Validating mini-mental status, cognitive capacity screening and Hamilton depression scales utilizing subjects with vascular headaches

Introduction The Mini-Mental State Examination (MMSE) and Cognitive Capacit y Screening Examination (CCSE) are easily and rapidly administered tests fo r quantifying the general cognitive status of young as well as geriatric su bjects. Likewise, the Hamilton Depression Rating Scale (HDRS) is a brief in strument for quantifying depression that may confound cognitive test perfor mances, Testing by means of all three scales concurrently provides useful i nformation for longitudinal research among the elderly. Objectives To validate the combined longitudinal use of MMSE, CCSE and HDRS among a specific cohort of normal subjects with vascular headaches charact erized by known well-established temporary cognitive decline occurring only during temporary intervals with headache. Methods The MMSE, CCSE and HDRS were serially tested at 3-12 monthly interv als among 196 healthy subjects attending our out-patient headache clinic wh o suffered from migraine or cluster headaches. Stability and specificity of MMSE. CCSE and HDRS were evaluated by comparing consecutive normative scor es during headache-free intervals. Sensitivity of MMSE and CCSE for detecti ng temporary cognitive decline were evaluated by comparing scores during he adache and headache-free intervals. Results CCSE, MMSE and HDRS gave stable headache-free normative values over intervals of 3-10 years among 182 subjects. Among 77 subjects during heada che intervals, temporary cognitive decline were confirmed by both CCSE and MMSE (p < 0.0001). When cutoff points for both CCSE and MMSE normal scores were placed at 127, specificity for detecting cognitively normal values for CCSE and MMSE when headache-free were 92.2 and 89.6%, respectively (p > 0. 05), while sensitivity for detecting cognitively decline during headache in tervals were 83.7 and 49%, respectively (p < 0.001). Compared with scoring by a single rater, reliability estimates for all three rating scales were s lightly lower when tested by different raters, but these differences were n ot significant. Conclusion CCSE is reliable and more sensitive than MMSE for detecting cogn itive decline. Copyright (C) 2001 John Wiley B Sons. Ltd.