Detecting dementia with the mini-mental state examination in highly educated individuals

Objective: To evaluate the utility of Mini-Mental State Examination ( MMSE) scores in detecting cognitive dysfunction in a sample of highly educated individuals. Design: Archival data were reviewed on 4248 participants enrolled in the Mayo Clinic Alzheimer Disease Research Center and Alzheimer Disease Patient Registry. Patients: A total of 1141 primarily white ( 93%) individuals with 16 or more years of self- reported education were identified. These included 307 ( 164 men and 143 women) patients with dementia ( any type), 176 ( 106 men and 70 women) patients with mild cognitive impairment, and 658 ( 242 men and 416 women) control participants without dementia. Setting: Mayo Clinic Alzheimer Disease Research Center and Alzheimer Disease Patient Registry cohort. Main Outcome Measures: Diagnostic accuracy estimates ( sensitivity, specificity, and positive and negative predictive power) of MMSE cut scores in detecting cognitive dysfunction. Results: In this sample of highly educated, largely white older adults, the standard MMSE cut score of 24 ( 23 or below) yielded a sensitivity of 0.66, a specificity of 0.99, and an overall correct classification rate of 89% in detecting dementia. A cut score of up to 27 ( 26 or below) resulted in an optimal balance of sensitivity and specificity ( 0.89 and 0.91, respectively) with an overall correct classification rate of 90%. In a cognitively impaired group ( dementia and mild cognitive impairment), a cut score of 27 ( sensitivity, 0.69; specificity, 0.91) or 28 ( sensitivity and specificity, 0.78) might be more appropriate. Conclusion: Older patients with a college education who present with complaints of cognitive decline ( reported by themselves or others) and score less than 27 on theMMSE are at a greater risk of being diagnosed with dementia and should be referred for a comprehensive dementia evaluation, including formal neuropsychological testing.