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. 2023 Jan 12;8(1):12.
doi: 10.3390/geriatrics8010012.

Mini-Mental State Examination: Optimal Cut-Off Levels for Mild and Severe Cognitive Impairment

Francesco Salis  1 , Diego Costaggiu  1 , Antonella Mandas  1
Affiliations

Mini-Mental State Examination: Optimal Cut-Off Levels for Mild and Severe Cognitive Impairment

Francesco Salis et al. Geriatrics (Basel). .

Abstract

Considering the need to intercept neurocognitive damage as soon as possible, it would be useful to extend cognitive test screening throughout the population. Here, we propose differential cut-off levels that can be used to identify mild and severe cognitive impairment with a simple and widely used first-level neurocognitive screening test: the Mini-Mental State Examination (MMSE). We studied a population of 262 patients referred for cognitive impairment testing using the MMSE and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), a neuropsychological battery. The sample consisted of 262 participants with mean age 73.8 years (60-87), of whom 154 (58.8%) women. No significant gender-related differences in cognitive ability were identified. The two tests (MMSE and RBANS) showed a moderate correlation in identifying cognitive deficit. We used RBANS as a categorial variable to identify different degrees of cognitive impairment. Youden's J indexes were used to consider the better sensitivity/specificity balance in the 24-point cut-off score for severe cognitive deficit, 29.7-point score for mild cognitive deficit, and 26.1-point score for both mild and severe cognitive deficit. The study shows that the MMSE does not identify early cognitive impairment. Though different cut-offs are needed to discriminate different impairment degrees, the 26.1-point score seems to be preferable to the others.

Keywords: Mini-Mental State Examination (MMSE); Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); dementia; memory; mild cognitive impairment (MCI); screening.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Pearson’s correlation coefficient (RBANS vs. MMSE). MMSE, Mini-Mental State Examination; RBANS, Repeatable Battery for the Assessment of Neurocognitive Status.
Figure 2
Figure 2
AUC (severe impairment). MMSE, Mini-Mental State Examination; AUC, area under the ROC curve.
Figure 3
Figure 3
AUC (mild impairment). MMSE, Mini-Mental State Examination; AUC, area under the ROC curve.
Figure 4
Figure 4
AUC (mild and severe impairment). MMSE, Mini-Mental State Examination; AUC, area under the ROC curve.
See this image and copyright information in PMC

References

    1. Alzheimer’s Disease International . World Alzheimer Report 2019: Attitudes to Dementia. Alzheimer’s Disease International; London, UK: 2019.
    1. Salis F., Locci G., Mura B., Mandas A. Anemia in Elderly Patients—The Impact of Hemoglobin Cut-Off Levels on Geriatric Domains. Diagnostics. 2023;13:191. doi: 10.3390/diagnostics13020191. - DOI - PMC - PubMed
    1. Loddo S., Salis F., Rundeddu S., Serchisu L., Peralta M.M., Mandas A. Nutritional Status and Potentially Inappropriate Medications in Elderly. J. Clin. Med. 2022;11:3465. doi: 10.3390/jcm11123465. - DOI - PMC - PubMed
    1. Hlavka J.P., Mattke S., Liu J.L. Assessing the Preparedness of the Health Care System Infrastructure in Six European Countries for an Alzheimer’s Treatment. Rand Health Q. 2019;8:2. - PMC - PubMed
    1. Pani A., Mandas A., Diaz G., Abete C., Cocco P.L., Angius F., Brundu A., Muçaka N., Pais M.E., Saba A., et al. Accumulation of neutral lipids in peripheral blood mononuclear cells as a distinctive trait of Alzheimer patients and asymptomatic subjects at risk of disease. BMC Med. 2009;7:66. doi: 10.1186/1741-7015-7-66. - DOI - PMC - PubMed

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