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Screening for cognitive impairment in multiple sclerosis. An evaluation of the Mini-Mental State Examination
1Clinical Neuroscience Research Program, Neuropsychiatric Research Institute, Fargo, ND.
Abstract:
The usefulness of the Mini-Mental State Examination (MMSE) as a screening test for identifying cognitive impairment in patients with multiple sclerosis (MS) has been questioned because many patients who score above the suggested cutoff score of 24 exhibit severe focal or global cognitive deficits. We reevaluated the usefulness of the MMSE by studying 85 patients with clinically definite MS who also received an extensive battery of neuropsychological tests. Although scores on the MMSE were negatively correlated with the number of neuropsychological tests on which patients with MS displayed impairment, the MMSE was not sufficiently sensitive to identify precisely defined dementia in these patients. The MMSE was nonetheless a useful predictor of focal cognitive impairment, particularly in relapsing-remitting patients with relatively minor physical disabilities. Additional analyses suggested strategies for minor modifications of the MMSE that may improve its sensitivity and specificity for identifying dementia while preserving its major advantages as a screening examination: brevity and ease of administration and scoring.
Insights
The Mini-Mental State Examination (MMSE) is not sensitive enough for detecting dementia in multiple sclerosis (MS) patients. However, it can predict focal cognitive impairment, especially in early-stage MS.
Area of Science:
- Neurology
- Neuropsychology
Background:
- The Mini-Mental State Examination (MMSE) is a widely used screening tool for cognitive impairment.
- Its utility in multiple sclerosis (MS) is debated due to potential underestimation of deficits.
Purpose of the Study:
- To reevaluate the effectiveness of the MMSE in identifying cognitive impairment in patients with multiple sclerosis.
- To assess the MMSE's sensitivity and specificity for dementia and focal cognitive deficits in MS.
Main Methods:
- Studied 85 patients with clinically definite MS.
- Administered the MMSE and an extensive battery of neuropsychological tests.
- Correlated MMSE scores with neuropsychological findings.
Main Results:
- MMSE scores showed a negative correlation with the number of impaired neuropsychological tests.
- The MMSE was not sensitive enough to detect defined dementia in MS patients.
- The MMSE effectively predicted focal cognitive impairment, particularly in relapsing-remitting MS with minor physical disability.
Conclusions:
- The MMSE has limitations in screening for dementia in MS.
- The MMSE remains a useful tool for predicting focal cognitive impairment in specific MS subgroups.
- Minor modifications to the MMSE may enhance its diagnostic accuracy for dementia in MS.