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Prediction of Probable Alzheimer Disease in Patients With Symptoms Suggestive of Memory Impairment
Value of the Mini-Mental State Examination
Mary C. Tierney, PhD;
John P. Szalai, PhD;
Earl Dunn, MD;
Daphne Geslani;
Ian McDowell, PhD
Arch Fam Med. 2000;9:527-532.
Background The Mini-Mental State Examination (MMSE) is a widely used diagnostic tool for dementia. Its use as a predictive indicator of probable Alzheimer disease (AD) has not been established.
Objectives To determine the accuracy of the MMSE in predicting emergent AD in a sample of patients who were referred because of symptoms suggestive of memory problems and to determine whether an abbreviated version of the MMSE could be developed that would be as accurate as the full MMSE in predicting emergent AD.
Design Inception cohort of participants with symptoms suggestive of memory impairment by their family physicians were given baseline assessments, including MMSE. After 2 years, the participants' conditions were diagnosed following the standard criterion for AD. Diagnosticians were blind to baseline scores.
Setting and Participants One hundred eighty-three community-residing participants were referred by their family physicians to a university teaching hospital research investigation. After baseline screening, 165 participants were included in the study who did not have dementia and had no identifiable cause for memory impairment. After 2 years, 29 participants met criteria for AD, 98 did not develop dementia, 18 developed vascular lesions or non-AD dementia, and 20 did not return.
Main Outcome Measure Diagnostic classification of AD or no evidence of dementia.
Results Logistic regression model was significant. At a cutoff score of 24 or less, sensitivity was 31%; specificity, 96%; with a likelihood ratio of 7.75. A reduced model of 2 subtests was identified with a sensitivity of 41%; specificity, 98%; with a likelihood ratio of 20.70.
Conclusions Results suggest that the full or abbreviated MMSE is useful in predicting emergent AD in patients with postive test results. However, it is not recommended for use as a screening or diagnostic instrument since a negative test result did not rule out emergent AD. It is recommended as a tool to identify those needing closer monitoring.
From Geriatric Research and the Department of Family and Community Medicine (Drs Tierney and Dunn and Ms Geslani), Clinical Epidemiology and Health Services Research (Dr Szalai), Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario; and the Department of Epidemiology University of Ottawa, Ottawa, Ontario (Dr McDowell).
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