This paper reports on a comparison of the two alternative tests of attention in the Mini-Mental State Examination (MMSE), a well-known cognitive screening tool. The two tests, serial subtraction by seven and backwards spelling of the word world, are often used interchangeably. In a large population-based sample, the two tests were found to be weakly associated with each other, with the former test appearing more difficult, although both were strongly associated with educational level. The authors discuss the implications of this finding in clinical and research settings, and make recom mendations for more consistent use of the instrument. (J Geriatr Psychiatry Neurol 1990;3:203-207).
References
1.
Folstein M., Folstein SE, McHugh PR: "Mini-Mental State": A practical method of grading the cognitive state of patients for the clinician. J Psychiatr Res1975;12:189.
2.
Pfeiffer E.: A short portable mental status questionnaire for the assessment of organic brain defect in elderly patients. J Am Geriatr Soc1975;23:433.
3.
Klein LE, Roca RR, McArthur J., et al: Diagnosing dementia: Univariate and multivariate analyses of the mental status examination. J Am Geriatr Soc1985;33:483.
4.
Morris JC, Heyman A., Mohs RC, et al: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology1989;39:1159.
5.
Holzer CE, Tischler GL, Leaf PJ, et al: An Epidemiologic Assessment of Cognitive Impairment in a Community Population, in Greenley JR (ed): Research in Community and Mental Health. Greenwich, JAI Press, 1984, p 3.
6.
Escobar JI, Burnam A., Karno M., et al: Use of the Mini-Mental State Examination (MMSE) in a community population of mixed ethnicity. J Nerv Ment Dis1986;174:607.
7.
Anthony JC, LeResche L., Niaz U., et al: Limits of the 'Mini-Mental State' as a screening test for dementia and delirium among hospital patients. Psychol Med1982; 12:397-408.
8.
Kay Dwk, Henderson AS, Scott R., et al: Dementia and depression among the elderly living in the Hobart community: The effect of the diagnostic criteria on the prevalence rates. Psychol Med1985;15:771.
9.
Ganguli M., Ratcliff G., Huff FJ, et al: Effects of age, gender, and education on cognitive tests in a rural elderly community sample: Norms from the Monongahela Valley Independent Elders Survey (MoVIES). Neuroepidemiology, in press.
10.
Kuller LH, Ganguli M., Belle S., et al: The University of Pittsburgh ADPR: The Monongahela Valley Independent Elders Survey (MoVIES), National Institute on Aging Alzheimer's Disease Patient Registries (NIA ADPRs): The methods and problems in the development of large area registries for dementing diseases, in Radebaugh TS, Khachathurian ZS, Mortimer JA, Madison R (eds): Aging: Clinical and Experimental Research. Milan, Editrice Kurtis, 1990, pp 302-305.
11.
Cohen J.: A coefficient of agreement for nominal scales. Educ Psychol Measures1960;20:37.
12.
Fleiss JL: Statistical Methods for Rates and Proportions, 2nd ed. New York, John Wiley, 1981.
13.
O'Connor DW , Pollitt PA, Treasure FP, et al: The influence of education, social class and sex on Mini-Mental State scores. Psychol Med1989;19:771.
14.
Smith A.: The serial sevens subtraction test. Arch Neurol1967;17:78.
