Restrictions of the Mini-Mental State Examination in acute stroke

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...

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Bibliographic Details
Published in:Archives of clinical neuropsychology 2005-07, Vol.20 (5), p.623-629
Main Authors: Nys, G.M.S., van Zandvoort, M.J.E., de Kort, P.L.M., Jansen, B.P.W., Kappelle, L.J., de Haan, E.H.F.
Format: Article
Language:English
Subjects:
Acute Disease
Aged
Biological and medical sciences
Cognition Disorders - diagnosis
Cognition Disorders - etiology
Construct validity
False Negative Reactions
Female
Humans
Male
Medical sciences
Mental Status Schedule
Middle Aged
Mini-Mental State Examination (MMSE)
Neurology
Neuropsychological assessment
Psychology. Psychoanalysis. Psychiatry
Psychometrics. Diagnostic aid systems
Psychopathology. Psychiatry
Reproducibility of Results
Sensitivity and Specificity
Stroke
Stroke - complications
Stroke - psychology
Techniques and methods
Vascular diseases and vascular malformations of the nervous system
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Summary: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; p = 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.
ISSN:0887-6177
1873-5843
DOI:10.1016/j.acn.2005.04.001