Mini Mental State Exam sensitivity specificity

While the Mini-Mental State Examination (MMSE) was originally developed to screen for dementia and delirium, many neurologists use this measure as a screening instrument for ‘cognitive impairment’ in hospitalized stroke patients. However, the validity of the MMSE as such has never been evaluated in acute stroke. We administered the MMSE in addition to a neuropsychological examination covering six cognitive domains to 34 stroke patients (mean interval between stroke and examination, 6.5 ± 2.9 days) and 34 healthy controls. The area under the receiver operating characteristic curve (AUC) was calculated in addition to the sensitivity and specificity for various cut-off points on the MMSE.

Seventy percent of the patients were impaired in at least one cognitive domain. The accuracy of the MMSE in detecting cognitive impairment was no better than chance (AUC = 0.67; = 0.13). No optimum MMSE cut-off value could be identified. The MMSE is particularly insensitive to impairments in abstract reasoning, executive functioning, and visual perception/construction.

Keywords

• Mini-Mental State Examination (MMSE);
• Stroke;
• Construct validity;
• Neuropsychological assessment

1. Introduction

Cognitive disorders in the acute stage of stroke are common and are important independent predictors of adverse outcome in the long term. Therefore, a whole range of brief cognitive measures has been used to screen for cognitive impairment in patients with acute stroke. The Mini-Mental State Examination (MMSE) is currently the mainstay of screening instruments. This instrument was originally developed to screen for dementia and delirium in a psychiatric setting, and has been shown to have a good sensitivity and specificity as such. Subsequently, the use of the MMSE has been extended and many studies now use it as a screening instrument for ‘global cognitive impairment’ (e.g. ; ). However, the validity of the MMSE as a cognitive screening instrument has been questioned in both neurological and psychiatric patients (; ). Moreover, there is no consensus in the cut-off values that are applied to discriminate between cognitively intact and impaired patients.