A longitudinal population study of the mini-mental state examination in the very old: relation to dementia and education
Abstract
We examined the Mini-Mental State Examination (MMSE) in relation to the prevalence and incidence of dementia in a representative population sample (n = 494), followed from age 85 to 88. The study included a neuropsychiatric examination (including the MMSE) and a key informant interview conducted by a psychiatrist. Dementia was defined according to the DSM-III-R. Among non-demented 85-year-olds, 75% of those who scored below the cut-off score of 23/24 and 37% of those scoring 24-25 became demented during the follow-up. Non-demented 85-year-olds who did not develop dementia during the following 3 years had a mean decline in MMSE score of 0.6 per year, while those who became demented decreased by 2.3 points per year. A decrease of 4 or more points during the 3 years had a sensitivity of 83% and a specificity of 80% for a diagnosis of dementia. High and low MMSE score at base-line was related to a smaller decrease in MMSE score between age 85 and 88. Higher education was related to higher scores on MMSE at age 85 and to a smaller decline in scores between age 85 and 88. Change in MMSE score in non-demented individuals is small especially among individuals with high education. Non-demented individuals scoring below 26 should receive close attention, as a high proportion are at risk of developing dementia.
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The MMSE has excellent reproducibility that lends itself well to longitudinal use in tracking progression of cognitive impairments associated with AD.
“The MMSE has excellent reproducibility that lends itself well to longitudinal use in tracking the progression of the cognitive impairments associated with AD (Jacqmin-Gadda et al., 1997; Aevarsson and Skoog, 2000; Chatfield et al., 2007).”
From Using mice to model Alzheimer's dementia: an overview of the clinical disease and the preclinical behavioral changes in 10 mouse models (2014) · cites this paper as Aevarsson and Skoog, 2000
Cites
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · see citing works
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. M. (1984) · Neurology · doi:10.1212/wnl.34.7.939 · Cited by 27,915 · see citing works
Statistical Methods for Rates and Proportions
Fleiss, J. L., Levin, B., & Paik, M. C. (2003) · Wiley Series in Probability and Statistics · doi:10.1002/0471445428 · Cited by 18,646 · see citing works
The Mini‐Mental State Examination: A Comprehensive Review
Tombaugh, T. N., & McIntyre, N. J. (1992) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1992.tb01992.x · Cited by 5,152 · see citing works
Population-Based Norms for the Mini-Mental State Examination by Age and Educational Level
Crum, R. M. (1993) · JAMA · doi:10.1001/jama.1993.03500180078038 · Cited by 2,906 · see citing works
Statistical Methods for Rates and Proportions.
D., F. N., & Fleiss, J. L. (1973) · Biometrics · doi:10.2307/2529186 · Cited by 1,394 · see citing works
Anthony, J. C., LeResche, L., Niaz, U., Korff, M. R. V., & Folstein, M. F. (1982) · Psychological Medicine · doi:10.1017/s0033291700046730 · Cited by 1,105 · see citing works
Ott, A., Breteler, M. M. B., van Harskamp, F., Claus, J. J., van der Cammen, T. J. M., Grobbee, D. E., & Hofman, A. (1995) · BMJ · doi:10.1136/bmj.310.6985.970 · Cited by 792 · see citing works
A Population-Based Study of Dementia in 85-Year-Olds
Skoog, I. G., Nilsson, L., Palmertz, B., Andreasson, L., & Svanborg, A. (1993) · New England Journal of Medicine · doi:10.1056/nejm199301213280301 · Cited by 692 · see citing works
Self-citationFratiglioni, L., Viitanen, M., von Strauss, E., Tontodonati, V., Herlitz, A., & Winblad, B. (1997) · Neurology · doi:10.1212/wnl.48.1.132 · Cited by 556 · see citing works
Morris, J. C., Edland, S., Clark, C., Galasko, D., Koss, E., Mohs, R., van Belle, G., Fillenbaum, G., & Heyman, A. (1993) · Neurology · doi:10.1212/wnl.43.12.2457 · Cited by 441 · see citing works
Kay, D. W. K., Henderson, A. S., Scott, R., Wilson, J., Rickwood, D., & Grayson, D. A. (1985) · Psychological Medicine · doi:10.1017/s0033291700005006 · Cited by 333 · see citing works
Seventy‐year‐old People in Gothenburg A Population Study in an Industrialized Swedish City
Rinder, L., Roupe, S., Steen, B., & Svanborg, A. (1975) · Acta Medica Scandinavica · doi:10.1111/j.0954-6820.1975.tb19563.x · Cited by 320 · see citing works
Level of education and change in cognitive function in a community population of older persons
Evans, D. A., Beckett, L. A., Albert, M., Hebert, L. E., Scherr, P. A., Funkenstein, H. H., & Taylor, J. O. (1993) · Annals of Epidemiology · doi:10.1016/1047-2797(93)90012-s · Cited by 312 · see citing works
A 5-year longitudinal study of the Mini-Mental State Examination in normal aging.
Jacqmin-Gadda, H., Fabrigoule, C., Commenges, D., & Dartigues, J. (1997) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009137 · Cited by 293 · see citing works
The influence of education, social class and sex on Mini-Mental State scores
O’Connor, D., Pollitt, P. A., Treasure, P., Brook, C. P. B., & Reiss, B. B. (1989) · Psychological Medicine · doi:10.1017/s0033291700024375 · Cited by 242 · see citing works
Erkinjuntti, T., Haltia, M., Palo, J., Sulkava, R. O., & Paetau, A. E. (1988) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.51.8.1037 · Cited by 229 · see citing works
Education and change in cognitive function
Farmer, M. E., Kittner, S. J., Rae, D. S., Bartko, J. J., & Regier, D. A. (1995) · Annals of Epidemiology · doi:10.1016/1047-2797(94)00047-w · Cited by 200 · see citing works
Brækhus, A., Laake, K., & Engedal, K. (1992) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1992.tb01804.x · Cited by 188 · see citing works
Grut, M., Fratiglioni, L., Viitanen, M. H., & Winblad, B. G. (1993) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.1993.tb05514.x · Cited by 166 · see citing works
Butler, S. M., Ashford, J. W., & Snowdon, D. A. (1996) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1996.tb01831.x · Cited by 154 · see citing works
A Course in Theortical Statistics.
Blackmor, R. W., & Rahman, N. A. (1970) · Journal of the Royal Statistical Society Series D (The Statistician) · doi:10.2307/2987374 · Cited by 153 · see citing works
Launer, L. J., Dinkgreve, M. A. H. M., Jonker, C., Hooijer, C., & Lindeboom, J. (1993) · Journal of Gerontology · doi:10.1093/geronj/48.6.p271 · Cited by 152 · see citing works
Agüero‐Torres, H., Fratiglioni, L., Guo, Z., Viitanen, M., & Winblad, B. (1998) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1998.tb02464.x · Cited by 147 · see citing works
The gerontological and geriatric population studies in Gothenburg, Sweden.
Steen, B., & Djurfeldt, H. (1993) · PubMed · Cited by 146 · see citing works
Predicting Performance on the Mini‐Mental State Examination
Magaziner, J. S., Bassett, S. S., & Rebel, J. R. (1987) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1987.tb04002.x · Cited by 146 · see citing works
Progression of Cognitive Impairment in Alzheimer's Disease
Burns, A. S., Jacoby, R. J., & Levy, R. (1991) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1991.tb05904.x · Cited by 140 · see citing works
Cognitive decline in an elderly population – a two wave study of change
Brayne, C., Gill, C., Paykel, E., Huppert, F., & O'Connor, D. T. (1995) · Psychological Medicine · doi:10.1017/s0033291700034930 · Cited by 127 · see citing works
A Population‐Based Study on the Incidence of Dementia Disorders Between 85 and 88 Years of Age
Aevarsson, Ó., & Skoog, I. G. (1996) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1996.tb04070.x · Cited by 105 · see citing works
Self-citationReischies, F. M., & Geiselmann, B. (1997) · The British Journal of Psychiatry · doi:10.1192/bjp.171.5.449 · Cited by 101 · see citing works
Ylikoski, R., Erkinjuntti, T., Sulkava, R. O., Juva, K., Tilvis, R. S., & Valvanne, J. (2009) · Acta Neurologica Scandinavica · doi:10.1111/j.1600-0404.1992.tb06034.x · Cited by 90 · see citing works
Fratiglioni, L., Jorm, A. F., Grut, M., et al. (1993) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(93)90076-d · Cited by 78 · see citing works
Brækhus, A., Laake, K., & Engedal, K. (1995) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1995.tb07201.x · Cited by 72 · see citing works
Age-associated cognitive decline in healthy old people
Starr, J. M., Deary, I. J., Inch, S., Cross, S., & MACLENNAN, W. J. (1997) · Age and Ageing · doi:10.1093/ageing/26.4.295 · Cited by 69 · see citing works
The screening of cognitive impairment in the elderly: A critical review of current methods
Ritchie, K. A. (1988) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(88)90115-1 · Cited by 46 · see citing works
Psychological functioning in 70- and 75-year-old people. A study in an industrialized city.
Berg, S. (1980) · PubMed · Cited by 43 · see citing works
Three-year follow-up of Mini-Mental State Examination score in community residents aged 85 and over
Izaks, G. J., Gussekloo, J., Dermout, K. M. T., Heeren, T. J., & Ligthart, G. J. (1995) · Psychological Medicine · doi:10.1017/s0033291700035091 · Cited by 36 · see citing works
Cognitive Stability over 2 Years in a Rural Elderly Population: The MoVIES Project
Ganguli, M., Seaberg, E. C., Ratcliff, G. G., Belle, S. H., & DeKosky, S. T. (1995) · Neuroepidemiology · doi:10.1159/000109888 · Cited by 28 · see citing works
Effects of Sequential Neuropsychological Testing of an Elderly Community-Based Sample
Frank, R. I., Wiederholt, W. C., Kritz‐Silverstein, D. C., et al. (1996) · Neuroepidemiology · doi:10.1159/000109915 · Cited by 26 · see citing works
Aevarsson, Ó., & Skoog, I. G. (1997) · International Psychogeriatrics · doi:10.1017/s104161029700416x · Cited by 21 · see citing works
Self-citationLiu, I. Y., & Anthony, J. C. (1989) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115350 · Cited by 13 · see citing works
Christensen (1997) · doi:10.1002/(sici)1099-1166(199703)12:3
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Webster, S. J., Bachstetter, A. D., Nelson, P. T., Schmitt, F. A., & Van Eldik, L. J. (2014) · Frontiers in Genetics · doi:10.3389/fgene.2014.00088 · Cited by 755 · see citing works
“The MMSE has excellent reproducibility that lends itself well to longitudinal use in tracking the progression of the cognitive impairments associated with AD (Jacqmin-Gadda et al., 1997; Aevarsson and Skoog, 2000; Chatfield et al., 2007).”
MethodBeydoun, M. A., Beydoun, H. A., Gamaldo, A. A., Teel, A., Zonderman, A. B., & Wang, Y. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-643 · Cited by 671 · see citing works
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Sindi, S., Kåreholt, I., Johansson, L., Skoog, J., Sjöberg, L., Wang, H., Johansson, B., Fratiglioni, L., Soininen, H., Solomon, A., et al. (2018) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2018.05.012 · Cited by 144 · see citing works
Self-citation
- Authors
- Aevarsson, Ó., & Skoog, I.
- Affiliations
- Sahlgrenska University Hospital (SE)
- ORCID
- Skoog, Ingmar
- Venue
- Dementia and Geriatric Cognitive Disorders
- Publisher
- S. Karger AG
- Published
- 2000
- Volume
- 11
- Issue
- 3
- Pages
- 166-175
- ISSN
- 1420-8008 (ISSN-L)
- 1421-9824
- OpenAlex
- W1999516133
- Cited by
- 94
- References
- 42
- Citations by year
- 2025: 2 · 2023: 1 · 2022: 5 · 2021: 5 · 2020: 1 · 2019: 4 · 2018: 1 · 2017: 1 · 2016: 3 · 2015: 6 · 2014: 9 · 2013: 5 · 2012: 4
- FWCI
- 1.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Dementia and Geriatric Cognitive Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- Mini-Mental State Examination, dementia, oldest old, cognitive decline, educational attainment, dementia screening, dementia incidence, cognitive assessment, older adults
- MeSH terms
- Aged, Aged, 80 and over, Catchment Area, Health, Cognition Disorders, Dementia, Educational Status, Follow-Up Studies, Humans, Male, Neuropsychological Tests, Population Surveillance, Sweden, Prevalence
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