Limitations and recommendations regarding the Mini-Mental State Examination (MMSE) in illiterate and low educated older adults
Published:
Dec 31, 2023
Keywords:
illiterate low-educated Mini-Mental State Examination recommendations
Abstract
Increasing life expectancy has been associated with higher rates of dementia. As illiterate/uneducated individuals are typically over-represented among older cohorts, it is imperative that we identify and/or develop appropriate, non-biased scales and psychometric tests for early detection of, and screening for, cognitive impairment in this group. Given that many traditional neuropsychological tests may underestimate cognitive abilities in illiterate/uneducated and low educated individuals, their use in these groups needs to be reappraised or their format adapted. One of the most commonly used screening tests worldwide is the Mini-Mental State Examination (MMSE). Level of education has been shown to be a significant predictor of performance on the MMSE, hence, there is dispute among researchers related to its applicability in populations with low or no schooling. A wide range of recommendations have been made by scholars for overcoming the education effect on the MMSE, as well as other sources of bias, but some methodological limitations remain, and new ones have emerged concerning its administration to illiterate/uneducated and low educated older individuals. In the present study, we present a theoretical discussion of the challenges inherent in the administration and interpretation of MMSE performance in illiterate/uneducated and low educated individuals, consider previous recommendations and address their limitations, and highlight the optimal methods for clinical assessment of these groups when the MMSE is used.
Article Details
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Mandyla, M.-A., & Kosmidis, M. H. (2023). Limitations and recommendations regarding the Mini-Mental State Examination (MMSE) in illiterate and low educated older adults. Psychology: The Journal of the Hellenic Psychological Society, 28(2), 141–157. https://doi.org/10.12681/psy_hps.31694
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References
Aiello, E. N., Fiabane, E., Manera, M. R., Radici, A., Grossi, F., Ottonello, M., Pain, D., & Pistarini, C. (2022). Screening for cognitive sequelae of SARS-CoV-2 infection: a comparison between the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Neurological Sciences, 43(1), 81–84. https://doi.org/10.1007/s10072-021-05630-3
Anthony, J. C., LeResche, L., Niaz, U., von Korff, M. R., & Folstein, M. F. (1982). Limits of the ‘Mini-Mental State’ as a screening test for dementia and delirium among hospital patients. Psychological Medicine, 12(2), 397–408. https://doi.org/10.1017/S0033291700046730
Aprahamian, I., Martinelli, J. E., Cecato, J., & Yassuda, M. S. (2011). Screening for Alzheimer’s Disease Among Illiterate Elderly: Accuracy Analysis for Multiple Instruments. Journal of Alzheimer’s Disease, 26(2), 221–229. https://doi.org/10.3233/JAD-2011-110125
Araujo, N. B., Nielsen, T. R., Barca, M. L., Engedal, K., Marinho, V., Deslandes, A. C., Coutinho, E. S., & Laks, J. (2020). Brazilian version of the European Cross-Cultural Neuropsychological Test Battery (CNTB-BR): diagnostic accuracy across schooling levels. Brazilian Journal of Psychiatry, 42(3), 286–294. https://doi.org/10.1590/1516-4446-2019-0539
Ardila, A., Bertolucci, P. H., Braga, L. W., Castro-Caldas, A., Judd, T., Kosmidis, M. H., Matute, E., Nitrini, R., Ostrosky-Solis, F., & Rosselli, M. (2010). Illiteracy: The neuropsychology of cognition without reading. Archives of Clinical Neuropsychology, 25(8), 689–712. https://doi.org/10.1093/arclin/acq079
Aslam, R. W., Bates, V., Dundar, Y., Hounsome, J., Richardson, M., Krishan, A., Dickson, R., Boland, A., Kotas, E., Fisher, J., Sikdar, S., & Robinson, L. (2016). Automated tests for diagnosing and monitoring cognitive impairment: A diagnostic accuracy review. Health Technology Assessment, 20(77). https://doi.org/10.3310/hta20770
Bertolucci, P. H., Brucki, S. M., Campacci, S. R., & Juliano, Y. (1994). The Mini-Mental State Examination in a general population: impact of educational status. Arquivos de Neuro-Psiquiatria, 52(1), 1–7.
Bich, N. N., Dung, N. T. T., Vu, T., Quy, L. T., Tuan, N. A., Binh, N. T. T., Hung, N. T., & Anh, L. V. (2019). Dementia and associated factors among the elderly in Vietnam: a cross-sectional study. International Journal of Mental Health Systems, 13(1), 57. https://doi.org/10.1186/s13033-019-0314-7
Bird, H. R., Canino, G., Stipec, M. R., & Shrout, P. (1987). Use of the Mini-mental State Examination in a Probability Sample of a Hispanic Population. The Journal of Nervous and Mental Disease, 175(12), 731–737. https://doi.org/10.1097/00005053-198712000-00005
Blesa, R., Pujol, M., Aguilar, M., Santacruz, P., Bertran-Serra, I., Hernández, G., Sol, J. M., Peñ A-Casanova, J., & Crespo, M. C. (2001). Clinical validity of the “mini-mental state” for Spanish speaking communities. Neuropsychologia, 39. www.elsevier.com/locate/neuropsychologia
Bonizzato, S., Ghiggia, A., Ferraro, F., & Galante, E. (2022). Cognitive, behavioral, and psychological manifestations of COVID-19 in post-acute rehabilitation setting: preliminary data of an observational study. Neurological Sciences, 43(1), 51–58. https://doi.org/10.1007/s10072-021-05653-w
Brayne, C., & Calloway, P. (1990). The Association of Education and Socioeconomic Status with the Mini Mental State Examination and the Clinical Diagnosis of Dementia in Elderly People. Age and Ageing, 19(2), 91–96. https://doi.org/10.1093/ageing/19.2.91
Brito-Marques, P. R., & Cabral-Filho, J. E. (2004). The role of education in mini-mental state examination: a study in Northeast Brazil. Arquivos de Neuro-psiquiatria, 62(2a), 206–11. https://doi.org/10.1590/S0004-282X2004000200003
Brucki, S. M. D., & Nitrini, R. (2010). Mini-Mental State Examination among lower educational levels and illiterates Transcultural evaluation. Dementia & Neuropsychologia, 4(2), 120–5. 10.1590/S1980-57642010DN40200008
Brucki, S. M. D., Nitrini, R., Caramelli, P., Bertolucci, P. H. F., & Okamoto, I. H. (2003).Suggestions for utilization of the mini-mental state examination in Brasil. Arquivos de Neuropsiquiatria, 61(3B). https://doi.org/10.1590/S0004-282X2003000500014
Carnero-Pardo, C. (2014). Should the Mini-Mental State Examination be retired? Neurología, 29(8), 473–481. https://doi.org/10.1016/j.nrleng.2013.07.005
Carnero-Pardo, C., Espejo-Martinez, B., Lopez-Alcalde, S., Espinosa-Garcia, M., Saez-Zea, C., Vilchez-Carrillo, R., Hernandez-Torres, E., & Navarro-Espigares, J. L. (2011). Effectiveness and costs of phototest in dementia and cognitive impairment screening. Neurology, 11(1), 92. https://doi.org/10.1186/1471-2377-11-92
Carpinelli Mazzi, M., Iavarone, A., Russo, G., Musella, C., Milan, G., D’Anna, F., Garofalo, E., Chieffi, S., Sannino, M., Illario, M., de Luca, V., Postiglione, A., & Abete, P. (2020). Mini-Mental State Examination: new normative values on subjects in Southern Italy. Aging Clinical and Experimental Research, 32(4), 699–702. https://doi.org/10.1007/s40520-019-01250-2
Contador, I., Bermejo-Pareja, F., Fernández-Calvo, B., Boycheva, E., Tapias, E., Llamas, S., & Benito-León, J. (2016). The 37 item Version of the Mini-Mental State Examination: Normative Data in a Population-Based Cohort of Older Spanish Adults (NEDICES). Archives of Clinical Neuropsychology, 31(3), 263–272. https://doi.org/10.1093/arclin/acw003
Crane, P. K., Gibbons, L. E., Jolley, L., van Belle, G., Selleri, R., Dalmonte, E., & de Ronchi, D. (2006). Differential item functioning related to education and age in the Italian version of the Mini-mental State Examination. International Psychogeriatrics, 18(3), 505–515. https://doi.org/10.1017/S1041610205002978
Creavin, S. T., Wisniewski, S., Noel-Storr, A. H., Trevelyan, C. M., Hampton, T., Rayment, D., Thom, V. M., Nash, K. J. E., Elhamoui, H., Milligan, R., Patel, A. S., Tsivos, D. v., Wing, T., Phillips, E., Kellman, S. M., Shackleton, H. L., Singleton, G. F., Neale, B. E., Watton, M. E., & Cullum, S. (2016). Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database of Systematic Reviews 2016, 1. https://doi.org/10.1002/14651858.CD011145.pub2
Crum, R. M., Antony, J. C., Bassett, S. S., & Folstein, M. F. (1993). Population-Based Norms for the Mini-Mental State Examination by Age and Educational Level. JAMA: The Journal of the American Medical Association, 269(18), 2386. https://doi.org/10.1001/jama.1993.03500180078038
Cruz-Orduna, I., Bellon, J. M., Torrero, P., Aparicio, E., Sanz, A., Mula, N., Marzana, G., Begue, C., Cabezon, D., & Olazaran, J. (2012). Detecting MCI and dementia in primary care: efficiency of the MMS, the FAQ and the IQCODE. Family Practice, 29(4), 401–406. https://doi.org/10.1093/fampra/cmr114
de Araujo, N. B., Nielsen, T. R., Engedal, K., Barca, M. L., Coutinho, E. S., & Laks, J. (2018). Diagnosing dementia in lower educated older persons: validation of a Brazilian Portuguese version of the Rowland Universal Dementia Assessment Scale (RUDAS). Revista Brasileira de Psiquiatria, 40(3), 264–269. https://doi.org/10.1590/1516-4446-2017-2284
ElKholy, N., & Ore, M. (2018). Defining Cut-off Scores for MMSE in an Educated and Illiterate Arabic Speaking Egyptian Elderly Population. The Egyptian Journal of Geriatrics and Gerontology, 6(1),1 –3. http://www.aoa.gov/AoA
Ertan, T. , Eker, E., Gόngen, C. E. (1999). The standardized Mini Mental State Examination for illiterate Turkish elderly population: SMME-E. Paper presented at 2nd International Symposium on Neurophysiological and Neurophysiological Assessment of Mental and Behavioral Disorders, August 28-30, Kirazlıyayla, Bursa, Turkey.
Escobar, J. I., Burnam, A., Karno, M., Forsythe, A., Landsverk, J., & Golding, J. M. (1986). Use of the Mini-Mental State Examination (MMSE) in a Community Population of Mixed Ethnicity. The Journal of Nervous and Mental Disease, 174(10), 607–614. https://doi.org/10.1097/00005053-198610000-00005
Escribano-Aparicio, M. v, Pérez-Dively, M., García-García, F. J., Pérez-Martín, A., Romero, L., Ferrer, G., Martín-Correa, E., & Sánchez-Ayala, M. I. (1999). Validación del MMSE de Folstein en una población española de bajo nivel educativo1. Revista Española de Geriatría y Gerontología, 34(6), 319–326. http://www.elsevier.es/es-revista-revista-espanola-geriatria-gerontologia-124-articulo-validacion-del-mmse-folstein-una-13011685
Evans, B. C., Crogan, N. L., & Greenberg, E. (2008). Lessons Learned in Clinical Research: Using the MMSE With Older Mexican American Nursing Home Residents. Journal of the American Psychiatric Nurses Association, 14(5), 373–378. https://doi.org/10.1177/1078390308325197
Fillenbaum, G. G., Hughes, D. C., Heyman, A., George, L. K., & Blazer, D. G. (1988). Relationship of health and demographic characteristics to Mini-Mental State Examination score among community residents. Psychological Medicine, 18(3), 719–726. https://doi.org/10.1017/S0033291700008412
Foderaro, G., Isella, V., Mazzone, A., Biglia, E., di Gangi, M., Pasotti, F., Sansotera, F., Grobberio, M., Raimondi, V., Mapelli, C., Ferri, F., Impagnatiello, V., Ferrarese, C., & Appollonio, I. M. (2022). Brand new norms for a good old test: Northern Italy normative study of MiniMental State Examination. Neurological Sciences. https://doi.org/10.1007/s10072-021-05845-4
Folstein, M., Anthony, J. C., Parhad, I., Duffy, B., & Gruenberg, E. M. (1985). The Meaning of Cognitive Impairment in the Elderly. Journal of the American Geriatrics Society, 33(4), 228–235. https://doi.org/10.1111/j.1532-5415.1985.tb07109.x
Folstein, M. F., Folstein, S. E., & Mchugh, P. R. (1975). “Mini-mental state” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–98.
Freitas, S., Simões, M. R., Alves, L., & Santana, I. (2015). The Relevance of Sociodemographic and Health Variables on MMSE Normative Data. Applied Neuropsychology:Adult, 22(4), 311–319. https://doi.org/10.1080/23279095.2014.926455
Frisoni, G. B., Rozzini, R., Bianchetti, A., & Trabucchi, M. (1993). Principal Lifetime Occupation and MMSE Score in Elderly Persons. Journal of Gerontology, 48(6), 310–314. https://doi.org/10.1093/geronj/48.6.S310
Ganguli, M., Ratcliff, G., Sharma, S., Gilby, J., Pandav, R., Belle, S., Ryan, C., Bakers, C., Seaberg, E., & Dekosky, S. (1995). A Hindi Version Of The MMSE: The Development of a cognitive screening instrument for a largely illiterate rural elderly population in India. International Journal Og Geriatric Psychiatry, 10(5), 367–77. https://doi.org/10.1002/gps.930100505
Gómez, F., Zunzunegui, M., Lord, C., Alvarado, B., & García, A. (2013). Applicability of the MoCA-S test in populations with little education in Colombia. International Journal of Geriatric Psychiatry, 28(8), 813–820. https://doi.org/10.1002/gps.3885
Goudsmit, M., van Campen, J., Franzen, S., van den Berg, E., Schilt, T., & Schmand, B. (2021). Dementia detection with a combination of informant-based and performance-based measures in low-educated and illiterate elderly migrants. The Clinical Neuropsychologist, 35(3), 660–678. https://doi.org/10.1080/13854046.2020.1711967
Han, C., Jo, S. A., Jo, I., Kim, E., Park, M. H., & Kang, Y. (2008). An adaptation of the Korean mini-mental state examination (K-MMSE) in elderly Koreans: Demographic influence and population-based norms (the AGE study). Archives of Gerontology and Geriatrics, 47(3), 302–310. https://doi.org/10.1016/j.archger.2007.08.012
Heeren, T. I., Lagaay, A. M., Beek, W. C. A. v, Rooymans, G. M., & Hijrnans, W. (1990). Reference Values for the Mini-Mental State Examination (MMSE) in Octo-and Nonagenarians. Journal of the American Geriatric Society, 38(10), 1093–6. https://doi.org/10.1111/j.1532-5415.1990.tb01371.x
Herlitz, A., & Kabir, Z. N. (2006). Sex differences in cognition among illiterate Bangladeshis: A comparison with literate Bangladeshis and Swedes. Scandinavian Journal of Psychology, 47(6), 441–447. https://doi.org/10.1111/j.1467-9450.2006.00531.x
Ishizaki, J., Meguro, K., Ambo, H., Shimada, M., Yamaguchi, S., Hayasaka, C., Komatsu, H., Sekita, Y., & Yamadori, A. (1998). A Normative, Community-Based Study of Mini-Mental State in Elderly Adults: The Effect of Age and Educational Level. Journal of Gerontology, 53(6), 359–363. https://academic.oup.com/psychsocgerontology/article/53B/6/P359/618597
Kabir, Z. N., & Herlitz, A. (2000). The Bangla adaptation of Mini-Mental State Examination (BAMSE): an instrument to assess cognitive function in illiterate and literate individuals. International Journal of Geriatric Psychiatry, 15(5), 441–50. 10.1002/(sici)1099-1166(200005)15:5<441::aid-gps142>3.0.co;2-o
Kim, H., & Chey, J. (2010). Effects of education, literacy, and dementia on the clock drawing test performance. Journal of the International Neuropsychological Society, 16(6), 1138–1146. https://doi.org/10.1017/S1355617710000731
Kim, J., Yoon, J. H., Kim, S. R., & Kim, H. (2014). Effect of literacy level on cognitive and language tests in Korean illiterate older adults. Geriatrics & Gerontology International, 14(4), 911–917. https://doi.org/10.1111/ggi.12195
Kochhann, R., Cerveira, M. O., Godinho, C., Camozzato, A., Lorena, M., & Chaves, F. (2009). Evaluation of Mini-Mental State Examination scores according to different age and education strata, and sex, in a large Brazilian healthy sample. Dementia & Neuropsychologia, 3(2), 88–93. https://doi.org/10.1590/S1980-57642009DN30200004
Kochhann, R., Santos Varela, J., Saraiva, C., Lisboa, M., Lorena, M., & Chaves, F. (2010). The Mini Mental State Examination Review of cutoff points adjusted for schooling in a large Southern Brazilian sample. Dementia & Neuropsychologia, 4(1), 35–41. 10.1590/S1980-57642010DN40100006
Kosmidis, M. H. (2018). Challenges in the neuropsychological assessment of illiterate older adults. Language, Cognition and Neuroscience, 33(3), 373–386. https://doi.org/10.1080/23273798.2017.1379605
Kraemer, H. C., Moritz, D. J., & Yesavage, J. (1998). Adjusting Mini-Mental State Examination Scores for Age and Educational Level to Screen for Dementia: Correcting Bias or Reducing Validity? International Psychogeriatrics, 10(1), 43–51. https://doi.org/10.1017/S1041610298005134
Laks, J., Baptista, E. M. R., Contino, A. L. B., Paula, E. O. de, & Engelhardt, E. (2007). Mini-Mental State Examination norms in a community-dwelling sample of elderly with low schooling in Brazil. Cadernos de Saúde Pública, 23(2), 315–319. https://doi.org/10.1590/S0102-311X2007000200007
Lee, D. Y. , Lee, K. U. , Lee, J. H. , Kim, K. W. , Jhoo, J. H. , Youn, J. C. , Kim, S. Y. , Woo, S. I. , & Woo, J. I. (2002). A Normative Study of the Mini-Mental State Examination in the Korean Elderly. Journal of Korean Neuropsychiatric Association. Journal of Korean Neuropsychiatric Associaton, 41(3), 508–525.
Lee, J. Y., Park, S., Park, S. E., Kim, M. J., Jung, H. Y., Choi, J. S., Park, K. H., & Kim, I. (2014). Development and validation of the Pictorial Cognitive Screening Inventory for illiterate people with dementia. Neuropsychiatric Disease and Treatment, 1837. https://doi.org/10.2147/ndt.s64151
Lin, J. S., O’connor, E., Rossom, R. C., Perdue, L. A., & Eckstrom, E. (2013). Screening for Cognitive Impairment in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 159(9), 601–612. https://doi.org/10.7326/0003-4819-159-9-201311050-00730
Lourenço, R. A., Veras, R. P. (2006). Mini-Mental State Examination: psychometric characteristics in elderly outpatients. Revista de Saúde Pública, 40(4), 712–719. 10.1590/s0034-89102006000500023
Magaziner, J., Bassett, S. S., & Rebel, J. R. (1987). Predicting Performance on the Mini-Mental State Examination. Journal of the American Geriatrics Society, 35(11), 996–1000. https://doi.org/10.1111/j.1532-5415.1987.tb04002.x
Magklara, E., Stephan, B. C. M., & Robinson, L. (2019). Current approaches to dementia screening and case finding in low- and middle-income countries: Research update and recommendations. International Journal of Geriatric Psychiatry, 34(1), 3–7. https://doi.org/10.1002/gps.4969
Mandyla, M. A., Yannakoulia, M., Hadjigeorgiou, G., Dardiotis, E., Scarmeas, N., & Kosmidis, M. H. (2021). Identifying Appropriate Neuropsychological Tests for Uneducated/Illiterate Older Individuals. Journal of the International Neuropsychological Society, 31, 1–14. https://doi.org/10.1017/S1355617721001016
Matallana, D., de Santacruz, C., Cano, C., Reyes, P., Samper-Ternent, R., Markides, K. S., Ottenbacher, K. J., & Reyes-Ortiz, C. A. (2011). The relationship between education level and mini-mental state examination domains among older Mexican Americans. Journal of Geriatric Psychiatry and Neurology, 24(1), 9–18. https://doi.org/10.1177/0891988710373597
Mathuranath, P. S., Hodges, J. R., Mathew, R., Cherian, P. J., George, A., & Bak, T. H. (2004). Adaptation of the ACE for a Malayalam speaking population in southern India. International Journal of Geriatric Psychiatry, 19(12), 1188–1194. https://doi.org/10.1002/gps.1239
Mokri, H., Avila-Funes, J. A., Le Goff, L., Ruiz-Arregui, L., Gutierrez Robledo, L. M., & Amieva, H. (2012). Self-reported reading and writing skills in elderly who never attended school influence cognitive performances: results from the Coyoacán cohort study. Journal of Nutrition, Health & Aging, 16, 621–624. https://doi.org/10.1007/s12603-012-0070-8
Monroe, T., & Carter, M. (2012). Using the Folstein Mini Mental State Exam (MMSE) to explore methodological issues in cognitive aging research. European Journal of Ageing, 9(3), 265–274. https://doi.org/10.1007/s10433-012-0234-8
Morris, J. C., Storandt, M., McKeel, D. W., Rubin, E. H., Price, J. L., Grant, E. A., & Berg, L. (1996). Cerebral amyloid deposition and diffuse plaques in ``normal’’ aging: Evidence for presymptomatic and very mild Alzheimer’s disease. Neurology, 46(3), 707–719. https://doi.org/10.1212/WNL.46.3.707
Mungas, D., Marshall, S. C., Weldon, M., Haan, M., & Reed, B. R. (1996). Age and education correction of Mini-Mental State Examination for English- and Spanish-speaking elderly. Neurology, 46(3), 700–706. https://doi.org/10.1212/WNL.46.3.700
Murden, R. A., McRae, T. D., Kaner, S., & Bucknam, M. E. (1991). Mini-Mental State Exam Scores Vary with Education in Blacks and Whites. Journal of the American Geriatrics Society, 39(2), 149–155. https://doi.org/10.1111/j.1532-5415.1991.tb01617.x
Nell, V. (1999). Cross-Cultural Neuropsychological Assessment (1st ed.). Psychology Press. https://doi.org/10.4324/9781410603562
Ng, T.P., Niti, M., Chiam, P., C., & Kua, E. H. (2007). Ethnic and Educational Differences in Cognitive Test Performance on Mini-Mental State Examination in Asians. The American Journal of Geriatric Psychiatry, 15(2), 130–9. https://doi.org/10.1097/01.JGP.0000235710.17450.9a
Nielsen, T. R., & Jørgensen, K. (2013). Visuoconstructional abilities in cognitively healthy illiterate turkish immigrants: A quantitative and qualitative investigation. Clinical Neuropsychologist, 27(4), 681–692. https://doi.org/10.1080/13854046.2013.767379
Nieuwenhuis-Mark, R. E. (2010). The death knoll for the MMSE: Has it outlived its purpose? Journal of Geriatric Psychiatry and Neurology, 23(3), 151–157. https://doi.org/10.1177/0891988710363714
Nilsson, F. M. (2007). Mini Mental State Examination (MMSE) - Probably one of the most cited papers in health science. Acta Psychiatrica Scandinavica, 116(2), 156–157. https://doi.org/10.1111/j.1600-0447.2007.01037.x
Nitrini, R., Caramelli, P., Herrera, E., Charchat-Fichman, H., & Porto, C. S. (2005). Performance in Luria's fist-edge-palm test according to educational level. Cognitive Behavioral Neurology, 18(4), 211–4. http://journals.lww.com/cogbehavneurol
Noroozian, M., Shakiba, A., & Iran-nejad, S. (2014). The impact of illiteracy on the assessment of cognition and dementia: A critical issue in the developing countries. International Psychogeriatrics, 26(12), 2051–2060. https://doi.org/10.1017/S1041610214001707
O’Bryant, S. E., Humphreys, J. D., Smith, G. E., Ivnik, R. J., Graff-Radford, N. R., Petersen, R. C., & Lucas, J. A. (2008). Detecting Dementia with the Mini-Mental State Examination in Highly Educated Individuals. Archives of Neurology, 65(7). https://doi.org/10.1001/archneur.65.7.963
O’ Connor, D. W., Pollitt, P. A., Treasure, F. P., Brook, C. P. B., & Reiss, B. B. (1989). The influence of education, social class and sex on Mini-Mental State scores. Psychological Medicine, 19(3), 771–776. https://doi.org/10.1017/S0033291700024375
O’Driscoll, C., & Shaikh, M. (2017). Cross-Cultural Applicability of the Montreal Cognitive Assessment (MoCA): A Systematic Review. Journal of Alzheimer’s Disease, 58(3), 789–801. https://doi.org/10.3233/JAD-161042
Ortega, L. de F. V., Aprahamian, I., Borges, M. K., Cação, J. de C., & Yassuda, M. S. (2019). Screening for Alzheimer’s disease in low-educated or illiterate older adults in brazil: A systematic review. Arquivos de Neuro-Psiquiatria, 77(4), 279–288. https://doi.org/10.1590/0004-282x20190024
Ostrosky-Solis, F., Lopez-Arango, G., & Ardila, A. (2000). Sensitivity and specificity of the mini-mental state examination in a Spanish-speaking population. Applied Neuropsychology, 7(1), 25–31. https://doi.org/10.1207/S15324826AN0701_4
Paddick, S.-M., Gray, W. K., McGuire, J., Richardson, J., Dotchin, C., & Walker, R. W. (2017). Cognitive screening tools for identification of dementia in illiterate and low-educated older adults, a systematic review and meta-analysis. International Psychogeriatrics, 29(6), 897–929. https://doi.org/10.1017/S1041610216001976
Parker, C., & Philp, I. (2004). Screening for cognitive impairment among older people in black and minority ethnic groups. Age and Ageing, 33(5), 447–452. https://doi.org/10.1093/ageing/afh135
Pedraza, O., Clark, J. H., O’Bryant, S. E., Smith, G. E., Ivnik, R. J., Graff-Radford, N. R., Willis, F. B., Petersen, R. C., & Lucas, J. A. (2012). Diagnostic validity of age and education corrections for the mini-mental state examination in older African Americans. Journal of the American Geriatrics Society, 60(2), 328–331. https://doi.org/10.1111/j.1532-5415.2011.03766.x
Prince, M., Acosta, D., Ferri, C. P., Guerra, M., Huang, Y., Llibre, R. J. J., … Liu Z. (2012). Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study. Lancet, 380(9836), 50–8. 10.1016/S0140-6736(12)60399-7.
Raina, S. K., Raina, S., Chander, V., Grover, A., Singh, S., & Bhardwaj, A. (2013). Development of a cognitive screening instrument for tribal elderly population of Himalayan region in northern India. Journal of Neurosciences in Rural Practice, 4(02), 147–153. https://doi.org/10.4103/0976-3147.112744
Reisberg, B. (2007). Global measures: utility in defining and measuring treatment response in dementia. International Psychogeriatrics, 19(3), 421–456. https://doi.org/10.1017/S1041610207005261
Rosli, R., Tan, M. P., Gray, W. K., Subramanian, P., & Chin, A. V. (2016). Cognitive assessment tools in Asia: A systematic review. International Psychogeriatrics, 28(2), 189–210. https://doi.org/10.1017/S1041610215001635
Rosselli, D., Ardila, A., Pradilla G, Morillo, L., Bautista, L., Rey, O., & Camacho, M. (2000). The Mini-Mental State Examination as a selected diagnostic test for dementia: a Colombian population study GENECO. Revista de Neurologia, 30(5), 428–432.
Scazufca, M., Almeida, O. P., Vallada, H. P., Tasse, W. A., & Menezes, P. R. (2009). Limitations of the Mini-mental state examination for screening dementia in a community with low socioeconomic status : RResults from the Sao Paulo Ageing& health study. European Archives of Psychiatry and Clinical Neuroscience, 259(1), 8–15. https://doi.org/10.1007/s00406-008-0827-6
Shim, Y. S., Yang, D. W., Kim, H. J., Park, Y. H., & Kim, S. Y. (2017). Characteristic differences in the mini-mental state examination used in Asian countries. BMC Neurology, 17(1). https://doi.org/10.1186/s12883-017-0925-z
Shiroky, J. S., Schipper, H. M., Bergman, H., & Chertkow, H. (2007). Can you have dementia with an MMSE score of 30? American Journal of Alzheimer’s Disease and Other Dementias, 22(5), 406–415. https://doi.org/10.1177/1533317507304744
Shyu, Y. I. L., & Yip, P. K. (2001). Factor structure and explanatory variables of the Mini-Mental State Examination (MMSE) for elderly persons in Taiwan. Journal of the Formosan Medical Association, 100(10), 676–83.
Son, E. J. (2002). Norms for the Korean Mini-Mental State Examination (K-MMSE) among rural community populations in Korea. Chonnam Medical Journal, 38(1), 12–16.
Song, M., Jahng, S., Kim, S., & Kang, Y. (2020). A Normative Study of the Full Version of Story Memory in the Korean-Mini Mental State Examination, 2nd Edition: Expanded Version (K-MMSE-2: EV). Dementia and Neurocognitive Disorders, 19(4), 161. https://doi.org/10.12779/dnd.2020.19.4.161
Spencer, R. J., Wendell, C. R., Giggey, P. P., Katzel, L. I., Lefkowitz, D. M., Siegel, E. L., & Waldstein, S. R. (2013). Psychometric limitations of the mini-mental state examination among nondemented older adults: An evaluation of neurocognitive and magnetic resonance imaging correlates. Experimental Aging Research, 39(4), 382–397. https://doi.org/10.1080/0361073X.2013.808109
Stewart, R. B., Moore, M. T., May, F. E., Marks, R. G., & Hale, W. E. (1991). Correlates of Cognitive Dysfunction in an Ambulatory Elderly Population. Gerontology, 37(5), 272–280. https://doi.org/10.1159/000213271
Tiwari, S. C., Tripathi, R. K., & Kumar, A. (2009). Applicability of the Mini-mental State Examination (MMSE) and the Hindi Mental State Examination (HMSE) to the urban elderly in India: A pilot study. International Psychogeriatrics, 21(1), 123–128. https://doi.org/10.1017/S1041610208007916
Tombaugh, T. N., & McIntyre, N. J. (1992). The Mini-Mental State Examination: A Comprehensive Review. Journal of the American Geriatrics Society, 40(9), 922–935. https://doi.org/10.1111/j.1532-5415.1992.tb01992.x
Uhlmann, R. F., & Larson, E. B. (1991). Effect of Education on the Mini-Mental State Examination as a Screening Test for Dementia. Journal of the American Geriatrics Society, 39(9), 876–880. https://doi.org/10.1111/j.1532-5415.1991.tb04454.x
UNESCO. (2018). Global Education Monitoring Report 2019: Migration, Displacement and Education – Building Bridges, not Walls.
Vasconcelos, L. G., Brucki, S. M. D., Francisco, O., & Bueno, A. (2007). Cognitive and functional dementia assessment tools Review of Brazilian literature. Dementia & Neuropsychologia, 1(1), 18–23.
1590/S1980-57642008DN10100004
Velayudhan, L., Ryu, S. H., Raczek, M., Philpot, M., Lindesay, J., Critchfield, M., & Livingston, G. (2014). Review of brief cognitive tests for patients with suspected dementia. International Psychogeriatrics, 26(8), 1247–1262. https://doi.org/10.1017/S1041610214000416
Verghese, J., Noone, M. L., Johnson, B., Ambrose, A. F., Wang, C., Buschke, H., Pradeep, V. G., Abdul Salam, K., Shaji, K. S., & Mathuranath, P. S. (2012). Picture-based memory impairment screen for dementia. Journal of the American Geriatrics Society, 60(11), 2116–2120. https://doi.org/10.1111/j.1532-5415.2012.04191.x
Werner, P., Heinik, J., Lin, R., & Bleich, A. (1999). “Yes” ifs, ands or buts: examining performance and correlates of the repetition task in the mini-mental state examination. International Journal of Geriatric Psychiatry, 14(9), 719–725. https://doi.org/10.1002/(sici)1099-1166(199909)14:9<719::aid-gps2>3.0.co;2-k
Woodford, H. J., & George, J. (2007). Cognitive assessment in the elderly: A review of clinical methods. QJM International Journal of Medicine, 100(8), 469–484. https://doi.org/10.1093/qjmed/hcm051
Xu, G., Meyer, J. S., Huang, Y., Du, F., Chowdhury, M., & Quach, M. (2003). Adapting Mini-Mental State Examination for dementia screening among illiterate or minimally educated elderly Chinese. International Journal of Geriatric Psychiatry, 18(7), 609–616. https://doi.org/10.1002/gps.890
Ylikoski, R., Erkinjuntti, T., Sulkava, R., Juva, K., Tilvis, R., & Valvanne, J. (2009). Correction for age, education and other demographic variables in the use of the Mini Mental State Examination in Finland. Acta Neurologica Scandinavica, 85(6), 391–396. https://doi.org/10.1111/j.1600-0404.1992.tb06034.x
Youn, J. H., Siksou, M., Mackin, R. S., Choi, J. S., Chey, J., & Lee, J. Y. (2011). Differentiating illiteracy from Alzheimer’s disease by using neuropsychological assessments. International Psychogeriatrics, 23(10), 1560–1568. https://doi.org/10.1017/S1041610211001347
Zunzunegui, M. V., & Otero, A. (2010). Screening for dementia in populations with little education. International Journal of Geriatric Psychiatry, 25(11), 1199–1199. https://doi.org/10.1002/gps.2523
