title: The accuracy of the MMSE in detecting cognitive impairment when administered by general practitioners: a prospective observational study.
abstract: BACKGROUND
  The Mini-Mental State Examination (MMSE) has contributed to detecting cognitive impairment, yet few studies have evaluated its accuracy when used by general practitioners (GP) in an actual public-health setting.
  
  
  OBJECTIVE
  We evaluated the accuracy of MMSE scores obtained by GPs by comparing them to scores obtained by Alzheimer's Evaluation Units (UVA).
  
  
  METHODS
  The study was observational in design and involved 59 voluntary GPs who, after having undergone training, administered the MMSE to patients with symptoms of cognitive disturbances. Individuals who scored < or = 24 (adjusted by age and educational level) were referred to Alzheimer's Evaluation Units (UVA) for diagnosis (including the MMSE). UVAs were unblinded to the MMSE score of the GP. To measure interrater agreement, the weighted Kappa statistic was calculated. To evaluate factors associated with the magnitude of the difference between paired scores, a linear regression model was applied. To quantify the accuracy in discriminating no cognitive impairment from any cognitive impairment and from Alzheimer's disease (AD), the ROC curves (AUC) were calculated.
  
  
  RESULTS
  For the 317 patients, the mean score obtained by GPs was significantly lower (15.8 vs. 17.4 for the UVAs; p < 0.01). However, overall concordance was good (Kappa = 0.86). Only the diagnosis made by the UVA was associated with the difference between paired scores: the adjusted mean difference was 3.1 for no cognitive impairment and 3.8 for mild cognitive impairment. The AUC of the scores for GPs was 0.80 (95%CI: 0.75-0.86) for discriminating between no impairment and any impairment and 0.89 (95%CI: 0.84-0.94) for distinguishing patients with AD, though the UVA scores discriminated better.
  
  
  CONCLUSIONS
  In a public-health setting involving patients with symptoms of cognitive disturbances, the MMSE used by the GPs was sufficiently accurate to detect patients with cognitive impairment, particularly those with dementia.
authors.affiliation: Lazio Sanità - Agenzia di Sanità Pubblica della Regione Lazio, Rome, Italy. pezzotti@asplazio.it.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pezzotti
authors.forename: Silvia
authors.initials: S
authors.lastname: Scalmana
authors.forename: Antonio
authors.initials: A
authors.lastname: Mastromattei
authors.forename: Domenico
authors.initials: D
authors.lastname: Di Lallo
mesh_terms: D000328:Adult; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis; D002983:Clinical Competence; D003072:Cognition Disorders / Q000175:diagnosis*; D003865:Major Depressive Disorder / Q000175:diagnosis; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011594:Psychometrics; D011795:Surveys and Questionnaires