title: Mini mental state examination and the Addenbrooke's cognitive examination: effect of education and norms for a multicultural population.
abstract: OBJECTIVE
  To derive population norms on the Malayalam adaptation of Addenbrooke's Cognitive Examination (M-ACE) and the inclusive Malayalam mini mental state examination (M-MMSE).
  
  
  METHODS
  Education-stratified norms were obtained on randomly selected cognitively unimpaired community elders (n = 519).
  
  
  RESULTS
  Valid data on norms was available on 488 subjects (age 68.5 +/- 7.1 and education 7.9 +/- 5.4). Education and age, but not gender had a significant effect on both M-ACE and M-MMSE. When compared to the effect of age, the effect of education was sevenfold more on the M-ACE and ninefold more on the M-MMSE. The mean composite score on the M-ACE (and the M-MMSE) was 42.8 +/- 9.8 (14.9 +/- 3.1) for those with 0 (n = 72), 55.9 +/- 12.5 (19.7 +/- 4.1) with 1-4 (n = 96), 62.6 +/- 11.4 (21.9 +/- 3.7) with 5-8 (n = 81), 77 +/- 10.2 (25.7 +/- 2.4) with 9-12 (n = 136) and 83.4 +/- 7.2 (26.7 +/- 1.6) with > 12 (n = 103) years of formal education.
  
  
  CONCLUSIONS
  Education has the most potent effect on performance on both M-ACE and M-MMSE in the Indian cohort. Education-stratified scores on the M-ACE and the M-MMSE, will provide a more appropriate means of establishing the cognitive status of patients. It is also our feeling that these cut-off scores will be useful across India.
authors.affiliation: Cognition and Behavioral Neurology Center, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India. mathu@sctimst.ac.in
authors.forename: P S
authors.initials: PS
authors.lastname: Mathuranath
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Cherian
authors.forename: Robert
authors.initials: R
authors.lastname: Mathew
authors.forename: Annamma
authors.initials: A
authors.lastname: George
authors.forename: Aley
authors.initials: A
authors.lastname: Alexander
authors.forename: Sankara P
authors.initials: SP
authors.lastname: Sarma
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003469:Culture; D004493:Education; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards*; D011153:Population; D012015:Reference Standards; D012737:Sex Factors