Validation of a Telephone Version of the Mini‐Mental State Examination

Abstract

Objective: To assess the construct validity of a telephone‐administered version of the Mini‐Mental State Examination (MMSE). Design: Validity testing by comparing a telephone version of the MMSE administered first to a face‐to‐face evaluation done several days later. Setting: Outpatient geriatric assessment center. Subjects: 100 of 175 consecutive referrals. Main Outcome Measures: MMSE and a brief neuropsychological screening test (BNPS) face‐to‐face and a telephone version of the MMSE as part of the Adult Lifestyles and Function Interview (ALFI‐MMSE). Results: Test scores of the two MMSE versions correlated strongly for all subjects (Pearson's r = 0.85, P = 0.001) and remained significant for the cognitively intact ( P = 0.02) and questionably ( P = 0.002), mildly ( P = 0.0001), and moderately ( P = 0.003) demented. Comparison of the two versions' equivalent 22 items revealed no significant difference for scores of all subjects ( P = 0.07) but with a trend toward higher scores in the original version. Diminished hearing, reported either by the subject ( P = 0.003) or by the collateral source ( P = 0.02) was associated with lower scores on the telephone version. Five individual test items were biased by the route of test administration. Sensitivity and specificity relative to the BNPS were 67% and 100% for the ALFI‐MMSE and 68% and 100% for the MMSE, respectively. Conclusion: The scores on the ALFI‐MMSE correlated strongly with the scores of the original version given face‐to‐face in subjects undergoing geriatric assessment. The results indicate that the ALFI‐MMSE could be a useful and economical tool to screen for cognitive impairment.