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Age-Normative MMSE Data for Older Persons Aged 85 to 93 in a Longitudinal Swedish Cohort
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.ORCID iD: 0000-0002-6452-3930
2019 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 67, no 3, p. 534-538Article in journal (Refereed) Published
Abstract [en]

BACKGROUND/OBJECTIVES: Normative Mini-mental state examination (MMSE) reference values in elderly are scarce. Therefore, the aim is to present normative MMSE values for 85-93 year olds.

DESIGN: A longitudinal age cohort study.

SETTING: A population study of the residents in the municipality of Linköping, Sweden.

PARTICIPANTS: Residents (n = 650) born in 1922 during the course of 2007. In total, 374 individuals participated and were tested with MMSE at age 85, 280 of these were willing and able to also participate at age 86, 107 at age 90 and 51 at age 93.

MEASUREMENTS: MMSE, from 0-30, with lower scores denoting more impaired cognition.

RESULTS: Median MMSE values for the total population over the ages 85, 86, 90 and 93 years was 28 for all ages investigated. The 25th percentile values were 26, 26, 26 and 27, respectively. For a "brain healthy" sub-group median values were 28, 29, 28, and 28. The 25th percentile values were 27, 28, 26 and 27, respectively. Comparisons for age-effects showed no differences when all individuals for each age group were compared. When only the individuals reaching 93 years of age (n = 50) were analyzed, there was a significant lowering of MMSE in that age group.

CONCLUSION: The literature is variable and in clinical practice a low (24) MMSE cut off is often used for possible cognitive impairment in old age. The present data indicate that MMSE 26 is a reasonable cut off for possible cognitive decline in older persons up to the age of 93. J Am Geriatr Soc 67:534-538, 2019.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019. Vol. 67, no 3, p. 534-538
Keywords [en]
aged 80 and over, dementia test, mental status
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:liu:diva-160367DOI: 10.1111/jgs.15694ISI: 000461567700019PubMedID: 30536796Scopus ID: 2-s2.0-85058337422OAI: oai:DiVA.org:liu-160367DiVA, id: diva2:1352896
Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2019-09-30Bibliographically approved
In thesis
1. Dementia diagnostics in primary care: with a focus on cognitive testing
Open this publication in new window or tab >>Dementia diagnostics in primary care: with a focus on cognitive testing
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Age is the greatest risk factor for developing dementia and the total number of people aged 60 years and above is expected to more than double globally from 2013 to 2050 (1). Primary health care (PHC) is important for basic diagnostic evaluations. Objective test measurements have been shown to be more reliable than a patient's subjective memory complaints in dementia assessments (2). However, several studies indicate the low use of objective cognitive screening tools in dementia diagnostics in PHC (3). Some general practitioners (GPs) do not perceive today’s cognitive instruments as helpful in the diagnostic process and administration problems have been reported in PHC (4, 5).

The overall aim of this thesis was to investigate the accuracy of several cognitive tests used in dementia assessments in PHC, especially among older patients: A Quick Test of Cognitive Speed (AQT), Cognistat and Cognitive Assessment Battery (CAB). The normative values of the Mini Mental Status Examination (MMSE) in the oldest old was also studied.

Methods

The studies included in this thesis are from two different study populations.

  • Studies I, II and IV. Patients with and without cognitive symptoms were recruited from four primary health care centres in Sweden between 2007 and 2009.
  • Study III. The Elderly in Linköping Screening Assessment (ELSA 85) cohort-population examined people born in 1922 in the municipality of Linköping, Sweden.

Results

Study I. Results showed that AQT is a usable test for dementia diagnosis in PHC. Sensitivity for AQT is superior to the Clock Drawing Test (CDT), equivalent to MMSE and the combination MMSE and CDT. The AUC for AQT was 0.773, valued good enough.

Study II. Overall, the results for Cognistat in this study are superior to MMSE and CDT, also in combination. Cognistat is promising for improved dementia diagnosis in PHC with a quick and easily administered multi-domain test for dementia assessments.

Study III. This study presents valuable information about normative MMSE data for the oldest patients. Results, suggest using the 25th percentile in MMSE of 25 to 26 points, and indicate that MMSE 26 is as a reasonable cut-off for cognitive decline and further medical evaluation in older persons aged from 85 to 93 years.

Study IV. In summary, the additive value of the CAB test in dementia investigations in PHC is not obvious. In addition to questionable accuracy, the test is quite time consuming and normative values are scarce. By introducing the numerical sum (CABsum) the accuracy was increased.

Conclusion

In conclusion, objective cognitive tests are an important part of dementia diagnosis in PHC and there is a need for improved instruments and norm-values. From our results, several cognitive quick tests are usable in PHC - MMSE, AQT and Cognistat - but they have some disadvantages. MMSE 26 is a reasonable cut-off for cognitive decline in the oldest patients 85 to 93 years from a well-educated population with quite good socioeconomic. There is a great interest in finding short and better multi-domain instruments but the additive value of CAB in dementia investigations in PHC is questionable.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. p. 80
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1691
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-160371 (URN)10.3384/diss.diva-160371 (DOI)9789176850374 (ISBN)
Public defence
2019-10-18, Berzeliussalen, Hus 463, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2019-10-01Bibliographically approved

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Segernäs Kvitting, AnnaFällman, KatarinaWressle, EwaMarcusson, Jan

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