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Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.4 no.1 São Paulo Jan./Mar. 2010

http://dx.doi.org/10.1590/S1980-57642010DN40100006 

Original Articles

The Mini Mental State Examination: Review of cutoff points adjusted for schooling in a large Southern Brazilian sample

Mini Exame do Estado Mental: revisão de pontos de corte ajustados para a escolaridade em uma grande amostra do sul do Brasil

Renata Kochhann1  2 

Juliana Santos Varela2 

Carolina Saraiva de Macedo Lisboa3 

Márcia Lorena Fagundes Chaves2  4 

1Medical Sciences Post-Graduate Course, UFRGS School of Medicine.Brazil

2Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre. Brazil

3Internal Psychology Department, UNISINOS School of Psychology Brazil

4Internal Medicine Department, UFRGS School of Medicine. Brazil

Abstract

The increase in life expectancy can influence the prevalence of dementias in the population. Instruments that evaluate cognitive functions such as the Mini Mental State Examination (MMSE) are necessary for the investigation of dementia. The supposition that patient score on the MMSE can be influenced by academic level points to the need for establishing cut-off values that take into account educational level. The aim of this study was to review MMSE cut-off values adjusted for schooling in a large southern Brazilian sample. Method: Demographic data and MMSE scores of 968 subjects, of which 162 were dementia patients and 806 healthy participants, were analyzed. The sample was grouped according to education. The cut-off values were established by ROC Curve analysis. Results: The total sample mean age was 70.6±7.3 years, and the mean years of education was 7.2±5.3. The cut-off score of 23 points (sensitivity=86%, specificity=83%) was observed as the optimal level to detect dementia on the MMSE instrument for the overall sample. Regarding level of schooling, the cut-off values were: 21 for the illiterate group (sensitivity=93%, specificity=82%), 22 for the low education group (sensitivity=87%, specificity=82%), 23 for the middle education group (sensitivity=86%, specificity=87%) and 24 for the high education group (sensitivity=81%, specificity=87%). Conclusions: The cut-off values revealed by this analysis, and adjusted for level of schooling, can improve the clinical evaluation of cognitive deficits.

Key words: Mini Mental State Examination; cognition; cognitive assessment; educational attainment; cutoffs

Resumo

A elevação da expectativa de vida pode influenciar na prevalência das demências na população. Instrumentos que avaliem as funções cognitivas, como o Mini Exame do Estado Mental (MEEM), são necessários para a investigação de demência. A suposição de que o resultado do MEEM de um paciente pode ser influenciado pelo nível de escolaridade demonstra a necessidade do estabelecimento de pontos de corte que levem em consideração a escolaridade. O objetivo deste estudo foi revisar os pontos de corte do MEEM ajustados para a escolaridade em uma grande amostra do sul do Brasil. Método: Dados demográficos e escores do MEEM de 968 indivíduos, 162 pacientes com demência e 806 participantes saudáveis foram analisados. A amostra foi agrupada de acordo com a educação. Para estabelecer os pontos de corte foi utilizada a Curva ROC. Resultados: A média de idade da amostra total foi 70,6±7,3 e a média de anos de estudo foi 7,2±5,3. O ponto de corte 23 (sensibilidade=86%), (especificidade=83%) foi o ponto que melhor detectou demência na amostra total. Considerando o nível de escolaridade, os pontos de corte foram: 21 no grupo de analfabetos (sensibilidade=93%, especificidade=82%), 22 no grupo de baixa escolaridade (sensibilidade=87%, especificidade=82%), 23 no grupo de média escolaridade (sensibilidade=86%, especificidade=87%) e 24 no grupo de alta escolaridade (sensibilidade=81%, especificidade=87%). Conclusões: Os pontos de corte, quando se considera a escolaridade, podem aperfeiçoar a avaliação clínica dos déficits cognitivos.

Palavras-chave: Mini Exame do Estado Mental; cognição; avaliação cognitiva; nível educacional; pontos de corte

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Received: October 30, 2009; Accepted: January 27, 2010

Márcia L.F. Chaves - Rua Ramiro Barcelos 2350 / sala 2040 - 90035-091 Porto Alegre RS - Brazil. Email: mchaves@hcpa.ufrgs.br

Disclosure: The authors report no conflicts of interest

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