A 5-year longitudinal study of the Mini-Mental State Examination in normal aging

The Mini-Mental State Examination (MMSE) measures global cognitive performance and is often used as a screening test for dementia. This paper presents a 5-year longitudinal study of the MMSE score in a sample of 2,537 non-demented French community residents aged 65 years and older who were participants in the Paquid Study in 1988-1992. Subjects were evaluated at the baseline visit (T0) and 1 year (T1), 3 years (T3), and 5 years (T5) later. Analyses performed with a random effects linear model showed that the score rose between T0 and T1 (by 0.60 points for subjects aged 65 years at T0 to 0.83 points for subjects aged 85 years at T0), then it decreased very slightly between T1 and T5 (by 0.02 points for subjects aged 65 years to 0.57 points for subjects aged 85 years). The improvement during the first year, which was larger for less educated subjects, may be explained by the stress due to the test situation at T0 or by a learning effect at T1. The decline during the last 4 years was more pronounced for older and less well educated subjects. The cross-sectional measure of age effect was larger than the longitudinal measure of time effect. This difference may be explained by a cohort effect or by a practice effect induced by repetition of the test. The authors conclude that the MMSE score declines very slightly in non-demented subjects, thus suggesting that the cognitive processes involved are spared by the aging process. These results may have implications for dementia screening.