An Arabic Version of the Mini-Mental State Examination for the Lebanese Population: Reliability, Validity, and Normative Data

Abstract

Background: The Mini-Mental State Examination (MMSE) has not been validated in the Lebanese population and no normative data exist at the national level. Objective: To evaluate the reliability and validity of an Arabic version of MMSE developed by the "Groupe de Travail sur les Démences de l'Université Saint Joseph" (A-MMSE(GTD-USJ)) and to provide normative data by gender, age, and education in adults over 55. Methods: Study design: national cross-sectional survey. Study population: 1,010 literate community-dwelling Lebanese residents aged 55 and above. Outcomes: reproducibility, internal consistency, sensitivity, specificity, predictive values, and area under the curve of the A-MMSE(GTD-USJ) for the detection of cognitive impairment using the Clinical Dementia Rating (CDR) as the gold standard. Normative data were established from 720 healthy adults. A-MMSE(GTD-USJ) scores corresponding to the 5th, 10th, 15th, and 50th percentiles were identified according to gender, age, and education. Results: Intra-rater and inter-rater test-retest score correlations were 0.89 and 0.72, respectively. Cronbach alpha coefficient for internal consistency of the A-MMSE(GTD-USJ) was 0.71. A threshold value of 23 provided a sensitivity of 80% and a specificity of 89.4%. The area under the curve was 0.92. A-MMSE(GTD-USJ) scores increased with education and decreased with age. Women had significantly lower scores than men. Normative data for A-MMSE(GTD-USJ) stratified by gender, age, and education were generated.

Dietary Patterns and Risk Factors of Frailty in Lebanese Older Adults

“…Recruitment of participants and data collection were carried out in collaboration with the Ministry of Social Affairs (MOSA) through 77 medico-social centers serving low to middle class income families, from October 2017 to October 2019. The sample was weighed according to the proportion of older adults over 60 years in each governorate and was randomly selected based on the sample previously drawn for the validation of the Arabic version of Mini-Mental State Examination (MMSE) [ 44 , 45 ].…”

“…The interview with each participant or caretaker lasted around 30–45 min. Depending on literacy, the cognitive functions of each participant were assessed either through the Mini-Mental State Examination (MMSE) [ 44 ] or “Test des Neufs Images” (TNI) [ 46 ]. In case of significant cognitive decline, then the accompanying person was asked to fill the questionnaire on behalf of the participant.…”

“…Since cognitive decline might influence reporting in the elderly population, cognitive impairment was evaluated depending on literacy, using population specific cut-offs based on age, educational level and sex, of MMSE for literate participants, and a score of TNI, Total Recall ≤ 9, for illiterate participants [ 44 , 46 , 48 ].…”

Prevalence and risk factors of delirium and subsyndromal delirium in older adults

“…The sensitivity of CAM has varied from 46 to 100% [12,13]. Detection of cognitive impairments early can identify treatable conditions including ischemic brain disease, when risk factors can be then better controlled, helping to prevent progression of disease, the mini-mental state examination (MMSE), a 30-item interviewed administered assessment, is a validated and commonly used screening tool [14,15], functional performance can be viewed as a measure of overall impact of health conditions in the context of a patient's environment and social support system; therefore, it is essential to assess the patient's functional status at the first visit, and any change in functional status should prompt further investigation. Barthel Index (BI) was developed as a measure of basic activity of daily living and assessment of disability in patients with neuromuscular and musculoskeletal conditions receiving hospital rehabilitation and was recommended for routine use by the Royal College of Physicians in the assessment of older people [16].…”

Psychological Complications at 3 Months Following Stroke: Prevalence and Correlates Among Stroke Survivors in Lebanon

“…Lower scores designate severe cases with higher impairment. Previous research has validated the use of the Arabic version of MMSE among the Lebanese population and recommended the use of 23 as a cut off to describe “normal” intellectual function (El-Hayeck et al, 2019 ).…”