LIMITATIONS OF THE MINI-MENTAL-STATE-EXAMINATION IN DIAGNOSING DEMENTIA IN GENERAL-PRACTICE

The aim of the study was to investigate the value of the Mini-Mental S tate Examination (MMSE) for use by general practitioners (GPs) in a gr oup of elderly patients in whom the GPs are considering a dementia dia gnosis, The study population consisted of 533 elderly patients (aged 6 5 and older) judged by 36 GPs as suffering from 'minimal to severe' de mentia. Cross-sectional data were used to determine the criterion vali dity of separate items, a set of items and the total MMSE, The GMS/AGE CAT diagnosis was used as an external criterion. MMSE items were analy sed and two items testing general knowledge were added. The most effec tive set of items was determined using a stepwise logistic regression analysis. Adjusted for age, sex and education, the differentiating abi lity of the set of items was compared to that of the total MMSE score. The total MMSE score was divided into three categories (cutoffs 21/22 and 26/27) and into two categories (cutoff 23/24). In total, 114 pati ents (21%) were diagnosed as having an 'organic syndrome' by the GMS/A GECAT. The differentiating ability of separate items was poor, The fol lowing combination of items had the best predictive ability: items con cerning the date, the day of the week, the patient's address and the c urrent prime minister. This set of items was just as adequate in diffe rentiating dementia from non-dementia as the total MMSE score (sensiti vity 64.9% and 64.8% respectively, specificity 96.4% and 93.3%), The v alue of the MMSE in diagnosing dementia in general practice is limited . The score on cognitive test items can be one aspect of the individua l's overall clinical picture, on which the diagnosis should be based.