Limitations of the mini-mental state examination in diagnosingdementia in general practice
A.W. Wind
Bok Engelsk 1997
| Utgitt | 1997
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| Omfang | Side 101- 108
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| Opplysninger | The aim of the study was to investigate the value of the Mini-MentalState Examination (MMSE) for use by general practitioners (GPs) in agroup of elderly patients in whom the GPs are considering a dementiadiagnosis, The study population consisted of 533 elderly patients(aged 65 and older) judged by 36 GPs as suffering from 'minimal tosevere' dementia. Cross-sectional data were used to determine thecriterion validity of separate items, a set of items and the totalMMSE, The GMS/AGECAT diagnosis was used as an external criterion.MMSE items were analysed and two items testing general knowledge wereadded. The most effective set of items was determined using astepwise logistic regression analysis. Adjusted for age, sex andeducation, the differentiating ability of the set of items wascompared to that of the total MMSE score. The total MMSE score wasdivided into three categories (cutoffs 21/22 and 26/27) and into twocategories (cutoff 23/24). In total, 114 patients (21%) werediagnosed as having an 'organic syndrome' by the GMS/AGECAT. Thedifferentiating ability of separate items was poor, The followingcombination of items had the best predictive ability: itemsconcerning the date, the day of the week, the patient's address andthe current prime minister. This set of items was just as adequate indifferentiating dementia from non-dementia as the total MMSE score(sensitivity 64.9% and 64.8% respectively, specificity 96.4% and93.3%), The value of the MMSE in diagnosing dementia in generalpractice is limited. The score on cognitive test items can be oneaspect of the individual's overall clinical picture, on which thediagnosis should be based.
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