Prediction of probable Alzheimer disease in patients with symptoms suggestive of memory impairment - Value of the mini-mental state examination

Background: The Mini-Mental State Examination (MMSE) is a widely used diagn ostic tool for dementia. Its use as a predictive indicator of probable Alzh eimer disease (AD) has not been established. Objectives: To determine the accuracy of the MMSE in predicting emergent AD in a sample of patients who were referred because of symptoms suggestive o f memory problems and to determine whether an abbreviated version of the MM SE could be developed that would be as accurate as the full MMSE in predict ing emergent AD. Design: Inception cohort of participants with symptoms suggestive of memory impairment by their family physicians were given baseline assessments, inc luding MMSE. After 2 years, the participants' conditions were diagnosed fol lowing the standard criterion for AD. Diagnosticians were blind to baseline scores. Setting and Participants: One hundred eighty-three community-residing parti cipants were referred by their family physicians to a university teaching h ospital research investigation. After baseline screening, 165 participants were included in the study who did not have dementia and had no identifiabl e cause for memory impairment. After 2 years, 29 participants met criteria for AD, 98 did not develop dementia, 18 developed vascular lesions or non-A D dementia, and 20 did not return. Main Outcome Measurer Diagnostic classification of AD or no evidence of dem entia. Results: Logistic regression model was significant. At a cutoff score of 24 or less, sensitivity was 31%; specificity, 96%; with a likelihood ratio of 7.75. A reduced model of 2 subtests was identified with a sensitivity of 4 1%; specificity, 98%; with a likelihood ratio of 20.70. Conclusions: Results suggest that the full or abbreviated MMSE is useful in predicting emergent AD in patients with postive test results. However, iri s not recommended for use as a screening or diagnostic instrument since a n egative test result did not rule out emergent AD. It is recommended as a to ol to identify those needing closer monitoring.