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[The Mini Mental Status test inadequate as screening test for cognitive deterioration in a neurological department]
H Harder1, J B Lanser, E H de Haan
1Academisch Ziekenhuis, afd. Neurologie, Leiden.
Objective:
To study the validity of the Mini-mental state (MMS) in a neurological population.
Design:
Comparing the results of a neuropsychological examination and the MMS score.
Setting:
Departments of Neurology/Neuropsychology of the University Hospital Leiden.
Methods:
One hundred and forty-seven patients participated in the study. One hundred and eight patients were classified into two diagnostic groups according to the deterioration index (obtained from test results of the neuropsychological examination) and DSM-III-R criteria: 63 patients had dementia, 45 did not; the other 39 patients were found to have specific cognitive impairments and were excluded from the group comparisons. The discriminative powers of the deterioration index and the MMS were compared; sensitivity and specificity were determined with several cut-off scores of the MMS.
Results:
The MMS had limited power to discriminate between demented and non-demented patients. The MMS score was strongly related to premorbid intelligence, occupational level and age. Increasing the original cut-off score to 25 points improved sensitivity and specificity to 79% and 84% respectively (with the original cut-off level these were 68% and 93%).
Conclusion:
The diagnostic value of the MMS is limited, especially in patients for whom a correct diagnosis is most relevant.