Psychometric Limitations of the Mini-Mental State Examination Among Nondemented Older Adults: An Evaluation of Neurocognitive and Magnetic Resonance Imaging Correlates

Spencer, Robert J.; Wendell, Carrington R.; Giggey, Paul P.; Katzel, Leslie I.; Lefkowitz, David M.; Siegel, Eliot L.; Waldstein, Shari R.

doi:10.1080/0361073x.2013.808109

Cited by 137 publications

(95 citation statements)

References 17 publications

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“…15,16 Similarly, the method used to measure cognitive function, the MMSE, is a validated and widely used method of cognitive assessment, although it may have poor sensitivity for the detection of mild cognitive impairment, subtle changes in word recall, or impairment in executive function. 22,23 Our study has a number of limitations. First, because this is an observational study, we can only establish association and not causation, and the effect of residual confounding cannot be ruled out, as dietary habits tend to be lifelong and may be a proxy for other poor health behaviors that were either unknown or unmeasured.…”

Section: Resultsmentioning

confidence: 99%

Healthy eating and reduced risk of cognitive decline

et al. 2015

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Objective: We sought to determine the association of dietary factors and risk of cognitive decline in a population at high risk of cardiovascular disease.Methods: Baseline dietary intake and measures of the Mini-Mental State Examination were recorded in 27,860 men and women who were enrolled in 2 international parallel trials of the ONTARGET (Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial) and TRANSCEND (Telmisartan Randomised Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease) studies. We measured diet quality using the modified Alternative Healthy Eating Index. Cox proportional hazards regression was used to determine the association between diet quality and risk of $3-point decline in Mini-Mental State Examination score, and reported as hazard ratio with 95% confidence intervals with adjustment for covariates.Results: During 56 months of follow-up, 4,699 cases of cognitive decline occurred. We observed lower risk of cognitive decline among those in the healthiest dietary quintile of modified Alternative Healthy Eating Index compared with lowest quintile (hazard ratio 0.76, 95% confidence interval 0.66-0.86, Q5 vs Q1). Lower risk of cognitive decline was consistent regardless of baseline cognitive level. Conclusion:We found that higher diet quality was associated with a reduced risk of cognitive decline. Improved diet quality represents an important potential target for reducing the global burden of cognitive decline.

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Section: Resultsmentioning

confidence: 99%

Healthy eating and reduced risk of cognitive decline

et al. 2015

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“…Moreover, according to Kim et al (2014) MMSE can be considered as a promising screening tool for mild cognitive impairment (MCI) when detailed neuropsychological tests are not feasible. On the other hand, Spencer et al (2013) using MMSE in the group of healthy older people showed its ceiling effects, poor test-retest reliability, and limited sensitivity to subtle brain abnormalities. It should be noted that awareness of the MMSE's limitations makes that it is used as screening assessment of cognition.…”

Section: Introductionmentioning

confidence: 92%

The assessment of cognitive impairment suspected of dementia in Polish elderly people: results of the population-based PolSenior Study

Klich-Rączka¹,

Piotrowicz²,

Mossakowska³

et al. 2014

Experimental Gerontology

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“…One important limitation of the latent class approach is that the number of identified classes may reflect floor or ceiling effects in available data [45]. The CPS and MMSE scores may lack appropriate sensitivity at lower levels of impairment to detect subtle changes [46,47], a limitation that has been discussed in previous research on heterogeneity in terminal decline [11]. That we were nevertheless able to observe terminal change in individuals with relatively low levels of impairment shows that floor effects were not particularly severe in the present study.…”

Section: Discussionmentioning

confidence: 99%

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

et al. 2018

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Background: Research on terminal decline has widely documented that cognitive performance steeply declines with nearing death. To date, it is unclear whether these changes are normative, based on pathologies associated with (preclinical) dementia, or both. Objectives: We analyzed heterogeneity in trajectories of terminal cognitive change in Swiss nursing home residents with the objective of examining whether terminal change is normative or whether one or multiple subgroup(s) with relative stability exist. Methods: We performed a longitudinal analysis based on routine assessments with the Resident Assessment Instrument – Minimal Data Set in 341 nursing homes between 1998 and 2014. In sum, we used 143,052 observations from 30,054 residents (69% women, average age at death 87 years) in the last 3 years of life. We analyzed trajectories of the Cognitive Performance Scale (CPS) score with latent class growth curve models and examined sociodemographic factors (age at death, sex, marital status, prior living situation) as well as functional and mental health (Activities of Daily Living Index and Depression Rating Scale) and dementia diagnosis as correlates of group membership. Results: We identified three distinct classes based on longitudinal trajectories of the CPS score. In the first group (transition from no to mild impairment, 27%), cognitive impairment increased with time to death (linear and quadratic), but remained at relatively mild levels at all times. The trajectories of the second group (transition from moderate to severe impairment, 43%) were characterized by linear and quadratic changes across time to death. The trajectories of the third group (severe impairment, 30%) were characterized by the lowest amount of linear increase across all groups and no quadratic increase indicating no accelerated change. Better functional health and absence of a dementia diagnosis predicted less impairment. Fewer depressive symptoms were associated with low as opposed to moderate or severe, but also severe versus moderate impairment. Conclusion: Our findings suggest that the majority of residents experience terminal change, with the exception of those at already high levels of impairment. Furthermore, late-life cognitive change is related to functional and mental health.

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Psychometric Limitations of the Mini-Mental State Examination Among Nondemented Older Adults: An Evaluation of Neurocognitive and Magnetic Resonance Imaging Correlates

Cited by 137 publications

References 17 publications

Healthy eating and reduced risk of cognitive decline

Healthy eating and reduced risk of cognitive decline

The assessment of cognitive impairment suspected of dementia in Polish elderly people: results of the population-based PolSenior Study

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

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