The role of education in mini-mental state examination: a study in Northeast Brazil.
BACKGROUND
There is evidence that schooling can influence performance in cognitive assessment tests. In developing countries, formal education is limited for most people. The use of tests such as Mini-Mental State Examination (MMSE), could have an adverse effect on the evaluation of illiterate and low education individuals.


OBJECTIVE
To propose a new version of MMSE as a screening test to assess Illiterate and low education people.


METHODS
A study was carried out enrolling 232 individuals, aged 60 or more of low and middle socio-economic classes. Three groups were studied: Illiterate;1-4 schooling years; 5-8 schooling years. The new version (MMSEmo) consisted of modifications in copy and calculation items of the adapted MMSE (MMSEad) to Portuguese language. The maximum possible score was the same in the two versions: total, 30; copy, 1 and calculation, 5.


RESULTS
In the total test score ANOVA detected main effects for education and test, as well as an interaction between these factors: higher schooling individuals performed better than lower schooling ones in both test versions; scores in MMSE-mo were higher than in MMSE-ad in every schooling group.


CONCLUSIONS
Higher schooling levels improve the performance in both test versions, the copy and calculation items contributing to this improvement. This might depend on cultural factors. The use of MMSE-mo in illiterate and low school individuals could prevent false positive and false negative cognitive evaluations.
Brito-Marques
Paulo Roberto de
PR
Behavioral Neurology Unit, Department of Neurology, Faculty of Medical Sciences, University of Pernambuco, Recife, PE, Brazil. pbrito@truenet.com.br
Cabral-Filho
José Eulálio
JE
D000368:Aged; D000704:Analysis of Variance; D001938:Brazil; D010054:Brief Psychiatric Rating Scale / Q000592:standards*; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000175:diagnosis; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis*; D004522:Educational Status; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results