The mini-mental state examination: age and education distribution for a Latin American population

An Arabic Version of the Mini-Mental State Examination for the Lebanese Population: Reliability, Validity, and Normative Data

BACKGROUND

The Mini-Mental State Examination (MMSE) has not been validated in the Lebanese population and no normative data exist at the national level.

OBJECTIVE

To evaluate the reliability and validity of an Arabic version of MMSE developed by the "Groupe de Travail sur les Démences de l'Université Saint Joseph" (A-MMSE(GTD-USJ)) and to provide normative data by gender, age, and education in adults over 55.

METHODS

Study design: national cross-sectional survey.

STUDY POPULATION

1,010 literate community-dwelling Lebanese residents aged 55 and above.

OUTCOMES

reproducibility, internal consistency, sensitivity, specificity, predictive values, and area under the curve of the A-MMSE(GTD-USJ) for the detection of cognitive impairment using the Clinical Dementia Rating (CDR) as the gold standard. Normative data were established from 720 healthy adults. A-MMSE(GTD-USJ) scores corresponding to the 5th, 10th, 15th, and 50th percentiles were identified according to gender, age, and education.

RESULTS

Intra-rater and inter-rater test-retest score correlations were 0.89 and 0.72, respectively. Cronbach alpha coefficient for internal consistency of the A-MMSE(GTD-USJ) was 0.71. A threshold value of 23 provided a sensitivity of 80% and a specificity of 89.4%. The area under the curve was 0.92. A-MMSE(GTD-USJ) scores increased with education and decreased with age. Women had significantly lower scores than men. Normative data for A-MMSE(GTD-USJ) stratified by gender, age, and education were generated.

CONCLUSION

In reference to the CDR, the A-MMSE(GTD-USJ) is a valid tool to assess cognitive status among Lebanese subjects aged 55 and above. Normative data will help clinicians in detecting cognitive impairment in this population.

Correlation between Location of Brain Lesion and Cognitive Function and Findings of Videofluoroscopic Swallowing Study

Objective

To investigate whether patterns of swallowing difficulties were associated with the location of the brain lesion, cognitive function, and severity of stroke in stroke patients.

Method

Seventy-six patients with first-time acute stroke were included in the present investigation. Swallowing-related parameters, which were assessed videofluoroscopically, included impairment of lip closure, decreased tongue movement, amount of oral remnant, premature loss of food material, delay in oral transit time, laryngeal elevation, delay in pharyngeal triggering time, presence of penetration or aspiration, and the amount of vallecular and pyriform sinus remnants. The locations of brain lesions were classified into the frontal, parietotemporal, subcortical, medulla, pons, and cerebellum. The degree of cognitive impairment and the severity of stroke were assessed by the Mini Mental Status Examination (MMSE) and the National Institute of Health Stroke Scale (NIHSS), respectively.

Results

An insufficient laryngeal elevation, the amount of pyriform sinus, and vallecular space remnant in addition to the incidence of aspiration were correlated with medullary infarction. Other swallowing parameters were not related to lesion topology. Lip closure dysfunction, decreased tongue movement, increased oral remnant and premature loss were associated with low MMSE scores. A delayed oral transit time were associated with NIHSS scores.

Conclusion

In-coordination of the lip, the tongue, and the oropharynx were associated with the degree of cognitive impairment and the stroke severity rather than with the location of the lesion, whereas incomplete laryngeal elevation and aspiration were predominant in medullary lesions.

White matter microstructure changes in the thalamus in Parkinson disease with depression: A diffusion tensor MR imaging study

BACKGROUND AND PURPOSE

Depression occurs frequently in PD; however the neural basis of depression in PD remains unclear. The aim of this study was to characterize possible depression-related white matter microstructural changes in the thalamus of patients with DPD compared with those with NDPD.

MATERIALS AND METHODS

FA and MD maps from DTI were obtained in 14 patients with DPD and 18 patients with NDPD. Region-of-interest-guided VBA was conducted on the FA maps to detect possible microstructural differences in the thalamus between these 2 patient groups. Moreover, mean FA and MD in regions with a detected difference were compared between DPD and NDPD groups, and correlations between diffusion quantities and the severity of depression were analyzed.

RESULTS

White matter microstructure differences were found between the patients with DPD and NDPD in the bilateral mediodorsal thalamic regions. In these regions, patients with DPD showed significantly decreased FA values (P < .005) compared with patients with NDPD, and the mean values of FA were negatively correlated with the scores of depression severity (P < .05) for patients with PD. No significant differences of MD were found in the mediodorsal thalamus between these 2 groups.

CONCLUSIONS

Our results provide preliminary evidence that the mediodorsal thalamus may play an important role in depression in PD and suggest a relationship between FA in the mediodorsal thalamus and the presence of depressive symptoms in patients with DPD. These findings may be helpful for further understanding the potential mechanisms of depression in PD.

Normalisation du Mini-Mental State Examination (MMSE) chez les Québécois francophones âgés de 65 ans et plus et résidant dans la communauté

This study was aimed at providing normative data for the Mini-Mental State Examination (MMSE). The norms were built from a sample (n = 2409) of community-dwelling French speaking residents from Québec aged 65 and older. The analyses indicated that socio-demographic variables such as education level, age, and gender of individuals influenced significantly the scores of older adults on the MMSE. More precisely, MMSE scores increased with education level and decreased with age. Moreover, women had significantly higher scores than men. On this basis, distinct tables of normative data were produced for women and men. In each table, the MMSE scores corresponding to percentiles 5, 10, 15 and 50 were identified according to four age categories and three education levels. Overall, the use of the present normative data by clinicians will improve their accuracy in detecting cognitive impairment in older adults from Québec.

Cross-cultural comparisons of the Mini-mental State Examination between Japanese and U.S. cohorts

BACKGROUND

The Mini-mental State Examination (MMSE) is widely used in Japan and the U.S.A. for cognitive screening in the clinical setting and in epidemiological studies. A previous Japanese community study reported distributions of the MMSE total score very similar to that of the U.S.A.

METHODS

Data were obtained from the Monongahela Valley Independent Elder's Study (MoVIES), a representative sample of community-dwelling elderly people aged 65 and older living near Pittsburgh, U.S.A., and from the Tajiri Project, with similar aims in Tajiri, Japan. We examined item-by-item distributions of the MMSE between two cohorts, comparing (1) percentage of correct answers for each item within each cohort, and (2) relative difficulty of each item measured by Item Characteristic Curve analysis (ICC), which estimates log odds of obtaining a correct answer adjusted for the remaining MMSE items, demographic variables (age, gender, education) and interactions of demographic variables and cohort.

RESULTS

Median MMSE scores were very similar between the two samples within the same education groups. However, the relative difficulty of each item differed substantially between the two cohorts. Specifically, recall and auditory comprehension were easier for the Tajiri group, but reading comprehension and sentence construction were easier for the MoVIES group.

CONCLUSIONS

Our results reaffirm the importance of validation and examination of thresholds in each cohort to be studied when a common instrument is used as a dementia screening tool or for defining cognitive impairment.

Psychiatric epidemiology of the elderly population in Chile

OBJECTIVES

Little attention has been given to the prevalence rate of mental illness among elderly adults in Latin America. The prevalence rates for psychiatric disorders in Chile among those 65 and older compared with younger individuals, and the prevalence rate of psychiatric disorders among those age 75 and older are presented.

DESIGN

A stratified random sample of 2,659 individuals.

SETTING

Four provinces representative of the Chile's population were surveyed.

PARTICIPANTS

Adults age 15 and older were interviewed; however, the analysis is limited to those over age 20.

MEASUREMENTS

The Composite International Diagnostic Interview was administered to obtain Diagnostic and Statistical Manual of Mental Disorders, Third Edition-R diagnoses. Lifetime and 12-month prevalence rates were estimated.

RESULTS

Of the 2,659 interviewed 352 were over age 64. Overall, elderly adults had lower prevalence rates of lifetime disorders than the younger population, 20% in comparison with 34%. Dysthymia, agoraphobia, simple phobia, and alcohol dependence disorders were noted to be less common among elderly subjects. Those over the age of 64 in comparison with those over the age of 74 had higher prevalence rates of disorders. A sizable proportion of the disorders among older adults began after the age of 59. One third of elderly respondents with major depression had a late onset disorder. Service utilization was similar between elderly individuals and younger respondents, except for use of specialized psychiatric services, which was lower among elderly adults.

CONCLUSIONS

Both lifetime and 1-year prevalence of mental disorders were less common in older than in younger persons; however, among elderly adults late onset disorders were not uncommon. Additional studies of the prevalence rates of disorders among older individuals in Latin America are needed for public health planning.