Re-validation of the Mini-Examen Cognoscitivo (first Spanish version of the Mini-Mental Status Examination) in the elderly people

BACKGROUND: The revalidation of the Mini Examen Cognoscitivo (MEC), first S panish version (1978) of the Mini-Mental Status Examination (MMSE) and docu mentation of "population-based norms" should clarify the potential confusio n induced by later versions of MMSE. METHODS: Context: The Zaragoza Study on the prevalence of dementia and depr ession in a representative sample of the elderly community (N = 1,080), Ins truments: MEC-35 and MEC-30 points, and validated, Spanish versions of Geri atric Mental State (GMS), History and Aetiology Schedule (HAS) and Social S tatus Schedule (SSS). Procedure: a) validation of MEC (standardized lay int erviewers) against the gold standard of psychiatric diagnosis (DSM-III-R), two months later; bl population-based norms,, in the "healthy" population, and c) comparison with other MMSE versions. RESULTS: The instrument fulfills criteria of "feasibility", "content", "pro cedural" and "construct validity". Test-retest reliability: weighted kappa = 0.637. MEC-30 (cut-off point 23/24), sensitivity = 89.8%, specificity = 7 5.1% (80.8% with the cut-off at 22/23), and ROC curve, AUC = 0.920. The coe fficients of individual items were satisfactory and the specificity increas es in MEC-35 (83.9%), Other MMSE Spanish versions have not improved these c oefficients. "Population-based norms" confirm the hypothesized influence of age and education level. MEC-30 is the version with most comparable result s with the MMSE in USA. CONCLUSIONS: The validity of MEC is confirmed in the elderly population, wi th the same cut-off points recommended in the original standardization. MEC -30 is the best version for international comparisons.