Title : Factors other than dementia affecting performance in mini-mental state examination in elderly: Home health care based study
Abstract:
Subjects & Methods: A cross sectional study was conducted on 240 elderly patients aged ≥ 60years both males and females who were included in home health care program in Aseer central hospital, south Saudi Arabia . All participants underwent comprehensive geriatric assessment, mental status assessment using validated Arabic version of Mini mental status examination ,assessment of various comorbidities ,functional status and depression assessment using geriatric depression scale.
Results: The study sample included 240elderly,50%males and 50% females. Mean age of subjects was73.8(±5.1) years. Out of 240,60 patients scored <24 in MMSE assessment,40 (16.6%)of them had difficulties in completing one or more item of MMSE,24 were males and 16 were females. Percent of those who had difficulties increased with increasing age, highest percent was in the age group >80 years of age. The most common cause of inability to complete one or more items in MMSE among both males and females was manual disability as a consequence of neurological disease mostly in stroke patients and Parkinson disease followed by low educational level then visual and hearing impairment followed by other causes as aphasia, depression and psychosis.78% of persons with poor test performance due to causes other than dementia were unable to complete the writing of a sentence, and(75%) could not draw pentagons.(62%) did not complete the reading and repetition test item and(55%) could not complete calculations.
Conclusion: Mini-mental status protocol should contain components in which the heath care practitioner can report potential confounding factors which can lead to poor performance and false positive screening results of the test.
Audience Take Away Notes:
- The mini-mental status examination (MMSE) is a widely used assessment instrument designed toscreen the cognitive impairments seen in a variety of dementia conditions, especially Alzheimer dementia.
- Visual impairment, functional disability, very old age and lack of manual dexterity are also associated with lower MMSE scores and expose it to bias (7,8).
- It is recommended that mini-mental assessment protocol should contain components in which the heath care practitioner can report potential factors which can lead to poor performance and false positive screening results
- It is essential to consider confounding factors carefully, especially in very old individuals. This will be of interest not only to those who evaluate the patients for dementia, but also those who use the MMSE in research or who develop assessment tools.
