Normative performance of healthy older individuals on the Modified Mini-Mental State (3MS) examination according to ethno-racial group, gender, age, and education level

Abstract

Objective: To present normative performance data on the Modified Mini-Mental State (3MS) examination for healthy community-dwelling older individuals according to gender, age, education level, and ethno-racial group.

Method: More than 19,000 generally healthy older men and women without a diagnosis of dementia were recruited from the general population in Australia and the U.S. for the ASPirin in Reducing Events in the Elderly (ASPREE) study. The 3MS exam was administered as part of the baseline screening and individuals scoring above 77 were eligible to participate.

Results: The sample comprised 16,360 Australian whites, 1080 U.S. whites, 895 African-Americans and 316 Hispanic/Latinos. The median age of participants was 74 years (range 65-98), with an average of 12 years of education and 56% were female. Increasing age and fewer years of completed education were associated with lower scores on the 3MS. Women scored higher than men in most age and education categories. Differences across ethno-racial groups were found. With factor analysis, four factors were identified which accounted for 35% of the between-person variance in 3MS scores for white Australians.

Conclusions: This large cohort of older individuals provides some of the most comprehensive 3MS normative data to be generated for whites (Australian and U.S.), Hispanic/Latinos and African-Americans, by age, gender, and educational attainment. These findings will serve as important reference standards for monitoring cognitive function in generally healthy older individuals, becoming increasingly important as this fraction of the population increases.

Trial registration: ClinicalTrials.gov NCT01038583.

Keywords: Modified Mini-Mental Status examination (3MS); Word; aging; cognition; dementia; normative data.

Conflict of interest statement

Disclosure statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.. Participants recruited in ASPREE across groups defined by country, ethnicity, and race. 3MS: Modified Mini-Mental State examination.

Note: the two groups on the left are Australian participants and the four groups on the right are U.S. participants. Groups without shading could not be included in ethno-racial stratified analyses due to the small numbers.

Figure 2.

The distribution of total 3MS scores across all ASPREE participants included in this study (n = 18,659). 3MS: Modified Mini-Mental State examination.

Figure 3.

The distribution of total Modified Mini-Mental State (3MS) examination scores across participants within each ethno-racial category. (a). white Australians (n = 16,360); (b). white U.S. (n = 1,088); (c). African-American U.S. (n = 895); (d). Hispanic/Latino U.S. (n = 316).

Figure 4.

The distribution of total Modified Mini-Mental State (3MS) examination scores across ethno-racial categories and according to gender (n = 18,659). The box represents the interquartile range (IQR, 25–75% percentile) and the horizontal line the median. The whiskers extend to +/−1.5*IQR and the dots represent outlying observations (≥1 participants) that are above or below these limits for 75 and 25% percentiles, respectively.

Figure 5.

Modified Mini-Mental State (3MS) examination scores in Australian whites, according to demographic characteristics (n = 16,360). The box represents the interquartile range (IQR, 25–75% percentile) and the horizontal line the median. The whiskers extend to +/−1.5*IQR and the dots represent outlying observations (≥1 participant) that are above or below these limits for 75 and 25% percentile, respectively.

Figure 6.

Modified Mini-Mental state (3MS) examination scores in U.S. whites, according to demographic characteristics (n = 1088). The box represents the interquartile range (IQR, 25–75% percentile) and the horizontal line the median. The whiskers extend to +/−1.5*IQR and the dots represent outlying observations (≥1 participant) that are above or below these limits for 75 and 25% percentile, respectively.

Figure 7.

Modified Mini-Mental state (3MS) examination scores in U.S. African-Americans (n = 895) and Hispanic/Latinos (n = 316), according to demographic characteristics. The box represents the interquartile range (IQR, 25–75% percentile) and the horizontal line the median. The whiskers extend to +/−1.5*IQR and the dots represent outlying observations (≥1 participant) that are above or below these limits for 75 and 25% percentile, respectively.