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 Demences de l'Universite 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.