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Stress Relief and Memory Training Center

Cognitive Assessment in Dementia: the Usefulness of the Expanded Version of Mini Mental Status Exam

The expanded version of MMSE-2 overcomes the ceiling effect of standard MMSE, especially for highly educated individuals, and allows clinicians to initiate an appropriate treatment earlier.

Valentin Bragin(1), Gary Shereshevsky(1,3), Ilya Bragin(1,2), Elina Slobod(1), Tanya Silenko(1), Maksim Temnogorod(1), Anastasiya Tsoy(1).

  1. Stress Relief and Memory Training Center, Brooklyn, NY, USA,
  2. Upstate Medical University, Syracuse, New York, USA
  3. Staten Island University Hospital, Department of Rehabilitation Medicine, Staten Island, NY, USA

Poster Presentation at the Alzheimer’s Association International Conference. Washington D.C., United States, July 18-23, 2015

Background: Although Mini-Mental Status Exam (MMSE, standard version) has existed for years, this screening tool has a ceiling effect, limiting its application in clinical practice. The recently developed expanded version (MMSE-2:EV) includes 2 additional tasks: Story Memory (SM) and Processing Speed (PS). This presentation compares results of MMSE-2:EV with other well-known cognitive tests in people with dementia.

Methods: Data were collected from the charts of 91 patients (32 males, 59 females), mean age 76.3 ± 6.3, education 14.0 ± 2.5 yrs, with memory loss and depression. Cognitive testing included MMSE-2:EV (maximum score of 90), clock-drawing test (CDT), verbal fluency category (VFC) and letters (VFL) and cube drawing task (number of lines “CUBDL, corners “ CUBDC and dimensions – CUBDD. For analysis, the patients were divided in 2 groups: group 1 with standard MMSE  27 (44 patients) and group 2 with standard MMSE  24 (38 patients); 9 patients excluded with MMSE 25 and 26. SPSS-21 was used for descriptive statistics, Wilcoxon signed-rank test between groups 1 and 2 and Pearson’s R correlations within the groups.

Results: The mean standard MMSE score was 28.6 ± 1.0 in group 1 and in group 2 was 20.1 ± 3.9 (p< 0.001). The mean total MMSE-2:EV score in group 1 was 49.5 ± 8.7 and in group 2 was 26.8 ± 11.8 (p< 0.001). The cognitive performance in group 1 was significantly higher than in group 2 on most tasks. The number of significant correlations between SM and PS and the other tasks was different in each group. In group 1 there were only two significant correlations: between SM and VFT, and PS and VFC. In contrast, in group 2 there were ten significant correlations. The SM correlated with PS, VFC, CUBDL and CUBDD. PS had the same four and two additional correlations: with standard MMSE and VFL.

Conclusions: An expended version of MMSE-2 overcomes the ceiling effect of standard MMSE and yields more specific neurocognitive functioning information in dementia. We found a higher number of inter-test correlations in the more impaired group, which could reflect differences in neurocognitive network involvement.

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