Background/Aims: Almost half of community-dwelling patients and 59.6% of institutionalized residents with dementia are in moderate or severe stages of this disease. The Mini-Mental State Examination (MMSE) has limited applicability to these patients due to floor effects. We aimed to determine the correlation between the MMSE and the Severe Mini-Mental State Examination (SMMSE), as well as SMMSE association with functional scales in patients having moderate to severe dementia and low levels of education. Methods: A cross-sectional study of patients 60 years or older attending an outpatient clinic was conducted. The MMSE, SMMSE and functional scales were applied. Clinical and demographic data from medical records were reviewed. Results: Seventy-five patients with a mean of 4.1 ± 3.6 years of education were analyzed. The mean scores on the MMSE and SMMSE were 7.8 ± 7.0 and 17.8 ± 9.4, respectively. The results indicated that the MMSE and SMMSE correlated only in patients who had an MMSE score of less than 10 (r = 0.87; p < 0.001). In addition, significant correlations were found between the SMMSE and functional scales (p < 0.001). It was observed that educational level did not interact with SMMSE performance. Conclusion: The SMMSE is a useful and reliable tool for a brief cognitive assessment of advanced dementia patients with low educational levels.

Keywords:
Cognition, Neuropsychological tests, Alzheimer’s disease
1.
Rodriguez JJL, Ferri CP, Acosta D, Guerra M, Huang Y, Jacob KS, et al: Prevalence of dementia in Latin America, India and China: a population-based cross-sectional survey. Lancet 2008;372:464–474.
2.
Helmer C, Pérès K, Letenneur L, Guttiérez-Robledo LM, Ramaroson H, Barberger-Gateau P, Fabrigoule C, Orgogozo J-M, Dartigues J-F: Dementia in subjects aged 75 years or over within the PAQUID cohort: prevalence and burden by severity. Dement Geriatr Cogn Disord 2006;22:87–94.
3.
Albert M, Cohen C: The test for severe impairment: an instrument for the assessment of patients with severe cognitive dysfunction. J Am Geriatr Soc 1992;40:449–453.
4.
Saxton J, McGonigle-Gibson K, Swihart A, et al: Assessment of the severely impaired patient: description and validation of a new neuropsychological test battery. Psychol Assess 1990;2:298–303.
5.
Pélissier C, Roudier M, Boller F: Factorial validation of the severe impairment battery for patients with Alzheimer’s disease. Dement Geriatr Cogn Disord 2002;13:95–100.
6.
Peavy G, Salmon DP, Rice VA, et al: Neuropsychological assessment of severely demented elderly. Arch Neurology 1996;53:367–372.
7.
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.
8.
Harrell LE, Marson D, Chatterjee A, Parrish JA: The Severe Mini-Mental State Examination: a new neuropsychologic instrument for the bedside assessment of severely impaired patients with Alzheimer disease. Alzheimer Dis Assoc Disord 2000;14:168–175.
9.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4, text revision. Washington, American Psychiatric Association, 2000.
10.
Morris J: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412–414.
11.
Wajman JR, Bertolucci PHF: Comparison between neuropsychological evaluation instruments for severe dementia. Arq Neuropsiquiatr 2006;64:736–740.
12.
Sclan SG, Reisberg B: Functional Assessment Staging (FAST) in Alzheimer’s disease: reliability, validity, and ordinality. Int Psychogeriatr 1992;4(suppl 1):55–69.
13.
Katz S, Down TD, Cash HR, et al: Progress in the development of the index of ADL. Gerontologist 1970;10:20–30.
14.
Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S: Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323–329.
15.
Cummings JL, Mega M, Gary K, Rosenberg-Thompson S, Carusi DA, Gornbein J: The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308–2314.
16.
Goulart MTC, Fegyveres RA, Schultz RR, Okamoto I, Caramelli P, Bertolucci PHF Nitrini R: Versão Brasileira da Escala Cornel de Depressão em Demência. Arq Neuropsiquiatr 2007;65:912–915.
17.
Brayne C, Calloway P: The association of education and socioeconomic status with the Mini-Mental State Examination and the clinical diagnosis of dementia in elderly people. Age Aging 1990;19:91–96.
18.
Bertolucci PHF, Brucki SMD, Campacci SR, et al: O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1–7.
19.
Herrmann N, Gauthier S: Diagnosis and treatment of dementia: management of severe Alzheimer disease. CMAJ 2008;179:1279–1287.
20.
Schmitt FA, Wichems CH: A systematic review of assessment and treatment of moderate to severe Alzheimer’s disease. Prim Care Companion J Clin Psychiatry 2006;8:158–169.
21.
Draper B: Practical geriatrics: the diagnosis and treatment of depression in dementia. Psychiatr Serv 1999;50:1151–1153.
22.
Auer SR, Scalan SG, Yaffee RA, et al: The neglected half of Alzheimer’s disease: cognitive and functional components of severe dementia. J Am Geriatr Soc 1994;42:1266–1272.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.