Cochrane for Clinicians
Putting Evidence into Practice
Mini-Mental State Examination for the Detection of Dementia in Older Patients
Am Fam Physician. 2016 Dec 1;94(11):880-881.
Author disclosure: No relevant financial affiliations.
Is the Mini-Mental State Examination (MMSE) useful in detecting dementia in clinically unevaluated patients 65 years and older?
When scores are adjusted based on a patient's education level, the MMSE may be useful to rule out a diagnosis of dementia in clinically unevaluated patients 65 years and older (sensitivity = 97%; specificity = 70%). Scores of less than 24 may also be useful to rule in dementia in patients 65 years and older (sensitivity = 85%; specificity = 90%). These patients warrant further evaluation. There is insufficient evidence to recommend a specific score on the MMSE to confidently rule out or rule in dementia in patients 65 years and older.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)
Although the estimated prevalence of dementia ranges from 5% to 37% in U.S. adults older than 70 years, as many as 29% to 76% may go undiagnosed by their primary care physicians.2 The MMSE is a 30-point scale, with lower numbers equating to more severe impairment. It was originally used to characterize the severity of cognitive impairment and to monitor that severity over time.3 However, the MMSE and similar tests of cognition are also used in primary care as part of the initial evaluation of patients with suspected dementia.4
This Cochrane review is a meta-analysis of 28 community-based studies with 12,110 patients and six primary care studies with 1,681 patients.1 Community-based studies conducted mass screening of asymptomatic persons in a public-health format. All the patients in the studies were 65 years and older.
In the community-based studies, a score of less than 24 on the MMSE was 85% sensitive (95% confidence interval [CI], 74% to 92%) and 90% specific (95% CI, 82% to 95%) for dementia. Adjusting the score for education level yielded a higher sensitivity of 97% (95% CI, 83% to 100%) but a lower specificity of 70% (95% CI, 50% to 85%). When screening
REFERENCESshow all references
1. Creavin ST, Wisniewski S, Noel-Storr AH, et al. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016;(1):CD011145....
2. Lin JS, O’Connor E, Rossom R, et al. Screening for Cognitive Impairment in Older Adults: An Evidence Update for the U.S. Preventive Services Task Force. Evidence report no. 107. AHRQ publication no. 14-05198-EF-1. Rockville, Md.: Agency for Healthcare Research and Quality; 2013.
3. Tombaugh TN, McIntyre NJ. The Mini-Mental State Examination: a comprehensive review. J Am Geriatr Soc. 1992;40(9):922–935.
4. Galvin JE, Sadowsky CH; National Institute of Neurological, Communicative Disorders and Stroke–Alzheimer Disease and Related Disorders Association. Practical guidelines for the recognition and diagnosis of dementia. J Am Board Fam Med. 2012;25(3):367–382.
5. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699.
6. Neurocognitive disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dx.doi.org/10.1176/appi.books.9780890425596.dsm17. Accessed March 30, 2016.
7. Cordell CB, Borson S, Boustani M, et al.; Medicare Detection of Cognitive Impairment Workgroup. Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimers Dement. 2013;9(2):141–150.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.
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