Examining the validity of the Mini-Mental State Examination (MMSE) and its domains using network analysis.
Mini-Mental State Examination
cognitive domains
network analysis
neuropsychological assessments
Journal
Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society
ISSN: 1479-8301
Titre abrégé: Psychogeriatrics
Pays: England
ID NLM: 101230058
Informations de publication
Date de publication:
22 Dec 2023
22 Dec 2023
Historique:
revised:
04
12
2023
received:
06
06
2023
accepted:
11
12
2023
medline:
22
12
2023
pubmed:
22
12
2023
entrez:
22
12
2023
Statut:
aheadofprint
Résumé
The Mini-Mental State Examination (MMSE) is the most widely used standardised screener for impairments across a range of cognitive domains. However, the degree to which its domains (orientation, registration, attention, recall, language, and visuospatial) capture cognitive functioning measured using standardised neuropsychological tests is unclear. A longitudinal research design with four biannual assessments over a 6-year period was used with an initial sample of 1037 older adults (aged above 70 years). Participants completed MMSE and neuropsychological tests at each assessment. Network analysis was utilised to investigate unique associations among the MMSE and its domains and neuropsychological test performance at each time point. The total MMSE and two of its domains, language and recall, were associated with neuropsychological memory performance. The MMSE orientation, registration and visuospatial domains did not have any unique associations with neuropsychological performance. No stable internal interconnections between MMSE domains were found over time. The association of total MMSE as well as its recall domain with neuropsychological memory performance remained very similar over the 6-year period. The present study adds evidence to the validity of the MMSE and supports the clinical usage of the MMSE, whereby the total score is used for screening patients with or without cognitive impairments, with repeated administration to monitor cognitive changes over time, to inform intervention. However, the tool is not able to diagnose the cases for changes in specific cognitive domains and as such, should not replace a complete neuropsychological assessment.
Sections du résumé
BACKGROUND
BACKGROUND
The Mini-Mental State Examination (MMSE) is the most widely used standardised screener for impairments across a range of cognitive domains. However, the degree to which its domains (orientation, registration, attention, recall, language, and visuospatial) capture cognitive functioning measured using standardised neuropsychological tests is unclear.
METHOD
METHODS
A longitudinal research design with four biannual assessments over a 6-year period was used with an initial sample of 1037 older adults (aged above 70 years). Participants completed MMSE and neuropsychological tests at each assessment. Network analysis was utilised to investigate unique associations among the MMSE and its domains and neuropsychological test performance at each time point.
RESULTS
RESULTS
The total MMSE and two of its domains, language and recall, were associated with neuropsychological memory performance. The MMSE orientation, registration and visuospatial domains did not have any unique associations with neuropsychological performance. No stable internal interconnections between MMSE domains were found over time. The association of total MMSE as well as its recall domain with neuropsychological memory performance remained very similar over the 6-year period.
CONCLUSIONS
CONCLUSIONS
The present study adds evidence to the validity of the MMSE and supports the clinical usage of the MMSE, whereby the total score is used for screening patients with or without cognitive impairments, with repeated administration to monitor cognitive changes over time, to inform intervention. However, the tool is not able to diagnose the cases for changes in specific cognitive domains and as such, should not replace a complete neuropsychological assessment.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 The Authors. Psychogeriatrics published by John Wiley & Sons Australia, Ltd on behalf of Japanese Psychogeriatric Society.
Références
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198.
Lacy M, Kaemmerer T, Czipri S. Standardized mini-mental state examination scores and verbal memory performance at a memory center:implications for cognitive screening. Am J Alzheimers Dis Other Dement 2015; 30: 145-152.
Norris DR, Clark MS, Shipley S. The mental status examination. Am Fam Physician 2016; 94: 635-641.
Brayne C. The mini-mental state examination, will we be using it in 2001? Int J Geriatr Psychiatry 1998; 13: 285-290.
Tierney MC, Szalai JP, Snow WG, Fisher RH, Dunn E. Domain specificity of the subtests of the mini-mental state examination. Arch Neurol 1997; 54: 713-716.
Ciolek CH, Lee SY. Cognitive issues in the older adult. In: Avers D, Wong RA, editors. Guccione's Geriatric Physical Therapy. 4th ed. Missouri: Mosby; 2019. p. 425-452.
Cameron J, Worrall-Carter L, Page K, Stewart S, Ski C. Screening for mild cognitive impairment in patients with heart failure: Montreal cognitive assessment versus mini mental state exam. Eur J Cardiovasc Nurs 2012; 12: 252-260.
El-Hayeck R, Baddoura R, Wehbé A et al. An Arabic version of the mini-mental state examination for the Lebanese population: reliability, validity, and normative data. J Alzheimers Dis 2019; 71: 525-540.
Feeney J, Savva GM, O'Regan C, King-Kallimanis B, Cronin H, Kenny RA. Measurement error, reliability, and minimum detectable change in the mini-mental state examination, Montreal cognitive assessment, and color trails test among community living middle-aged and older adults. J Alzheimers Dis 2016; 53: 1107-1114.
Horton AM Jr, Slone DG, Shapiro S. Neuropsychometric correlates of the mini-mental state examination: preliminary data. Percept Mot Skills 1987; 65: 64-66.
Mitrushina M, Satz P. Effect of repeated administration of a neuropsychological battery in the elderly. J Clin Psychol 1991; 47: 790-801.
Wechsler D. WAIS-R Manual: Wechsler Adult Intelligence Scale-Revised. New York: Psychological Corporation, 1981.
Schmitt AL, Livingston RB, Goette WF, Galusha-Glasscock JM. Relationship between the mini-mental state examination and the repeatable battery for the assessment of neuropsychological status in patients referred for a dementia evaluation. Percept Mot Skills 2016; 123: 606-623.
Randolph C, Tierney MC, Mohr E, Chase TN. The repeatable battery for the assessment of neuropsychological status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol 1998; 20: 310-319.
Ramirez D, Wood RC, Becho J, Owings K, Espino DV. Mini-mental state exam domains predict falls in an elderly population: follow-up from the Hispanic established populations for epidemiologic Studiesof the elderly (H-EPESE) study. Ethn Dis 2010; 20: 48-52.
Strauss E, Sherman EM, Spreen O. A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. New York: Oxford University Press; 2006.
McGrew KS. CHC theory and the human cognitive abilities project: standing on the shoulders of the giants of psychometric intelligence research. Dermatol Int 2009; 37: 1-10.
Miyake A, Friedman NP. The nature and organization of individual differences in executive functions: four general conclusions. Curr Dir Psychol Sci 2012; 21: 8-14.
Borsboom D, Cramer AO. Network analysis: an integrative approach to the structure of psychopathology. Annu Rev Clin Psychol 2013; 9: 91-121.
Contreras A, Nieto I, Valiente C, Espinosa R, Vazquez C. The study of psychopathology from the network analysis perspective: a systematic review. Psychother Psychosom 2019; 88: 71-83.
Barcaccia B, Cervin M, Pozza A, Medvedev ON, Baiocco R, Pallini S. Mindfulness, self-compassion and attachment: a network analysis of psychopathology symptoms in adolescents. Mind 2020; 11: 2531-2541.
Cholerton B, Larson EB, Quinn JF et al. Precision medicine: clarity for the complexity of dementia. Am J Pathol 2016; 186: 500-506.
Chalmers RA, Cervin M, Choo C et al. Networks of inflammation, depression, and cognition in aging males and females. Aging Clin Exp Res 2022;34:2387-2398.
Borsboom D, Deserno MK, Rhemtulla M et al. Network analysis of multivariate data in psychological science. Nat Rev Methods Primers 2021; 1: 1-18.
Heeren A, McNally RJ. An integrative network approach to social anxiety disorder: the complex dynamic interplay among attentional bias for threat, attentional control, and symptoms. J Anxiety Disord 2016; 42: 95-104.
Åkerblom S, Cervin M, Perrin S, Rivano Fischer M, Gerdle B, McCracken LM. A network analysis of clinical variables in chronic pain: a study from the Swedish quality registry for pain rehabilitation (SQRP). Pain Med 2021; 22: 1591-1602.
Sachdev PS, Brodaty H, Reppermund S et al. The Sydney memory and ageing study (MAS): methodology and baseline medical and neuropsychiatric characteristics of an elderly epidemiological non-demented cohort of Australians aged 70-90 years. Int Psychogeriatr 2010; 22: 1248-1264.
Trollor JN, Smith E, Agars E et al. The association between systemic inflammation and cognitive performance in the elderly: the Sydney memory and ageing study. Age 2012; 34: 1295-1308.
Wechsler D. WISC-IV: Administration and Scoring Manual. Texas: Psychological Corporation, 2003.
Tombaugh TN. Trail making test a and B: normative data stratified by age and education. Arch Clin Neuropsychol 2004; 19: 203-214.
Kaplan E, Goodglass H, Weintraub S, Segal O. Boston naming test. Philadelphia: Lippincott Williams & Wilkins, 2001.
Spreen O. Neurosensory Center Comprehensive Examination for Aphasia. British Columbia: Neuropsychological Laboratory, 1977.
Benton AL. Problems of test construction in the field of aphasia. Cortex 1967; 3: 32-58.
Reitan RM, Wolfson D. The Halstead-Reitan Neuropsychological Test Battery. Theory and Clinical Interpretation. South Tucson: Neuropsychology Press, 1993.
Wechsler D. Wechsler adult intelligence scale: WAIS-R manual: Harcourt Brace Jovanovich [for] The Psychological Corporation, 1981.
Wechsler D. Wechsler Memory Scale (WMS-III). San Antonio, TX: The Psychological Corporation; 1997.
Benton AL, Sivan AB, Spreen O. Der Benton Test. Bern: Huber, 1996.
Williams DR, Mulder J. BGGM: Bayesian Gaussian graphical models in R. J Open Source Softw 2020; 5: 2111.
Hespanhol L, Vallio CS, Costa LM, Saragiotto BT. Understanding and interpreting confidence and credible intervals around effect estimates. Braz J Phys Ther 2019; 23: 290-301.
Fruchterman TMJ, Reingold EM. Graph drawing by force-directed placement. Softw - Pract Exp 1991; 21: 1129-1164.
Epskamp S, Cramer AO, Waldorp LJ, Schmittmann VD, Borsboom D. Qgraph: network visualizations of relationships in psychometric data. J Stat Softw 2012; 48: 1-18.
Robinaugh DJ, Millner AJ, McNally RJ. Identifying highly influential nodes in the complicated grief network. J Abnorm Psychol 2016; 125: 747-757.
Jones PJ, Heeren A, McNally RJ. Commentary: a network theory of mental disorders. Front Psychol 2017; 8: 1305.
Haslbeck J, Waldorp LJ. How well do network models predict observations? On the importance of predictability in network models. Behav Res Methods 2018; 50: 853-861.
Muthén B, Kaplan D. A comparison of some methodologies for the factor analysis of non-normal Likert variables. Br J Math Stat Psychol 1985; 38: 171-189.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Washington, DC: American Psychiatric Association, 2013.
Truong QC, Choo C, Numbers K et al. Clinical investigation of dynamic and enduring aspects of global cognition in aged population. Eur J Clin Invest 2022; 52: e13681.
Harvey PD. Domains of cognition and their assessment. Dialogues Clin Neurosci 2022; 21: 227-237.
Spearman C. The measurement of intelligence. Nature 1927; 120: 577-578.