Revised Mental Exam Cut Score May Benefit Well-Educated

Mini-Mental State Examination cut score of 27 offers better balance of specificity, sensitivity for dementia than traditional score of 24
By Eric Metcalf
HealthDay Reporter

TUESDAY, July 15 (HealthDay News) -- A cut score of 27 on the Mini-Mental State Examination (MMSE) may be more useful in identifying dementia in older patients with a college education than the traditional cut score of 24, according to research published in the July issue of the Archives of Neurology.

Sid E. O'Bryant, Ph.D., of the Texas Tech University Health Science Center in Lubbock, Texas, and colleagues reviewed data from 1,141 subjects who reported at least 16 years of education, who were comprehensively evaluated due to memory concerns. Of these, 307 were diagnosed with dementia, 658 were found to be free of dementia, and 176 had mild cognitive impairment.

The traditional MMSE cut score of 24 gave a specificity of 0.99, a sensitivity of 0.66, and an overall correct classification rate of 88.9 percent, the researchers report. However, 104 patients with dementia in the sample were incorrectly classified as not having dementia. A cut score of 27 yielded a better balance with a specificity of 0.91 and a sensitivity of 0.89, which would identify 70 of the 104 who were missed using the standard cutoff, the report indicates.

"Educational attainment is often considered a manifestation of cognitive reserve," the authors write. "Individuals with greater cognitive reserve are believed to maintain higher levels of cognitive functioning in the early stages of degenerative dementia. By the time cognitive symptoms are first identified, these patients are believed to have significantly greater disease burden and faster subsequent decline. Identifying such individuals at an earlier stage of disease development and progression is desirable for both treatment and research purposes."

A study co-author disclosed relationships with Elan, GE Healthcare, and Servier.

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