nd Edition Overview Original MMSE is one of the most widely used brief screening instruments for cognitive impairment Has been used in a variety of settings including screening individual patients tracking progress over time screening for large populations and clinical trials ID: 529339
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Slide1
Mini-Mental State Examination - 2nd EditionSlide2
OverviewOriginal MMSE is one of the most widely used brief screening instruments for cognitive impairment
Has been used in a variety of
settings,
including screening individual patients, tracking progress over time, screening for large populations, and clinical trialsSlide3
Goals for the Revision
Revise some of the original items to better standardize its administrations, particularly for translations
Provide an even briefer version that could be used for rapid assessment
Provide a slightly longer version that would be more sensitive to
subcortical
dementia and that would not have a ceiling effect
Develop equivalent alternate forms to decrease practice effects in serial administrationSlide4
Goal #1: Revise Original ItemsThe MMSE-2 Standard Version (MMSE-2:SV) maintains the same structure and scoring as the original MMSE
Changes were made to improve problematic items and to better standardize administration in other languages (e.g., penny, no if, ands, or buts)Slide5
MMSE-2: Standard Version
Task
Description
Identical
task on Original MMSE
Revision on
MMSE-2:SV
Registration & Recall
Ability
to repeat and retain three unrelated words, and then recall after a short intervention task
Words have been made slightly
more difficult and easier to translate
Orientation to Time
Identify current year, season, month, day of the week, and date
X
Orientation to Place
Identify state, county, city/town, building, and floor
currently in
X
Attention &
Calculation (Serial 7s)
Count backwards
by 7s
X
No
longer can use WORLD spelled backwards as alternate task
Naming
Ask to identify body parts when pointed to by examiner
Change from “watch” and “pencil” to body parts allows for translation and no use of external materials
Repetition
Required to repeat a sentence that contains words not often said
together
Revised to include a sentence that is easier to translate
and d
ifficulty
slightly decreased
Comprehension
Understand and carry out a three-stage
verbal command
Removed
the reliance on motor responses.
Reading
Read and follow instructions
X
Writing
Asked to write a sentence
X
Drawing
Asked to copy intersecting pentagons
XSlide6
Equivalency Between the MMSE and MMSE-2:SV
Like the MMSE, the MMSE-2:SV has a raw score range of 0-30
The
generalizability
coefficient (
n
= 411) between the MMSE and the MMSE-2:SV total raw score was .97
Therefore it is possible to switch from MMSE to the MMSE-2:SV without compromising longitudinal data and without any change in the normal range of scoresSlide7
Goal #2: Develop Briefer Version
Can be used for quick cognitive screener, specifically when an individual has
not
been referred for specific cognitive impairment
Composed of Registration/Recall, Orientation to Time, and Orientation to Place
Raw score ranges from 0-16 points
Tasks were selected based on literature review, use in the MMSE, and their sensitivity and specificity to detect dementiaSlide8
MMSE-2: Brief VersionSlide9
Goal #3: Develop Expanded Version
Consists of all of the items on the MMSE-2:SV plus two new tasks:
Story Memory: An immediate recall of a brief story
Processing Speed: A symbol-digit coding taskSlide10
MMSE-2: Expanded Version
Improves the clinical utility of the MMSE by:
Extending the test’s ceiling
Increasing the range of raw scores (0-90)
Increasing the sensitivity for individuals with less severe cognitive impairment (
subcortical
dementia, MCI)Slide11Slide12Slide13
Goal #4: Develop Equivalent Alternate Forms
Two forms (Blue and Red) were developed for each of the 3 versions of the MMSE-2
Based on the results of the equating study, the accuracy of the equating process was confirmed Slide14
Equating: MMSE & MMSE-2:SVSlide15
Administration Issues
18 years and older
Relatively easy to administer, typically one training session is sufficient
Test Materials:
User’s Manual
Pocket Norms Guide
Scoring Templates for Processing Speed
Administration Forms :
MMSE-2:BV Blue and Red Form
MMSE-2:SV Blue and Red Form
MMSE-2:EV Blue and Red FormSlide16
Overview of Administration Forms
Task
MMSE
MMSE-2:BV
MMSE-2:SV
MMSE-2:EV
Registration & Recall
X
X
X
X
Orientation to Time
X
X
X
X
Orientation to Place
X
X
X
X
Attention &
Calculation (Serial 7s)
X
X
X
Naming
X
X
X
Repetition
X
X
X
Comprehension
X
X
X
Reading
X
X
X
Writing
X
X
X
Drawing
X
X
X
Story Memory
X
Processing Speed
XSlide17
Determining Which Version is Appropriate
MMSE-2:BV
Adequate for screening large populations; screening individuals in practice who have
not
been referred because of cognitive complaints
MMSE-2:SV
Used first if referred because of complaint of cognitive decline or if patient indicates memory is not as good as it use to be; depending on results may want to supplement with MMSE-2:EV
MMSE-2:EV
Same as above + well educated (ceiling effect); suspected
subcortical
dementiaSlide18
Scoring
Mean raw total scores are presented by age and education level
T
scores are also presented by age and education level
Pocket Guide
Reliable Change ScoresSlide19
Reliable Change Scores
Reliable
change
refers to the extent to which
the change
in test performance shown by an
individual falls
beyond the range that can be attributed to
practice effects
or to measurement
variability that
is inherent to the instrument
itself
The approach
used here is a method developed
by Iverson
(2001
)Slide20
Interpretation
A cut score of 22/23 is typically used with the original MMSE
Because the MMSE-2:SV is equivalent to the MMSE, the same cut score is suggested
The authors have not provided specific recommendations for the new forms, however ranges of raw score cut scores are provided for the dementia, AD, and
subcortical
samples by formSlide21
Example of Cutoff TableSlide22
Development
Task Development – 5 additional tasks were tested
Bias Panel – assessed potential bias and offensiveness to protected groups
Expert Review:
2 neuropsychologist, 1 geriatric psychologist, 1 geriatric psychiatrist
Aided in selection of tasks, provided feedback on content, and assisted with refining items and instructions for the pilot and standardization versionsSlide23
Pilot TestingSlide24
Standardization Sample
n
= 1,531 healthy controlsSlide25
Cognitively Impaired SamplesSlide26
Effects of Age and EducationSlide27
Development of the Norms
Because of the importance of age and education on MMSE-2 scores norms were developed for several different age and education ranges
Two resources for age and education adjustments are provided:
Means and standard deviations of total raw scores by age and education groups
Age- and education-adjusted
T
scores (continuous
norming
method)Slide28
Reliability: Internal ConsistencySlide29
Reliability: Test RetestSlide30
Reliability: InterraterSlide31
Validity
Content Validity
– similar items on other tests (e.g., Serial 7s similar to attention and concentration task on WMS-III)
Intercorrelations
among task and total scores (presented for both the normative and clinical samples)
Diagnostic Validity
: Prior work on the MMSE using 22/23 or 23/24Slide32
Validity
Convergent Validity
:
WMS-III subtests
Category Naming Test
COWA
BNT
TMT
WAIS-R subtests
JOLO
HVLT-R
Stroop
Color and Word Test