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A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
Published on: January 11, 2020
Clinical utility of the mini-mental status examination when assessing decision-making capacity
Arlin Pachet1, Kevin Astner, Lenora Brown
1Regional Capacity Assessment Team, Calgary, Alberta, Canada. arlin.pachet@calgaryhealthregion.ca
Abstract:
The main objectives of this study were to examine the relationship between cognitive deficits, as measured by the Mini-Mental Status Examination (MMSE), and decision-making capacity and to determine whether the sensitivity and specificity of the MMSE varied based upon the patient population assessed. Using a sample size of 152 patients and varying cutoff scores, the MMSE demonstrated extremely poor sensitivity. In contrast, the MMSE had excellent specificity when scores of 19 or less were obtained. In our sample, not one patient, regardless of diagnosis, was deemed to have capacity if their MMSE score was below 20. However, reliance on the MMSE for scores above 19 would too frequently lead to misclassification and incorrect assumptions about a patient's decision-making abilities. Although a score below 20 consistently yielded findings of incapability in our sample, it remains our opinion that the MMSE should not be used as a stand-alone tool to make determinations related to capacity, especially when considering the complexities associated with capacity evaluations and the vital areas, such as executive functioning and individual values and beliefs, which are omitted by the MMSE.
Insights
The Mini-Mental Status Examination (MMSE) poorly identifies decision-making capacity, especially with higher scores. While low scores indicate incapability, the MMSE is not a reliable standalone tool for capacity assessments.
Area of Science:
- Neuroscience
- Gerontology
- Psychiatry
Background:
- Cognitive deficits significantly impact decision-making capacity.
- Accurate assessment of capacity is crucial in clinical practice.
- The Mini-Mental Status Examination (MMSE) is a common cognitive screening tool.
Purpose of the Study:
- To evaluate the relationship between MMSE scores and decision-making capacity.
- To assess the sensitivity and specificity of the MMSE in diverse patient populations.
- To determine the MMSE's utility in capacity evaluations.
Main Methods:
- A sample of 152 patients was analyzed.
- The Mini-Mental Status Examination (MMSE) was administered.
- Varying cutoff scores were used to assess sensitivity and specificity.
Main Results:
- The MMSE exhibited very low sensitivity across different cutoff scores.
- Excellent specificity was observed for MMSE scores of 19 or less.
- No patient with an MMSE score below 20 was deemed to have capacity.
Conclusions:
- The MMSE is unreliable for capacity assessment with scores above 19 due to misclassification risks.
- An MMSE score below 20 consistently indicated incapability in this sample.
- The MMSE should not be used alone for capacity determinations, omitting key factors like executive function and personal values.
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