Diagnostic Accuracy of the MMSE in Detecting Probable and Possible Alzheimer%26apos;s Disease in Ethnically Diverse Highly Educated Individuals: An Analysis of the NACC Database

作者：Spering Cynthia C; Hobson Valerie; Lucas John A; Menon Chloe V; Hall James R; O' Bryant Sid E

来源：Journals of Gerontology Series A-Biological Sciences and Medical Sciences, 2012, 67(8): 890-896.

DOI：10.1093/gerona/gls006

• Alzheimer%26apos
• s disease
• Dementia diagnosis
• Ethnicity
• Language
• Mini-Mental State Examination

Background. To validate and extend the findings of a raised cut score of O%26apos;Bryant and colleagues (O%26apos;Bryant SE, Humphreys JD, Smith GE, et al. Detecting dementia with the mini-mental state examination in highly educated individuals. Arch Neurol. 2008;65(7):963-967.) for the Mini-Mental State Examination in detecting cognitive dysfunction in a bilingual sample of highly educated ethnically diverse individuals. %26lt;br%26gt;Methods. Archival data were reviewed from participants enrolled in the National Alzheimer%26apos;s Coordinating Center minimum data set. Data on 7,093 individuals with 16 or more years of education were analyzed, including 2,337 cases with probable and possible Alzheimer%26apos;s disease, 1,418 mild cognitive impairment patients, and 3,088 nondemented controls. Ethnic composition was characterized as follows: 6,296 Caucasians, 581 African Americans, 4 American Indians or Alaska natives, 2 native Hawaiians or Pacific Islanders, 149 Asians, 43 %26quot;Other,%26quot; and 18 of unknown origin. %26lt;br%26gt;Results. Diagnostic accuracy estimates (sensitivity, specificity, and likelihood ratio) of Mini-Mental State Examination cut scores in detecting probable and possible Alzheimer%26apos;s disease were examined. A standard Mini-Mental State Examination cut score of 24 (%26lt;= 23) yielded a sensitivity of 0.58 and a specificity of 0.98 in detecting probable and possible Alzheimer%26apos;s disease across ethnicities. A cut score of 27 (%26lt;= 26) resulted in an improved balance of sensitivity and specificity (0.79 and 0.90, respectively). In the cognitively impaired group (mild cognitive impairment and probable and possible Alzheimer%26apos;s disease), the standard cut score yielded a sensitivity of 0.38 and a specificity of 1.00 while raising the cut score to 27 resulted in an improved balance of 0.59 and 0.96 of sensitivity and specificity, respectively. %26lt;br%26gt;Conclusions. These findings cross-validate our previous work and extend them to an ethnically diverse cohort. A higher cut score is needed to maximize diagnostic accuracy of the Mini-Mental State Examination in individuals with college degrees.

• 出版日期2012-8