Cross-cultural comparison of the Mini-Mental State examination in United Kingdom and United States participants with Alzheimer's disease.
OBJECTIVE
the relative difficulties of items on the Mini-Mental State Examination (MMSE) were compared in English-speaking Alzheimer's disease (AD) patients in the United States (US) and United Kingdom (UK).


METHODS
participants were aged 75 and over, with a clinical diagnosis of AD according to standardized methods. Initial MMSE scores from an AD patient registry in the US (n = 401), and a field survey in the UK (n = 139) were compared. Item Characteristic Curve analysis (ICC) was used to calculate the relative difficulty of individual MMSE items, adjusted for the remaining MMSE items. Age, gender, education, and severity of disease were evaluated as possible confounders.


RESULTS
UK participants found it relatively more difficult to name their county than US participants did to name their state. The relative difficulties of registration and recall, repeating a phrase, and following verbal directions also were significantly higher for the UK participants, even after adjustment for other factors.


CONCLUSIONS
differences between the cohorts could be explained by translation artifacts in the test items or by cultural differences in the manifestation of AD. In this study, most, if not all differences can be explained by the former. ICC analysis can be used to develop tests that are functionally equivalent, a prerequisite for comparing dementia in different populations.
Gibbons
Laura E
LE
Department of Psychosocial and Community Health, University of Washington, Seattle, Washington 98195, USA. gibbonsl@u.washington.edu
van Belle
Gerald
G
Yang
Minhua
M
Gill
Caroline
C
Brayne
Carol
C
Huppert
Felicia A
FA
Paykel
Eugene
E
Larson
Eric
E
D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000453:epidemiology; D003431:Cross-Cultural Comparison; D003469:Culture; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology