Influence of age and education in the Mini Mental State Examination in a Spanish speaking population.

The Spanish translation of the Minimental State Examination (MMSE), was app lied to a sample of 430 neurologically intact subjects from 16 to 85 years of age. Three age groups were used: 16 to 50 years, 51 to 65 years, and 66 to 89 years and in each age range four different educational levels were ta ken: illiterates (zero years of school), low educational level (1-4 years o f school), middle educational level (5-9 years of school) and high educatio nal level (more than 10 years of formal education). Educational level had a significant effect on the total score. The sample of illiterate but normal functional independent subjects obtained scores that classified them withi n severe cognitive alterations ((X) over bar =17.67) whereas subjects with low education (1 to 4 years) classified within moderate cognitive alteratio n ((X) over bar = 20.61). The sensitivity and specificity of the MMSE was e stablished using a sample of 40 patients with moderate to severe cognitive impairment that were matched according to age and educational level with th e sample of normal subjects. Using the 23/24 cutoff point suggested by Fols tein et al (1975), low sensitivity and specificity were found in subjects w ith zero and low schooling, 72.7 % and 50 % respectively. In the low educat ional group (1-4 years) the adjustment of the cutoff value according to the average performance for the neurologically intact group increased the spec ificity (90 %) but decreased the sensitivity (27.27 %). The scale achieves a high sensitivity at the expenses of an extremely high false positive rate . In subjects with more than 5 years of education the specificity (86.36 %) and sensitivity (86.36 %) of the scale were higher. In Spanish speaking su bjects the MMSE can be used to confirm the presence of severe cognitive alt erations in subjects with more than 5 years of education but it should not be considered for the detection of slight cognitive impairment. The MMSE is an instrument with little utility as a diagnostic tool in subjects with lo w level of education.