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Updated: Aug 24, 2026
A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
Published on: January 11, 2020
When mild impairment is not safe: mini-mental state examination scores of ≤21 are associated with emergency response
Howard Kim1, Caitlyn Parker1, Jennifer Jurado Severance1,2
1UNT Health Fort Worth Texas College of Osteopathic Medicine, Fort Worth, TX, United States.
Introduction:
Unrecognized emergency-response deficits contribute to preventable harm and loss of independence in older adults with cognitive decline. Although the Mini-Mental State Examination (MMSE) is widely used to assess global cognition, clinicians often use MMSE scores to inform judgments about everyday functioning. However, the relationship between MMSE performance and emergency-response ability remains unclear. The Test of Executive Functioning in an Emergency (TEFE) is a brief, performance-based assessment that evaluates a patient's ability to relay critical information and contact emergency services. This study examined whether an MMSE threshold was associated with failure on TEFE 911 tasks.
Methods:
A retrospective analysis included 905 patients from a university-affiliated memory clinic with Alzheimer's disease, vascular dementia, mixed dementia, mild cognitive impairment, or normal cognition. Associations between MMSE scores and TEFE 911 knowledge and behavioral task failure were examined using correlation, adjacent-score comparisons, receiver operating characteristic (ROC) analyses, Youden's J, and multivariable logistic regression adjusted for demographic and diagnostic covariates.
Results:
MMSE and TEFE scores were moderately correlated (r = 0.596, p < 0.0001). Failure rates were higher at MMSE scores of 21 than 22. ROC analyses demonstrated good discrimination for 911 task failure (AUC = 0.860-0.867). An MMSE cutoff of ≤21 yielded 61.9% sensitivity and 88.9% specificity for failure on 911 tasks and remained independently associated with failure after adjustment (adjusted OR = 3.71, 95% CI: 1.82-7.56).
Discussion:
Patients with MMSE scores ≤21 may warrant further performance-based assessment of emergency-response ability. Prospective studies should determine whether this threshold predicts real-world safety outcomes.
