Mapping Scores Onto Stages: Mini-Mental State Examination and Clinical Dementia Rating
Abstract
Objective Although the clinical course of Alzheimer disease (AD) is gradual, it is useful for a number of reasons to distinguish between different levels of severity. The Clinical Dementia Rating (CDR) has demonstrated high validity and reliability for this purpose, but it requires a considerable amount of data to be collected both from the patient and from an informant. In the present study, the authors mapped Mini-Mental State Examination (MMSE) scores onto CDR categories to determine how well the MMSE performs as a surrogate of the CDR as a timesaving method of staging dementia.Method Eight hundred sixty-three probands, including 524 patients with probable AD, 92 patients with questionable dementia, and 247 with memory complaints but no objective cognitive impairment, were included. Cutoff scores were identified on one-half of the sample using a receiver operating characteristic analysis. The cutoff values were then applied to the other half of the sample, and the agreement between MMSE score ranges and CDR stages was determined by calculating Cohen's kappa.Results The MMSE discriminated well between CDR stages 0.5, 1, 2, and 3 but performed poorly in the separation between CDR stages zero and 0.5. The MMSE ranges were 30 for no, 26-29 for questionable, 21-25 for mild, 11-20 for moderate, and 0-10 for severe dementia. Substantial agreement between the two instruments was obtained for the categories mild (kappa=0.62, p<0.001, N=115), moderate (kappa=0.69, p<0.001, N=114), and severe dementia (kappa=0.76, p<0.001, N=39), whereas the agreement was moderate for no (kappa=0.44, p<0.001, N=120) and only fair for questionable dementia (kappa=0.28, p<0.001, N=42).Conclusion The MMSE can be used as a surrogate measure for the CDR for the staging of dementia in AD.
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Previous studies have shown a strong correspondence between CDR scores and MMSE.
“Previous studies have shown a strong correspondence between CDR scores and MMSE (39), and therefore, MMSE would serve as a similar measure of dementia severity.”
From Molecular subtyping of Alzheimer’s disease using RNA sequencing data reveals novel mechanisms and targets (2021) · cites this paper as [39]
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- Authors
- Perneczky, R., Wagenpfeil, S., Komossa, K., Grimmer, T., Diehl, J., & Kurz, A.
- Affiliations
- Technical University of Munich (DE)
- Corresponding author
- Perneczky, Robert
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2006-02
- Volume
- 14
- Issue
- 2
- Pages
- 139-144
- ISSN
- 1064-7481 (ISSN-L)
- OpenAlex
- W2075819229
- Cited by
- 768
- References
- 23
- Citations by year
- 2026: 51 · 2025: 50 · 2024: 68 · 2023: 62 · 2022: 69 · 2021: 58 · 2020: 98 · 2019: 40 · 2018: 45 · 2017: 37 · 2016: 36 · 2015: 29 · 2014: 19 · 2013: 17 · 2012: 9
- FWCI
- 10.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- Alzheimer's disease, dementia staging, Mini-Mental State Examination, Clinical Dementia Rating, cut-off values, surrogate measures, informant assessment, cognitive impairment severity, interobserver agreement
- MeSH terms
- Aged, Alzheimer Disease, Diagnosis, Differential, Female, Humans, Male, Neuropsychological Tests, Severity of Illness Index
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