THE SLOVENE VERSION OF MINI MENTAL STATE EXAMINATION – STANDARDIZATION ON VOLUNTEERS FROM 55 TO 75 YEARS OLD (I)
Background. The incidence of dementia is growing due to the aging of the population. Active search for the population at risk is necessary. Short cognitive screening tests are one of the most suitable ways of doing that. The most often used test of this kind is Mini Mental State Examination (MMSE). Its distinctive features are simplicity and shortness. Kratek preizkus spoznavnih sposobnosti (KPSS) – Slovenian version of MMSE has been used in Slovenia since 1984, although there were no normative values for Slovenian population, which restricted its applicability and use in clinical practice. The aim of the present paper was to obtain the normative values for KPSS for different age and educational groups in population of adults older than 55 years. Our hypothesis was that test results would be significantly dependent on age and education which will justify the extensive nature of the study.
Methods. Some parts of the test were modified based on clinical experience in last years. The modified KPSS was used for testing at general practices in Ljubljana, Maribor and Novo mesto. The research comprised of KPSS testing in 154 volunteers, mean age 65.1 (ranged from 55 to 87 years). None of them had a diagnosis of dementia or other active psychiatric or neurologic ilness.
Results. We found that KPSS results are not influenced by gender. The volunteers were aranged in four age groups at five years intervals. Statistically significant differences (p < 0.0002) for the mean results among different age groups were found. The volunteers were further divided in groups according to the level of education and the differences in mean results among the educational groups were statistically significant (p < 0.0000). Normative values for the age and education groups were obtained.
Conclusions. The main result of our study are KPSS normative values for different age and education groups of Slovenians. The mean results on KPSS are significantlly dependent on age and education. The differences in mean results among the groups clearly show the normative values should be considered when interpreting the results in clinical practice.
Vodušek DB. Višja živčna dejavnost. Med Razgl 1992; 31: 369–400.
Folstein MF, Folstein SE, McHugh PA. »Mini Mental State.« A practical method for grading the cognitive state of patients for clinician. J Psihiatr Res 1975; 12 (3): 189–98.
Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968; 114: 797–811.
Katzman R, Brown T, Fuld P et al. Validation of a short Orientation – memory – concentration test of cognitive impairment. Am J Psychiatry 1983; 140: 734–9.
Jacobs J, Bernhard A, Strain JJ. Screening for organic mental syndromes in medically ill. Ann Intern Med 1977; 86: 40–6.
Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain defects in elderly patients. J Am Geriatr Soc 1975; 23: 433–41.
Saxton J, McGonigle K, Swihart A et al. Assessment of the severely impaired patient: description and validation of a new neuropsychological test battery. J Consult Clin Psycho 1992; 3: 298–303.
Rosen WG. A new rating scale for Alzheimer’s disease. Am J Psychiatry 1984; 4: 1356–464.
Kiernan RJ, Mueller J, Langston JW et al. The neurobehavioral cognitive status examination: A brief but differentiated approach to cognitive assessment. Ann Intern Med 1987; 107: 481–5.
Mitrushina M, Fuld PA. Cognitive screening methods. In: Grant I, Adams KM eds. Neuropsychological assessment of neuropsychiatric disorders. 2nd ed. New York: Oxford University Press, 1996: 118–31.
Knights EB, Folstein MF. Unsuspected emotional and cognitive disturbance in medical patients. Ann Intern Med 1977; 87: 723–4.
Folstein MF, McHugh PR. Psychopathology of dementia: implications for neuropathology. In: Katzman R ed. Congenital and acquired cognitive disorders. New York: Raven Press, 1982: 17–30.
Tsai L, Tsuang MT. The Mini-Mental State Test and computerized tomography. Am J Psychiatry 1979; 136: 436–9.
Eaton W, Reiger W, Locke DA et al. The Epidemiologic Catchment Area Program of the National Institute of Mental Health. Public Health Rep 1981; 96: 319–22.
Longstreth Jr. WT, Manolio TA, Arnold A et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The cardiovascular health study. Stroke 1996; 27: 1274–82.
De Groot JC, de Leeuw FE, Oudkerk M, van Gijn J, Hofman A, Jolles J. Cerebral white matter lesions and cognitive function: the Rotterdam scan study. Ann Neurol 2000; 47: 145–51.
Matsubayashi K, Shimada K, Kawamoto A, Ozawa T. Incidental brain lesions on Magnetic Resonance. Imaging and neurobehavioral functions in the apparently healthy elderly. Stroke 1992; 23: 175–80.
Kawano M, Ichimiya A, Ogomori K et al. Relationship between both IQ and Mini-Mental State Examination and the regional cerebral glucose metabolism in clinically diagnosed Alzheimer’s Disease: a PET Study. Dement Geriatr Cogn Disord 2001; 12: 171–6.
De Kosky ST, Shih WJ, Schmitt FA et al. Accessing utility of single photon emission computed tomography (SPECT) scan in Alzheimer’s disease: Correlation with cognitive severity. Alz Dis Assoc Disord 1990; 4: 14–23.
Schneider LS. An overview of rating scales used in dementia research. Alzheimer Insights 1996; 2 (3): 1–7.
Meyer A. Outlines of examinations. New York: Bloomingdale Hospital Press, 1918.
Mortimer AJ, Graves AB. Education and other socioeconomic determinants of dementia and Alzheimer’s disease. Neurology 1993; 43: Suppl 4: 39B–44B.
Anthony JC, Le Resche L, Folstein MF et al. Limits of the ˝Mini Mental State˝ as a screening test for dementia and delirium among hospital patients. Psychol Med 1982; 12: 397–408.
Riat G. Screening for depression and cognitive impairment in older people from ethnic minorities. Age Ageing 1998; 27: 271–5.
Jensterle J. Mini Mental Status. Priredba MMS. Interno gradivo Psihiatrične klinike Ljubljana, 1984.
Janko M ed. Klinična nevrološka preiskava, 3. izdaja. Ljubljana: Medicinski Razgledi, 1996: 1–136.
Jensterle J, Mlakar J, Vodušek DB. Uporaba Kratkega preizkusa spoznavnih sposobnosti pri ocenjevanju demenc. Zdrav Vestn 1996; 65: 577–82.
Kogoj A. Organske duševne motnje. In: Tomori M, Ziherl S. Psihiatrija. Ljubljana: Litterapicta, Medicinska fakulteta, 1999: 101–35.
Jensterle J, Mlakar J, Vodušek DB. Dodatek k članku »Uporaba Kratkega preizkusa spoznavnih sposobnosti« pri ocenjevanju demenc. Zdrav Vestn 2000; 69: 111–2.
Lezak MD. Neuropsychological assessment. 3rd ed. New York: Oxford University Press, 1995: 288–300.
Jones RN, Gallo JJ. Education bias in the Mini-Mental State Examination. Int Psychogeriatr 2001; 13 (3): 299–310.
Tombaugh TN, McIntyre NJ. The Mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992; 40 (9): 922–35.
Katzman R, Kawas C. The epidemiology of dementia and Alzheimer disease. In: Terry RD, Katzman R, Bick KL eds. Alzheimer Disease. New York: Raven Press, 1994: 105–22.
Jorm AF, Jolley MS. The incidence of dementia, a meta-analysis. Neurology 1998; 51: 728–33.
Bleecker ML, Bolla-Wilson K, Kawas C, Agnew J. Age-specific norms for the Mini-Mental State Exam. Neurology 1988; 38 (10): 1565–8.
Howieson DB, Holm LA, Kaye JA, Oken BS, Howieson J. Neurologic function in the optimally healthy oldest old: Neuropsychological evaluation. Neurology 1993; 43: 1882–6.
Morse CK. Does variability increase with age? An archival study of cognitive measures. Psychol Aging 1993; 8: 156–64.
Collie A, Maruff P, Shafiq-Antonacci R et al. Memory decline in healthy older people. Implications for identifying mild cognitive impairment. Neurology 2001; 56: 1533–8.
Murden RA, McRae RD, Kaner S et al. Mini-Mental State Exam. scores vary with education in blacks and whites. J Am Geriatr Soc 1991; 39: 149–55.
Fillenbaum GG, Hughes DC, Heyman A et al. Relationship of health and demographic characteristics to Mini-Mental State Examination score among community residents. Psychol Med 1988; 18: 719–26.
Ganguli M, Ratcliff G, Huff FJ. Effects of age, gender and education on cognitive tests in a rural elderly community: norms from Monongahela Valley Independent Elders Survey. Neuroepidemiology 1991; 10: 42–52.
Rasmussen DX, Carson KA, Brookmeyer R et al. Predicting rate of cognitive decline in probable Alzheimer disease. Brain Cogn 1996; 31: 133–47.
Scherr PA, Albert MS, Funkenstein NH et al. Correlates of cognitive function in an elderly community population. Am J Epidemiol 1988; 128: 1084–101.
Marra C, Silveri MC, Gainotti. Predictors of cognitive decline in the early stage of probable Alzheimer’s disease. Dement Geriatr Cogn Disord 2000; 11: 212–8.
Mescobar JI, Burnam A, Karno M et al. Use of the Mini-Mental State Examination in a community population of mixed ethnicity. Cultural and linguistic artifacts. J Nerv Ment Dis 1986; 174: 607–14.
Bondi MW, Salmon DP, Kaszniak AW. The neuropsychology of dementia. In: Grant I, Adams KM eds. Neuropsychological assessment of neuropsychiatric disorders. 2nd ed. New York: Oxford University Press, 1996: 118–38.
O’Connor DW, Politt PA, Hyde JB et al. The reliability and validity of the Mini Mental State in a British community survey. J Psychiatr Res 1989; 23: 87–96.
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