Hostname: page-component-745bb68f8f-l4dxg Total loading time: 0 Render date: 2025-02-09T20:12:44.834Z Has data issue: false hasContentIssue false
  • English
  • Français

Limits of the ‘Mini-Mental State’ as a screening test for dementia and delirium among hospital patients

Published online by Cambridge University Press:  09 July 2009

James C. Anthony ,
Linda LeResche ,
Unaiza Niaz ,
Michael R. Von Korff  and
Marshal F. Folstein
James C. Anthony*
Affiliation:
Department of Mental Hygiene, Johns Hopkins School of Hygiene and Public Health, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Linda LeResche
Affiliation:
Department of Mental Hygiene, Johns Hopkins School of Hygiene and Public Health, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Unaiza Niaz
Affiliation:
Department of Mental Hygiene, Johns Hopkins School of Hygiene and Public Health, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Michael R. Von Korff
Affiliation:
Department of Mental Hygiene, Johns Hopkins School of Hygiene and Public Health, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Marshal F. Folstein
Affiliation:
Department of Mental Hygiene, Johns Hopkins School of Hygiene and Public Health, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
*
1Address for correspondence: Dr James C. Anthony, Department of Mental Hygiene, Johns Hopkins School of Hygiene and Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
Get access Rights & Permissions [Opens in a new window]

Synopsis

With a psychiatrist's standardized clinical diagnosis as the criterion, the ‘Mini-Mental State’ Examination (MMSE) was 87% sensitive and 82% specific in detecting dementia and delirium among hospital patients on a general medical ward. The false positive ratio was 39% and the false negative ratio was 5 %. All false positives had less than 9 years of education; many were 60 years of age or older. Performance on specific MMSE items was related to education or age. These findings confirm the MMSE's value as a screen instrument for dementia and delirium when later, more intensive diagnostic enquiry is possible; they reinforce earlier suggestions that the MMSE alone cannot yield a diagnosis for these conditions.

Type
Research Article
Information
Psychological Medicine , Volume 12 , Issue 2 , May 1982 , pp. 397 - 408
Copyright
Copyright © Cambridge University Press 1982

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Amante, D., Van Houten, V. W., Grieve, J. H., Bader, C. A. & Margules, P. H. (1977). Neuropsychological deficit, ethnicity, and socioeconomic status. Journal of Consulting and Clinical Psychology 45, 524–535.CrossRefGoogle ScholarPubMed
Carr, A. C. (1975). Psychological testing of intelligence and personality. In Comprehensive Textbook of Psychiatry II, Vol. 1. (ed. Freedman, A. M., Kaplan, H. I. and Saddock, B. J.), pp. 736–757. Williams & Wilkins: Baltimore.Google Scholar
DePaulo, J. R. & Foistein, M. F. (1978). Psychiatric disturbances in neurological patients: detection, recognition, and hospital course. Annals of Neurology 4, 225–228.CrossRefGoogle ScholarPubMed
Eaton, W. W., Regier, D. A., Locke, B. Z. & Taube, C. A. (1981). The Epidemiologic Catchment Area Program of the National Institute of Mental Health. Public Health Reports 96, 319–322.Google ScholarPubMed
Fleiss, J. L. (1973). Statistical Methods for Rates and Proportions. John Wiley and Sons: New York.Google Scholar
Folstein, M. F. & McHugh, P. R. (1976). Phenomenological approach to the treatment of ‘organic’ psychiatric syndromes. In The Therapist's Handbook: Treatment Methods for Menial Disorders (ed. Wolman, B.), pp. 279–286. Van Nostrand-Reinhold: New York.Google Scholar
Folstein, M. F. & McHugh, P. R. (1979). Psychopathology of dementia: implications for neuropathology. In Congenital and Acquired Cognitive Disorders (ed. Katzman, R.), pp. 17–30. Raven Press: New York.Google Scholar
Foistein, M. F., Foistein, S. E. & McHugh, P. R. (1975). ‘MiniMental State’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.Google Scholar
Goldberg, D. (1978). The Manual of the General Health Questionnaire. NFER Publishing Company, Windsor.Google Scholar
Hinton, J. & Withers, E. (1971). The usefulness of the clinical tests of the sensorium. British Journal of Psychiatry 119, 9–18.CrossRefGoogle ScholarPubMed
Inglis, J. & Lawson, J. S. (1981). Sex differences in the effects of unilateral brain damage on intelligence. Science 212, 693–695.CrossRefGoogle ScholarPubMed
Jacobs, J. W., Bernhard, M. R., Delgado, A. & Strain, J. J. (1977). Screening for organic mental syndromes in the medically ill. Annals of Internal Medicine 86, 40–46.CrossRefGoogle ScholarPubMed
Kahn, R. L., Pollack, M. & Goldfarb, A. I. (1961). Factors related to individual differences in mental status of institutionalized aged. In Psychopathology of Aging (ed. Hoch, P. H. and Zubin, J.), pp. 104–113. Grune and Stratton: New York.Google Scholar
Katz, N. M., Agle, D. P., DePalma, R. G. & DeCosse, J. J. (1972). Delirium in surgical patients under intensive care. Archives of Surgery 104, 310–313.CrossRefGoogle ScholarPubMed
Kay, D. W. K. (1977). The epidemiology and identification of brain deficit in the elderly. In Cognitive and Emotional Disturbance in the Elderly. Clinical Issues (ed. Eisdorfer, C. and Friedel, R. O.), pp. 11–26. Year Book Medical Publishers, Inc: New York.Google Scholar
Knights, E. B. & Folstein, M. F. (1977). Unsuspected emotional and cognitive disturbance in medical patients. Annals of internal Medicine 87, 723–724.CrossRefGoogle ScholarPubMed
Lansdall, H. (1968). The use of factor scores from the Wechsler– Bellevue Scale of Intelligence in assessing patients with temporal lobe removals. Cortex 4, 257–268.CrossRefGoogle Scholar
McGlone, J. & Kertesz, A. (1973). Sex differences in cerebral processing of visuospatial tasks. Cortex 9, 313–320.CrossRefGoogle ScholarPubMed
Natelson, B. H., Haupt, E. J., Fleischer, E. J. & Grey, L. (1979). Temporal orientation and education. A direct relationship in normal people. Archives of Neurology 36, 444–446.CrossRefGoogle ScholarPubMed
Parsons, O. A. & Prigatano, G. P. (1978). Methodological considerations in clinical neuropsychological research. Journal of Consulting and Clinical Psychology 46, 608–619.CrossRefGoogle ScholarPubMed
Pfeiffer, E. (1975). A Short Portable Mental Status Questionnaire for the assessment of organic brain deficits in elderly patients. Journal of the American Geriatrics Society 23, 433–441.CrossRefGoogle Scholar
Prigatano, G. P. & Parsons, O. A. (1976). Relationship of age and education to Halstead Test performance in different patient populations. Journal of Consulting and Clinical Psychology 44, 527–533.CrossRefGoogle ScholarPubMed
Smyer, M. A., Hofland, B. F. & Jones, E. A. (1979). Validity study of the Short Portable Mental Status Questionnaire for the elderly. Journal of the American Geriatrics Society 27, 263–269.CrossRefGoogle ScholarPubMed
Thorner, R. M. & Remein, Q. R. (1967). Principles and procedures in the evaluation of screening for disease. Public Health Monograph No. 67.Google Scholar
Tsai, L. & Tsuang, M. T. (1979). The Mini-Mental State Test and computerized tomography. American Journal of Psychiatry 136, 436–439.CrossRefGoogle ScholarPubMed
Williamson, J., Stokoe, I. H., Gray, S., Fisher, M., Smith, A., McGhee, A. & Stephenson, E. (1964). Old people at home: their unreported needs. Lancet i, 1117–1120.CrossRefGoogle Scholar
Yerushalmy, J. (1947). Statistical problems in assessing methods of medical diagnosis, with special reference to X-Ray techniques. Public Health Reports 62, 1432–1449.CrossRefGoogle ScholarPubMed