Thai Mental State Examination

Mental state examination

Mini-Mental State Examination sentence writing among community-dwelling elderly adults in Brazil: text fluency and grammar complexity

a1 Faculty of Education and Faculty of Medical Sciences – State University of Campinas, Campinas – SP – Brazil

a2 Faculty of Education – State University of Campinas – SP – Brazil

a3 Department of Gerontology, School of Arts, Sciences and Humanities – University of São Paulo, São Paulo – SP – Brazil


Background: In normal aging, the decrease in the syntactic complexity of written production is usually associated with cognitive deficits. This study was aimed to analyze the quality of older adults' textual production indicated by verbal fluency (number of words) and grammatical complexity (number of ideas) in relation to gender, age, schooling, and cognitive status.

Methods: From a probabilistic sample of community-dwelling people aged 65 years and above (n = 900), 577 were selected on basis of their responses to the Mini-Mental State Examination (MMSE) sentence writing, which were submitted to content analysis; 323 were excluded as they left the item blank or performed illegible or not meaningful responses. Education adjusted cut-off scores for the MMSE were used to classify the participants as cognitively impaired or unimpaired. Total and subdomain MMSE scores were computed.

Results: 40.56% of participants whose answers to the MMSE sentence were excluded from the analyses had cognitive impairment compared to 13.86% among those whose answers were included. The excluded participants were older and less educated. Women and those older than 80 years had the lowest scores in the MMSE. There was no statistically significant relationship between gender, age, schooling, and textual performance. There was a modest but significant correlation between number of words written and the scores in the Language subdomain.

Conclusions: Results suggest the strong influence of schooling and age over MMSE sentence performance. Failing to write a sentence may suggest cognitive impairment, yet, instructions for the MMSE sentence, i.e. to produce a simple sentence, may limit its clinical interpretation.

Key words:

  • text production;
  • fluency;
  • syntactical complexity;
  • cognitive status;
  • aging


c1 Correspondence should be addressed to: Prof. Dr. Anita Liberalesso Neri, PhD, Graduate Program of Gerontology, Faculty of Medical Sciences, State University of Campinas UNICAMP. Avenida Tessália Vieira de Camargo, 126, Cidade Universitária “Zeferino Vaz”, Distrito de Barão Geraldo Campinas SP, CEP. 13.083-887, Brazil. Phone: +-9087; Fax: +-9087. e-mail: .

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