title: Norms for the Mini-Mental State Examination in a healthy population.
abstract: BACKGROUND
  Although the Mini-Mental State Examination (MMSE) is widely used in clinical practice, few norms exist for healthy populations covering a broad range of ages.
  
  
  OBJECTIVE
  To obtain MMSE norms specific for age, gender, and education in healthy adults.
  
  
  METHODS
  From the population registers of seven communities across Italy, we selected a proportionate random sample of residents age 20 to 79 years to evaluate their health status with respect to conditions affecting cognitive performance. This sample yielded 908 persons who were deemed to be without cognitive impairment and who were then given the MMSE. We calculated fifth percentile norms and presented them as step functions. We then validated the norms as a screening tool for dementia in persons age 65 to 79 years. The validation was based on unpublished data from a separate study and involved estimates of sensitivity and specificity.
  
  
  RESULTS
  The norms declined with advancing age, especially for less educated women. Given any age and sex, the norms were higher for individuals with higher educational levels. In screening for dementia, the norms had a sensitivity of 85% and a specificity of 89%.
  
  
  CONCLUSIONS
  When using MMSE scores, it is important to account for age, gender, and education, especially in populations where the educational level is low. Expressing MMSE norms as step functions provides an easy-to-use tool for neurologists and other clinicians.
authors.affiliation: Institute of Hygiene, University of Padua, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Grigoletto
authors.forename: G
authors.initials: G
authors.lastname: Zappalà
authors.forename: D W
authors.initials: DW
authors.lastname: Anderson
authors.forename: B D
authors.initials: BD
authors.lastname: Lebowitz
mesh_terms: D000328:Adult; D000368:Aged; D003625:Data Collection; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012015:Reference Standards; D012016:Reference Values; D012680:Sensitivity and Specificity