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. 2024 Jan-Mar;38(1):98-100.
doi: 10.1097/WAD.0000000000000609. Epub 2024 Jan 29.

Compassion Versus Accuracy: Lenient Scoring of the Spatial Orientation Items on the Mini-mental State Exam Lowers Sensitivity

Katrina Kent  1 , Nesrine Adly Ibrahim  2 , Kristoffer Romero  2 , Shannon Baker  1 , Matthew Greenacre  1 , Chantal M Boucher  2 , Robert M Roth  3 , Laszlo A Erdodi  2   4
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Compassion Versus Accuracy: Lenient Scoring of the Spatial Orientation Items on the Mini-mental State Exam Lowers Sensitivity

Katrina Kent et al. Alzheimer Dis Assoc Disord. 2024 Jan-Mar.

Abstract

The Mini-mental State Examination (MMSE) is a commonly used screening tool for cognitive impairment. Lenient scoring of spatial orientation errors (SOEs) on the MMSE is common and negatively affects its diagnostic utility. We examined the effect of lenient SOE scoring on MMSE classification accuracy in a consecutive case series of 103 older adults (age 60 or above) clinically referred for neuropsychological evaluation. Lenient scoring of SOEs on the MMSE occurred in 53 (51.4%) patients and lowered the sensitivity by 7% to 18%, with variable gains in specificity (0% to 11%) to psychometrically operationalized cognitive impairment. Results are consistent with previous reports that lenient scoring is widespread and attenuates the sensitivity of the MMSE. Given the higher clinical priority of correctly detecting early cognitive decline over specificity, a warning against lenient scoring of SOEs (on the MMSE and other screening tools) during medical education and in clinical practice is warranted.

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Conflict of interest statement

The authors declare no conflicts of interest.

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