The Validity and Reliability of the Mini-Mental State Examination-2 for Detecting Mild Cognitive Impairment and Alzheimer's Disease in a Korean Population

Min Jae Baek, Karyeong Kim, Young Ho Park, SangYun Kim, Min Jae Baek, Karyeong Kim, Young Ho Park, SangYun Kim

Abstract

Objective: To examine the validity and reliability of the MMSE-2 for assessing patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) in a Korean population. Specifically, the usefulness of the MMSE-2 as a screening measure for detecting early cognitive change, which has not been detectable through the MMSE, was examined.

Methods: Two-hundred and twenty-six patients with MCI, 97 patients with AD, and 91 healthy older adults were recruited. All participants consented to examination with the MMSE-2, the MMSE, and other detailed neuropsychological assessments.

Results: The MMSE-2 performed well in discriminating participants across Clinical Dementia Rating (CDR) stages and CDR-Sum of Boxes (CDR-SOB), and it showed excellent internal consistency, high test-retest reliability, high interrater reliability, and good concurrent validity with the MMSE and other detailed neuropsychological assessments. The MMSE-2 was divided into two factors (tests that are sensitive to decline in cognitive functions vs. tests that are not sensitive to decline in cognitive functions) in normal cognitive aging. Moreover, the MMSE-2 was divided into two factors (tests related overall cognitive functioning other than memory vs. tests related to episodic memory) in patients with AD. Finally, the MMSE-2 was divided into three factors (tests related to working memory and frontal lobe functioning vs. tests related to verbal memory vs. tests related to orientation and immediate recall) in patients with MCI. The sensitivity and specificity of the three versions of the MMSE-2 were relatively high in discriminating participants with normal cognitive aging from patients with MCI and AD.

Conclusion: The MMSE-2 is a valid and reliable cognitive screening instrument for assessing cognitive impairment in a Korean population, but its ability to distinguish patients with MCI from those with normal cognitive aging may not be as highly sensitive as expected.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. MMSE-2:BV.
Fig 1. MMSE-2:BV.
Receiver Operator Characteristic (ROC) curve analysis of the MMSE-2: Brief version in the three groups. (A) Normal vs. MCI, Area Under the Curve (AUC) = 0.71. (B) MCI vs. AD, Area Under the Curve (AUC) = 0.93. (C) Normal vs. AD, Area Under the Curve (AUC) = 0.97.
Fig 2. MMSE-2:SV.
Fig 2. MMSE-2:SV.
Receiver Operator Characteristic (ROC) curve analysis of the MMSE-2: Standard version in the three groups. (A) Normal vs. MCI, Area Under the Curve (AUC) = 0.72. (B) MCI vs. AD, Area Under the Curve (AUC) = 0.93. (C) Normal vs. AD, Area Under the Curve (AUC) = 0.95.
Fig 3. MMSE-2:EV.
Fig 3. MMSE-2:EV.
Receiver Operator Characteristic (ROC) curve analysis of the MMSE-2: Expanded version in the three groups. (A) Normal vs. MCI, Area Under the Curve (AUC) = 0.73. (B) MCI vs. AD, Area Under the Curve (AUC) = 0.92. (C) Normal vs. AD, Area Under the Curve (AUC) = 0.94.

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