and 10 cut points in primary care (MMSE score 17-26 inclusive). The total number of participants in studies included in the meta-analyses ranged from 37 to 2727, median 314 (interquartile range (IQR) 160 to 647). In the community, the pooled accuracy at a cut point of 24 (15 studies) was sensitivity 0.85 (95% confidence interval (CI) 0.74 to 0.92), specificity 0.90 (95% CI 0.82 to 0.95); at a cut point of 25 (10 studies), sensitivity 0.87 (95% CI 0.78 to 0.93), specificity 0.82 (95% CI 0.65 to 0.92); and in seven studies that adjusted accuracy estimates for level of education, sensitivity 0.97 (95% CI 0.83 to 1.00), specificity 0.70 (95% CI 0.50 to 0.85). There was insufficient data to evaluate the accuracy of the MMSE for diagnosing dementia subtypes.We could not estimate summary diagnostic accuracy in primary care due to insufficient data.

Authors' conclusions: The MMSE contributes to a diagnosis of dementia in low prevalence settings, but should not be used in isolation to confirm or exclude disease. We recommend that future work evaluates the diagnostic accuracy of tests in the context of the diagnostic pathway experienced by the patient and that investigators report how undergoing the MMSE changes patient-relevant outcomes.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

1
1
Inclusion of studies
2
2
PRISMA Flow diagram of included studies.
3
3
Risk of bias and applicability concerns graph: review authors' judgements about each domain presented as percentages across included studies
4
4
Risk of bias and applicability concerns summary: review authors' judgements about each domain for each included study
5
5
Summary ROC Plot of analysis 2 main community
6
6
Forest plot of analysis 2 Main community
7
7
Summary ROC plot of analysis 3 community, education adjusted. The black filled dot indicates the summary point estimate of diagnostic accuracy, the smaller dotted bubble indicates the 95% confidence interval around the summary point (containing the 'true value' within that region 95% of the time on the basis of the available data) and the larger dashed bubble indicates the 95% prediction region (containing results from a new future study 95% of the time).
8
8
Forest plot of analysis 3 MMSE community, education adjusted
9
9
Summary ROC plot of analysis 4 MMSE at 24 normality (23/24). The black filled dot indicates the summary point estimate of diagnostic accuracy, the smaller dotted bubble indicates the 95% confidence interval around the summary point (containing the 'true value' within that region 95% of the time on the basis of the available data) and the larger dashed bubble indicates the 95% prediction region (containing results from a new future study 95% of the time).
10
10
Forest plot of analysis 4 MMSE at 24 normality (23/24).
11
11
Summary ROC plot of analysis 5 MMSE at 25 normality. The black filled dot indicates the summary point estimate of diagnostic accuracy, the smaller dotted bubble indicates the 95% confidence interval around the summary point (containing the 'true value' within that region 95% of the time on the basis of the available data) and the larger dashed bubble indicates the 95% prediction region (containing results from a new future study 95% of the time).
12
12
Forest plot of analysis 5 MMSE at 25 normality.
13
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Summary ROC plot of analysis 1 Main analysis primary care
14
14
Forest plot of analysis 1 Main analysis primary care
1
1. Test
MMSE at 14 normality.
2
2. Test
MMSE at 15 normality.
3
3. Test
MMSE at 16 normality.
4
4. Test
MMSE at 17 normality.
5
5. Test
MMSE at 18 normality.
6
6. Test
MMSE at 19 normality.
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7. Test
MMSE at 20 normality.
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8. Test
MMSE at 21 normality.
9
9. Test
MMSE at 22 normality.
10
10. Test
MMSE at 23 normality.
11
11. Test
MMSE at 24 normality (23/24).
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12. Test
MMSE at 25 normality.
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13. Test
MMSE at 26 normality.
14
14. Test
MMSE at 27 normality.
15
15. Test
MMSE at 28 normality.
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16. Test
MMSE at 29 normality.
17
17. Test
MMSE at 30 normality.
18
18. Test
MMSE adjusted for education.
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22. Test
MMSE at 10 normality.
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23. Test
Main analysis.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD011145

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Tang 1999 {published data only}
    1. Tang M, Zou X, Han H, Wang Y, Zhang L, Tang M, et al. Application of the Chinese version of the Mini‐Mental State Exam (MMSE) in 55 year‐olds and above from districts of Chengdu City, China. Zhongguo Xinli Weisheng Zazh [Chinese Mental Health Journal] 1999;13(4):200‐2. Chinese.
West Beijing Study 1989 {published data only}
    1. Li G, Shen YC, Chen CH, Zhao YW, Li SR, Lu M. An epidemiological survey of age‐related dementia in an urban area of Beijing, China. Acta Psychiatrica Scandinavica 1989;79(6):557‐63. - PubMed
    1. Li G, Shen YC, Chen CH, Zhau YW, Li SR, Lu M. A 3‐year follow‐up study of age‐related dementia in an urban area of Beijing. Acta Psychiatrica Scandinavica 1991;83(2):99‐104. - PubMed
Wilder 1995 {published data only (unpublished sought but not used)}
    1. Wilder D, Cross P, Chen J, Gurland B, Lantigua RA, Teresi J, et al. Operating characteristics of brief screens for dementia in a multicultural population. American Journal of Geriatric Psychiatry 1995;3(2):96‐107. - PubMed
Winblad 2010 {published data only}
    1. Winblad I, Viramo P, Remes A, Manninen M, Jokelainen J. Prevalence of dementia ‐ a rising challenge among ageing populations. European Geriatric Medicine 2010;1(6):330‐3.

References to studies excluded from this review

Almeida 1998 {published data only}
    1. Almeida OP. Mini mental state examination and the diagnosis of dementia in Brazil [Mini exame do estado mental e o diagnostico de demencia no Brasil]. Arquivos de Neuro‐psiquiatria 1998;56(3B):605‐12. [CRS: 99900001000000156; PUBMED: 9850757] - PubMed
Al‐rajeh 1999 {published data only}
    1. Al‐Rajeh S, Ogunniyi A, Awada A, Daif A, Zaidan R. Preliminary assessment of an Arabic version of the Mini‐Mental state examination. Annals of Saudi Medicine 1999;19(2):150‐2. [CRS: 99900001000000008; PUBMED: 17337959] - PubMed
Basic 2009 {published data only}
    1. Basic D, Khoo A, Conforti D, Rowland J, Vrantsidis F, LoGiudice D, et al. Rowland universal dementia assessment scale, mini‐mental state examination and general practitioner assessment of cognition in a multicultural cohort of community‐dwelling older persons with early dementia. Australian Psychologist 2009;44(1):40‐53.
Bastide 2012 {published data only}
    1. Bastide L, Breucker S, Berge M, Fery P, Pepersack T, Bier JC. The Addenbrooke's Cognitive Examination Revised is as effective as the original to detect dementia in a French‐speaking population. Dementia and Geriatric Cognitive Disorders 2012;34(5‐6):337‐43. [CRS: 99900001000000014; PUBMED: 23222058] - PubMed
Belmin 2007 {published data only}
    1. Belmin J, Pariel‐Madjlessi S, Surun P, Bentot C, Feteanu D, Lefebvre des Noettes V, et al. The cognitive disorders examination (Codex) is a reliable 3‐minute test for detection of dementia in the elderly (validation study on 323 subjects). Presse Medicale 2007;36(9 Pt 1):1183‐90. [CRS: 99900001000000086; PUBMED: 17433613] - PubMed
Bermejo 1999 {published data only}
    1. Bermejo F, Morales JM, Valerga C, Ser T, Artolazabal J, Gabriel R. Comparison between two abbreviated Spanish versions of mental status assessment for the diagnosis of dementia. Data of study in the dwelling‐community elderly people [Comparación entre dos versiones Españolas abreviadas de evaluación del estado mental en el diagnóstico de demencia. Datos de un estudio en ancianos residentes en la comunidad]. Medicina Clinica 1999;112(9):330‐4. - PubMed
Bermejo‐Pareja 2009 {published data only}
    1. Bermejo‐Pareja F, Benito‐Leon J, Vega S, Olazaran J, Toledo M, Diaz‐Guzman J, et al. Consistency of clinical diagnosis of dementia in NEDICES: a population‐based longitudinal study in Spain. Journal of Geriatric Psychiatry and Neurology 2009;22(4):246‐55. [CRS: 99900001000000058; PUBMED: 19417217] - PubMed
    1. Prieto G, Contador I, Tapias‐Merino E, Mitchell AJ, Bermejo‐Pareja F. The Mini‐Mental‐37 test for dementia screening in the Spanish population: an analysis using the Rasch Model. Clinical Neuropsychologist 2012;26(6):1003‐18. - PubMed
Bland 2001 {published data only}
    1. Bland RC, Newman SC. Mild dementia or cognitive impairment: the Modified Mini‐Mental State examination (3MS) as a screen for dementia. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 2001;46(6):506‐10. [CRS: 99900001000000137; PUBMED: 11526806] - PubMed
Borson 1999 {published data only}
    1. Borson S, Brush M, Gil E, Scanlan J, Vitaliano P, Chen J, et al. The Clock Drawing Test: utility for dementia detection in multiethnic elders. Journals of Gerontology Series A‐Biological Sciences & Medical Sciences 1999;54(11):M534‐40. [CRS: 99900001000000152; PUBMED: 10619314] - PubMed
    1. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini‐cog: a cognitive 'vital signs' measure for dementia screening in multi‐lingual elderly. 2000; Vol. 15, issue 11:1021‐7. - PubMed
    1. Borson S, Scanlan JM, Watanabe J, Tu SP, Lessig M. Simplifying detection of cognitive impairment: comparison of the Mini‐Cog and Mini‐Mental State Examination in a multiethnic sample. Journal of the American Geriatrics Society 2005;53(5):871‐4. - PubMed
Borson 2000 {published data only}
    1. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini‐cog: a cognitive 'vital signs' measure for dementia screening in multi‐lingual elderly. International Journal of Geriatric Psychiatry 2000;15(11):1021‐7. [CRS: 99900001000000141; PUBMED: 11113982] - PubMed
Borson 2005 {published data only}
    1. Borson S, Scanlan JM, Watanabe J, Tu SP, Lessig M. Simplifying detection of cognitive impairment: comparison of the Mini‐Cog and Mini‐Mental State Examination in a multiethnic sample. Journal of the American Geriatrics Society 2005;53(5):871‐4. [CRS: 99900001000000111; PUBMED: 15877567] - PubMed
Braekhus 1995 {published data only}
    1. Braekhus A, Laake K, Engedal K. A low, 'normal' score on the Mini‐Mental State Examination predicts development of dementia after three years. Journal of the American Geriatrics Society 1995;43(6):656‐61. [CRS: 99900001000000180; PUBMED: 7775725] - PubMed
Brooke 1999 {published data only}
    1. Brooke P, Bullock R. Validation of a 6 item cognitive impairment test with a view to primary care usage. International Journal of Geriatric Psychiatry 1999;14(11):936‐40. [CRS: 99900001000000154; PUBMED: 10556864] - PubMed
Burnham 2012 {published data only}
    1. Burnham S, Graham P, Wilson B, Ames D, MacAulay L, Martins R, et al. Intensity of dementia through latent variable modelling (I‐DELV) in the AIBL cohort. Proceedings of the Alzheimer's Association International Conference; 2012 Jul 14‐19; Vancouver, BC Canada. Alzheimer's and Dementia 2012;8(4 Suppl):P131.
Cacho 2010 {published data only}
    1. Cacho J, Benito‐Leon J, Garcia‐Garcia R, Fernandez‐Calvo B, Vicente‐Villardon JL, Mitchell AJ. Does the combination of the MMSE and clock drawing test (mini‐clock) improve the detection of mild Alzheimer's disease and mild cognitive impairment?. Journal of Alzheimer's Disease 2010;22(3):889‐96. [CRS: 99900001000000042; PUBMED: 20858951] - PubMed
Canadian Study of Health and Aging {published data only}
    1. Bland RC, Newman SC. Mild dementia or cognitive impairment: the Modified Mini‐Mental State examination (3MS) as a screen for dementia. Canadian Journal of Psychiatry ‐ Revue Canadienne de Psychiatrie 2001;46(6):506‐10. - PubMed
    1. Lindsay J, Sykes E, Mcdowell I, Verreault R, Laurin D. More Than the Epidemiology of Alzheimer's Disease: Contributions of the Canadian Study of Health and Aging. Canadian Journal of Psychiatry‐Revue Canadienne De Psychiatrie 2004;49(2):83‐91. - PubMed
    1. McDowell I, Hill G, Lindsay J, Helliwell B, Costa L, Beattie BL, et al. Canadian Study of Health and Aging: Study methods and prevalence of dementia. Canadian Medical Association Journal 1994;150(6):899‐912. - PMC - PubMed
    1. McDowell I, Kristjansson B, Hill GB, Herbert R. Community screening for dementia: the Mini‐Mental State Exam (MMSE) and Modified Mini‐Mental State Exam (3MS) compared. Journal of Clinical Epidemiology 1997;50(4):377‐83. - PubMed
    1. O'Connell ME, Tuokko H, Graves RE, Kadlec H. Correcting the 3MS for bias does not improve accuracy when screening for cognitive impairment or dementia. Journal of Clinical and Experimental Neuropsychology 2004;26(7):970‐80. - PubMed
Cao 2012 {published data only}
    1. Cao L, Hai S, Lin X, Shu D, Wang S, Yue J, et al. Comparison of the Saint Louis University Mental Status Examination, the Mini‐Mental State Examination, and the Montreal Cognitive Assessment in detection of cognitive impairment in Chinese elderly from the geriatric department. Journal of the American Medical Directors Association 2012;13(7):626‐9. [CRS: 99900001000000016; PUBMED: 22698956] - PubMed
Carpenter 2011 {published data only}
    1. Carpenter CR, Bassett ER, Fischer GM, Shirshekan J, Galvin JE, Morris JC. Four sensitive screening tools to detect cognitive dysfunction in geriatric emergency department patients: brief Alzheimer's Screen, Short Blessed Test, Ottawa 3DY, and the caregiver‐completed. Academic Emergency Medicine 2011;18(4):374‐84. - PMC - PubMed
Cercy 2012 {published data only}
    1. Cercy SP. Diagnostic accuracy of a new instrument for detecting cognitive dysfunction. International Journal of Geriatric Psychiatry 2012;27(9):914‐23. [CRS: 99900001000000019; PUBMED: 22020766] - PubMed
    1. Cercy SP, Simakhodskaya Z, Elliott A. Diagnostic accuracy of a new instrument for detecting cognitive dysfunction in an emergent psychiatric population: the Brief Cognitive Screen. Academic Emergency Medicine 2010;17(3):307‐15. [CRS: 99900001000000053; PUBMED: 20370764] - PubMed
Cerveira 2009 {published data only}
    1. Cerveira MO, Heisler A, Fonseca M, Rech L, Silva MB, Camozzato AL, et al. Cognitive impairment screening in a Southern Brazilian elderly outpatient sample. Alzheimer's and Dementia 2009;5(4):274.
Cervilla 2004 {published data only}
    1. Cervilla J, Prince M, Joels S, Lovestone S, Mann A. Premorbid cognitive testing predicts the onset of dementia and Alzheimer's disease better than and independently of APOE genotype. Journal of Neurology, Neurosurgery & Psychiatry 2004;75(8):1100‐6. [CRS: 99900001000000120; 99900001000000120; PUBMED: 15258208] - PMC - PubMed
Chaves 2007 {published data only}
    1. Chaves ML, Camozzato AL, Godinho C, Kochhann R, Schuh A, Almeida VL, et al. Validity of the clinical dementia rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Disease and Associated Disorders 2007;21(3):210‐7. [PUBMED: 17804953] - PubMed
Chaves 2009 {published data only}
    1. Chaves ML, Camozzato AL, Godinho C, Piazenski I, Kaye J. Incidence of mild cognitive impairment and Alzheimer disease in Southern Brazil. Journal of Geriatric Psychiatry and Neurology 2009;22(3):181‐7. [CRS: 99900001000000060; PUBMED: 19307320] - PubMed
Chester 2011 {published data only}
    1. Chester JG, Grande LJ, Milberg WP, McGlinchey RE, Lipsitz LA, Rudolph JL. Cognitive screening in community‐dwelling elders: performance on the clock‐in‐the‐box. American Journal of Medicine 2011;124(7):662‐9. [CRS: 99900001000000035; 99900001000000035; PUBMED: 21592451] - PMC - PubMed
Chong 2010 {published data only}
    1. Chong MS, Lim WS, Chan SP, Feng L, Niti M, Yap P, et al. Diagnostic performance of the Chinese Frontal Assessment Battery in early cognitive impairment in an Asian population. Dementia and Geriatric Cognitive Disorders 2010;30(6):525‐32. [CRS: 99900001000000041; PUBMED: 21252547] - PubMed
Clark 1999 {published data only}
    1. Clark CM, Sheppard L, Fillenbaum GG, Galasko D, Morris JC, Koss E, et al. Variability in annual mini‐mental state examination score in patients with probable alzheimer disease: a clinical perspective of data from the consortium to establish a registry for alzheimer disease. Archives of Neurology 1999;56(7):857‐62. - PubMed
Clarke 1991 {published data only}
    1. Clarke M, Jagger C, Anderson J, Battcock T, Kelly F, Stern MC. The prevalence of dementia in a total population: a comparison of two screening instruments. Age and Ageing 1991;20(6):396‐403. [CRS: 99900001000000202; PUBMED: 1776585] - PubMed
    1. Collerton D, Collerton J, Jagger J, Bond J, Saxby BK, Brooker H, McKeith IG, Kirkwood T. Cognitive performance in a UK cohort of 85 year olds: The Newcastle 85+ study. Journal of Psychophysiology: International Conference “Aging & Cognition”. 2011; Vol. 25 (s1):9.
    1. Jagger C, Clarke M, Anderson J. Screening for dementia ‐ a comparison of 2 tests using receiver operating characteristic (Roc) analysis. International Journal of Geriatric Psychiatry 1992;7(9):659‐65.
Cossa 1997 {published data only}
    1. Cossa FM, Della Sala S, Musicco M, Spinnler H, Ubezio MC. Comparison of two scoring systems of the Mini‐Mental State Examination as a screening test for dementia. Journal of Clinical Epidemiology 1997;50(8):961‐5. - PubMed
Cossa 1999 {published data only}
    1. Cossa FM, Sala SD, Musicco M, Spinnler H, Ubezio MC. The Milan overall dementia assessment and the mini‐mental state examination compared: an epidemiological investigation of dementia. European Journal of Neurology 1999;6(3):289‐94. - PubMed
Costa 2012 {published data only}
    1. Costa D, Severo M, Fraga S, Barros H. Mini‐Cog and Mini‐Mental State Examination: agreement in a cross‐sectional study with an elderly sample. Dementia and Geriatric Cognitive Disorders 2012;33(2‐3):118‐24. - PubMed
Cullen 2005 {published data only}
    1. Cullen B, Fahy S, Cunningham CJ, Coen RF, Bruce I, Greene E, et al. Screening for dementia in an Irish community sample using MMSE: a comparison of norm‐adjusted versus fixed cut‐points. International Journal of Geriatric Psychiatry 2005;20(4):371‐6. [CRS: 99900001000000112; PUBMED: 15799072] - PubMed
Dahl 2007 {published data only}
    1. Dahl A, Berg S, Nilsson SE. Identification of dementia in epidemiological research: a study on the usefulness of various data sources. Aging Clinical and Experimental Research 2007;19(5):381‐9. [CRS: 99900001000000082; PUBMED: 18007116] - PubMed
Damian 2011 {published data only}
    1. Damian AM, Jacobson SA, Hentz JG, Belden CM, Shill HA, Sabbagh MN, et al. The Montreal Cognitive Assessment and the mini‐mental state examination as screening instruments for cognitive impairment: item analyses and threshold scores. Dementia and Geriatric Cognitive Disorders 2011;31(2):126‐31. [CRS: 99900001000000037; PUBMED: 21282950] - PubMed
Dash 2006 {published data only}
    1. Dash P, Troupin A, Thomson J, Knowlton M. The Q&E in the detection of mild Alzheimer's disease. Research and Practice in Alzheimer's Disease 2006;11:191‐5.
Davous 1988 {published data only}
    1. Davous P, Lamour Y. Elementary test of concentration, orientation and memory. Application to the detection of dementia states in daily practice [Le test elementaire de concentration, orientation et memoire. Application au depistage d'un etat dementiel en pratique quotidienne]. Presse Medicale 1988;17(11):513‐5. - PubMed
De Beaman {published data only}
    1. Beaman SR, Beaman PE, Garcia‐Pena C̃, Villa A, Heres J, Córdova A, et al. Validation of a modified version of the Mini‐Mental State Examination (MMSE) in Spanish. Aging Neuropsychology and Cognition 2004;11(1):1‐11.
De Jager 2009 {published data only}
    1. Jager CA, Schrijnemaekers AC, Honey TE, Budge MM. Detection of MCI in the clinic: evaluation of the sensitivity and specificity of a computerised test battery, the Hopkins Verbal Learning Test and the MMSE. Age and Ageing 2009;38(4):455‐60. [CRS: 99900001000000061; PUBMED: 19454402] - PubMed
Del‐Ser 1997 {published data only}
    1. Del‐Ser T, Morales JM, Barquero MS, Canton R, Bermejo F. Application of a Spanish version of the "Informant Questionnaire on Cognitive Decline in the Elderly" in the clinical assessment of dementia. Alzheimer Disease and Associated Disorders 1997;11(1):3‐8. [CRS: 99900001000000167; PUBMED: 9071438] - PubMed
Derrer 2001 {published data only}
    1. Derrer DS, Howieson DB, Mueller EA, Camicioli RM, Sexton G, Kaye JA. Memory testing in dementia: how much is enough?. Journal of Geriatric Psychiatry and Neurology 2001;14(1):1‐6. [CRS: 99900001000000140; PUBMED: 11281309] - PubMed
De Silva 2002 {published data only}
    1. Silva HA, Gunatilake SB. Mini Mental State Examination in Sinhalese: a sensitive test to screen for dementia in Sri Lanka. International Journal of Geriatric Psychiatry 2002;17(2):134‐9. [CRS: 99900001000000133; PUBMED: 11813275] - PubMed
Dierckx 2011 {published data only}
    1. Dierckx E, Carlon M, Engelborghs S, Raedt R, Deyn P, Ponjaert‐Kristoffersen I. Early detection of MCI: is the MOCA more sensitive for cognitive decline than the MMSE (a pilot study)?. Alzheimer's and dementia 2011;7(4):S535 (P3‐071).
Diniz 2007 {published data only}
    1. Diniz BS, Nunes PV, Yassuda MS, Pereira FS, Flaks MK, Viola LF, et al. Mild cognitive impairment: cognitive screening or neuropsychological assessment?. Revista Brasileira de Psiquiatria (Sao Paulo, Brazil : 1999) 2008;30(4):316‐21. [CRS: 99900001000000068; PUBMED: 19142405] - PubMed
Dong 2012 {published data only}
    1. Dong Y, Lee WY, Basri NA, Collinson SL, Merchant RA, Venketasubramanian N, et al. The Montreal Cognitive Assessment is superior to the Mini‐Mental State Examination in detecting patients at higher risk of dementia. International Psychogeriatrics 2012;24(11):1749‐55. [CRS: 99900001000000015; PUBMED: 22687278] - PubMed
Donnelly 2008 {published data only}
    1. Donnelly K, Donnelly JP, Cory E. Primary care screening for cognitive impairment in elderly veterans. American Journal of Alzheimer's Disease and Other Dementias 2008;23(3):218‐26. [CRS: 99900001000000075; PUBMED: 18375531] - PMC - PubMed
Drachmann 1996 {published data only}
    1. Drachman DA, Swearer JM, Kane K, Osgood D, O'Toole C, Moonis M. The cognitive assessment screening test (CAST) for dementia. Journal of Geriatric Psychiatry and Neurology 1996;9(4):200‐8. [CRS: 99900001000000168; PUBMED: 8970013] - PubMed
Duron {published data only}
    1. Duron E, Plichart M, Rigaud AS, Laboure F, Hanon O. Metabolic syndrome and cognitive function in an elderly cohort with memory complaints: A transversal study. Alzheimer's and Dementia 2011;7(4):S351.
Fabrigoule 1995 {published data only}
    1. Fabrigoule C, Letenneur L, Dartigues JF, Zarrouk M, Commenges D, Barberger‐Gateau P. Social and leisure activities and risk of dementia: a prospective longitudinal study. Journal of the American Geriatrics Society 1995;43(5):485‐90. [CRS: 99900001000000182; PUBMED: 7730528] - PubMed
Feher 1992 {published data only}
    1. Feher EP, Mahurin RK, Doody RS, Cooke N, Sims J, Pirozzolo FJ. Establishing the limits of the Mini‐Mental State. Examination of 'subtests'. Archives of Neurology 1992;49(1):87‐92. [CRS: 99900001000000201; PUBMED: 1728269] - PubMed
Fernandez‐Martinez 2008 {published data only}
    1. Fernandez‐Martinez M, Castro‐Flores J, Perez de Las Heras S, Mandaluniz‐Lekumberri A, Gordejuela‐Menocal M, Zarranz‐Imirizaldu JJ. Risk factors for dementia in the epidemiological study of Munguialde County (Basque Country‐Spain). BMC Neurology 2008;8:39. [CRS: 99900001000000072; 99900001000000072; PUBMED: 18922150] - PMC - PubMed
Fernandez‐Martinez 2010 {published data only}
    1. Fernandez‐Martinez M, Molano A, Castro J, Zarranz JJ. Prevalence of neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease, and its relationship with cognitive impairment. Current Alzheimer Research 2010;7(6):515‐26. - PubMed
Ferrero‐Arias 2001 {published data only}
    1. Ferrero‐Arias J, Sanchez‐Saudinos M, Lamet‐Gil I. Five by five test. A brief instrument for the detection of cognitive impediment in clinical settings [El test "cinco por cinco". Un instrumento breve para la detección de impedimento cognitivo en contextos clínicos]. Neurologia (Barcelona, Spain) 2001;16(6):254‐61. [CRS: 99900001000000138; PUBMED: 11423042] - PubMed
Ferruci 1998 {published data only}
    1. Ferrucci L, Lungo I, Guralnik JM, Bandinelli S, Benvenuti E, Salani B, et al. Is the telephone interview for cognitive status a valid alternative in persons who cannot be evaluated by the Mini Mental State Examination?. Aging Clinical and Experimental Research 1998;10(4):332‐8. [CRS: 99900001000000157; PUBMED: 9825025] - PubMed
Fong 2010 {published data only}
    1. Fong TG, Jones RN, Rudolph JL, Yang FM, Tommet D, Habtemariam D, et al. Development and validation of a brief cognitive assessment tool: the sweet 16. Archives of Internal Medicine 2011;171(5):432‐7. [CRS: 99900001000000038; PUBMED: 21059967] - PubMed
Forlani {published data only}
    1. Forlani C, Morri M, Ferrari B, Dalmonte E, Ronchi D, Atti AR. Cognitive status in 75 years and older subjects. A population‐based study. European Psychiatry 2010;25(1):1493.
Fountoulakis 1998 {published data only}
    1. Fountoulakis KN, Tsolaki M, Mohs RC, Kazis A. Epidemiological dementia index: a screening instrument for Alzheimer's disease and other types of dementia suitable for use in populations with low education level. Dementia and Geriatric Cognitive Disorders 1998;9(6):329‐38. [CRS: 99900001000000159; PUBMED: 9769446] - PubMed
Fountoulakis 2000 {published data only}
    1. Fountoulakis KN, Tsolaki M, Paulopoulos H, Kazis A. Validation of the epidemiological dementia index in geriatric outpatients. International Psychogeriatrics 2000;12(2):195‐208. [CRS: 99900001000000142; PUBMED: 10937540] - PubMed
Fratiglioni 1993 {published data only}
    1. Fratiglioni L. Epidemiology of Alzheimer's disease. Issues of etiology and validity. Acta Neurologica Scandinavica 1993;145 Supplementum:1‐70. [CRS: 99900001000000191; PUBMED: 8333250] - PubMed
Fratiglioni 1994 {published data only}
    1. Fratiglioni L, Forsell Y, Aguero Torres H, Winblad B. Severity of dementia and institutionalization in the elderly: prevalence data from an urban area in Sweden. Neuroepidemiology 1994;13(3):79‐88. [CRS: 99900001000000189; PUBMED: 8015667] - PubMed
Fujiawara 2003 {published data only}
    1. Fujiwara Y, Amano H, Mori S, Watanabe S, Kumagai S, Yoshida Y, et al. Toward constructing a system for detecting and coping with senile dementia in early stages among community‐dwelling older people. Nippon Koshu Eisei Zasshi [Japanese Journal of Public Health] 2003;50(8):739‐48. Japanese. [CRS: 99900001000000125; PUBMED: 14515751] - PubMed
Gabryelewicz 2002 {published data only}
    1. Gabryelewicz T, Parnowski T, Szafranska A, Matuszewska E, Jarkiewicz E, Kotapka‐Minc S, et al. The prevalence of dementia in Poland: a population‐based, door‐to‐door survey in an urban community. Archives of Psychiatry and Psychotherapy 2002;4(1):17‐26.
Galvin 2010 {published data only}
    1. Galvin JE, Fagan AM, Holtzman DM, Mintun MA, Morris JC. Relationship of dementia screening tests with biomarkers of Alzheimer's disease. Brain 2010;133(11):3290‐300. [CRS: 99900001000000044; 99900001000000044; PUBMED: 20823087] - PMC - PubMed
Ganguli 2004b {published data only}
    1. Ganguli M, Ratcliff G, Huff FJ, Belle S, Kancel MJ, Fischer L, et al. Effects of age, gender, and education on cognitive tests in a rural elderly community sample: norms from the Monongahela Valley Independent Elders Survey. Neuroepidemiology 1991;10(1):42‐52. [CRS: 99900001000000203; PUBMED: 2062416] - PubMed
Ganguli 2010a {published data only}
    1. Ganguli M, Bilt JV, Lee CW, Snitz BE, Chang CC, Loewenstein DA, et al. Cognitive test performance predicts change in functional status at the population level: the MYHAT Project. Journal of the International Neuropsychological Society 2010;16(5):761‐70. [CRS: 99900001000000045; 99900001000000045; PUBMED: 20609270] - PMC - PubMed
Ganguli 2010b {published data only}
    1. Ganguli M, Chang CC, Snitz BE, Saxton JA, Vanderbilt J, Lee CW. Prevalence of mild cognitive impairment by multiple classifications: The Monongahela‐Youghiogheny Healthy Aging Team (MYHAT) project. American Journal of Geriatric Psychiatry 2010;18(8):674‐83. [CRS: 99900001000000048; 99900001000000048; PUBMED: 20220597] - PMC - PubMed
Ganzer 2003 {published data only}
    1. Ganzer S, Arlt S, Schoder V, Buhmann C, Mandelkow E‐M, Finckh U, et al. CSF‐tau, CSF‐Aß1‐42, ApoE‐genotype and clinical parameters in the diagnosis of Alzheimer’s disease: combination of CSF‐tau and MMSE yields highest sensitivity and specificity. Journal of Neural Transmission 2003;110(10):1149‐60. - PubMed
Garcia {published data only}
    1. Garcia A, Hemraj A, Klar S, Chestney T, Khoja L, Day A. Homocysteine and cognitive tests as predictors of cognitive decline: a cohort study.
Garcia 1993 {published data only}
    1. Garcia CE, Loyola JC, Armstrong TC, Muhienbrock F, Blake PE. A simple method to assess cognitive function: the clock drawing test [Prueba del reloj: un método simple para evaluar demencia]. Revista Médica de Chile 1983;121(11):1284‐8. - PubMed
Geerlings 1999 {published data only}
    1. Geerlings MI, Jonker C, Bouter LM, Ader HJ, Schmand B. Association between memory complaints and incident Alzheimer's disease in elderly people with normal baseline cognition. American Journal of Psychiatry 1999;156(4):531‐7. - PubMed
Gibbons {published data only}
    1. Gibbons L, Carle A, Insel P, MacKin S, Mukherjee S, McKay Curtis S, et al. Composite scores for memory out performed other approaches to the neuropsychological data collected by the Alzheimer's disease neuroimaging initiative (ADNI). Alzheimer's and Dementia.
Goldman 2001 {published data only}
    1. Goldman WP, Morris JC. Evidence that age‐associated memory impairment is not a normal variant of aging. Alzheimer Disease and Associated Disorders 2001;15(2):72‐79. - PubMed
Gondo 2006 {published data only}
    1. Gondo Y, Hirose N, Arai Y, Inagaki H, Masui Y, Yamamura K, Shimizu K‐I, Takayama M, Ebihara Y, Nakazawa S, Kitagawa K. Functional status of centurians in Tokyo, Japan: developing better phentypes of exceptional longevity. Journal of Gerontology 2006;61A(3):305‐10. - PubMed
Grigoletto 1999 {published data only}
    1. Grigoletto F, Zappala G, Anderson DW, Lebowitz BD. Norms for the Mini‐Mental State Examination in a healthy population. Neurology 1999;53(2):315‐20. - PubMed
Grober 2008 {published data only}
    1. Grober E, Hall C, Lipton RB, Teresi JA. Primary care screen for early dementia. Journal of the American Geriatrics Society 2008;56(2):206‐13. - PubMed
Harder 1995 {published data only}
    1. Harder H, Lanser JBK, Haan EHF, Roos RAC. The Mini‐mental state is insufficient as a screening test for cognitive deterioration in a neurological setting [De 'Mini‐mental state' ‐ test ontoereikend als screeningtest voor cognitieve deterioratie op een afdeling Neurologie]. Ned Tijdschr Geneeskd 1995;139:1742‐5. - PubMed
Hashizume 2004 {published data only}
    1. Hashizume T. Severity of Alzheimer disease and the significance of a dementia test battery. Jikeikai Ika Daigaku zasshi [ Tokyo Jikeikai Medical Journal] 2004;119(1):41‐50.
Helkala 2002 {published data only}
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Tierney 2000 {published data only}
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References to studies awaiting assessment

Gungen 2002 {published data only}
    1. Gungen C, Ertan T, Eker E, Yasar R, Engin F. [Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population]. [Turkish]. Turk Psikiyatri Dergisi 2002;13(4):273‐81. - PubMed
Jianbo 2013 {published data only}
    1. Jianbo H, Weihua Z, Shaohua H, Ning W, Manli H, Yi X. Brief screening tool for mild cognitive impairment in elder chinese: Validation of the chinese version of the montreal cognitive assessment. American Journal of Geriatric Psychiatry 2011.
Kornsey {published data only (unpublished sought but not used)}
    1. Kornsey E, Rovner B, Casten R. Racial disparities in a community‐based sample of a novel memory screening protocol. Alzheimer's and Dementia 2011;7(4 Suppl):S613.
Kvitting 2013 {published data only (unpublished sought but not used)}
    1. Johansson MM, Kvitting AS, Wressle E, Marcusson J. Clinical utility of cognistat in multiprofessional team evaluations of patients with cognitive impairment in Swedish primary care. International Journal of Family Medicine 2014;2014:649253. [DOI: 10.1155/2014/649253] - DOI - PMC - PubMed
Orsi {published data only (unpublished sought but not used)}
    1. Orsi E, Xavier AJ, Sigulem D, Kupek E, Ramos LR. Temporal orientation is the best discriminative item of the folstein's mini mental status examination. Alzheimer's and Dementia. 2009; Vol. 5, issue 4 Suppl:275.
Shaaban 2013 {published data only (unpublished sought but not used)}
    1. Shaaban J, Aziz AA, Abdullah Z, Razak AA. Validation of the malay version of rowland universal dementia assessment scale (m‐rudas) among elderly attending primary care clinic. International Medical Journal 2013;20:555‐558.
Upadhyaya 2010 {published data only}
    1. Upadhyaya AK, Rajagopal M, Gale TM. The six item cognitive impairment test (6‐CIT) as a screening test for 150 dementia: Comparison with Mini‐Mental State Examination (MMSE). Current Aging Science 2010;3(2):138‐142. - PubMed
Yu 2012 {published data only (unpublished sought but not used)}
    1. Yu P, Dean RA, Hall SD, Qib Y, Sethuramana G, Willis BA, Siemers ER, Martenyi F, Tauscher JT, Schwarz AJ. Enriching Amnestic Mild Cogitive Impairment Populations for Clinical Trials: Optimal Combination of Biomarkers to Predict Conversion to Dementia. Journal of Alzheimer’s Disease 2012;32:373‐385. - PubMed

References to ongoing studies

Guiata 2012 {published data only (unpublished sought but not used)}
    1. Guaita A, Abbondanza S, Colombo M, Davin A, Forloni G, Polito L, Vaccaro R, Valle E, Vitali S, Ferretti VV, Villani S. Cognitive impairment, dementia and "good performers": Prevalence in the population study "InveCe.AB". Journal of nutrition, health & aging 2012;16(9):827‐828.

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