title: The Mini-mental State Examination revisited: ceiling and floor effects after score adjustment for educational level in an aging Mexican population.
abstract: BACKGROUND
  The Mini-mental State Examination (MMSE) is the most widely used cognitive test, both in clinical settings and in epidemiological studies. However, correcting its score for education may create ceiling effects when used for poorly educated people and floor effects for those with higher education.
  
  
  METHODS
  MMSE and a recent cognitive test, the seven minute screen (7MS), were serially administered to a community sample of Mexican elderly. 7MS test scores were equated to MMSE scores. MMSE-equated 7MS differences indicated ceiling or floor effects. An ordinal logistic regression model was fitted to identify predictors of such effects.
  
  
  RESULTS
  Poorly educated persons were more prevalent on the side of MMSE ceiling effects. Concentration (serial-sevens), orientation and memory were the three MMSE subscales showing the strongest relationship to MMSE ceiling effects in the multivariate model.
  
  
  CONCLUSIONS
  Even when MMSE scores are corrected for educational level they still have ceiling and floor effects. These effects should be considered when interpreting data from longitudinal studies of cognitive decline. When an education-adjusted MMSE test is used to screen for cognitive impairment, additional testing may be required to rule out the possibility of mild cognitive impairment.
authors.affiliation: Aging Division, Centro Médico Nacional XXI, Instituto Mexicano del Seguro Social, Mexico.
authors.forename: Francisco
authors.initials: F
authors.lastname: Franco-Marina
authors.forename: Jose Juan
authors.initials: JJ
authors.lastname: García-González
authors.forename: Fernando
authors.initials: F
authors.lastname: Wagner-Echeagaray
authors.forename: Joseph
authors.initials: J
authors.lastname: Gallo
authors.forename: Oscar
authors.initials: O
authors.lastname: Ugalde
authors.forename: Sergio
authors.initials: S
authors.lastname: Sánchez-García
authors.forename: Claudia
authors.initials: C
authors.lastname: Espinel-Bermúdez
authors.forename: Teresa
authors.initials: T
authors.lastname: Juárez-Cedillo
authors.forename: Miguel Angel Villa
authors.initials: MA
authors.lastname: Rodríguez
authors.forename: Carmen
authors.initials: C
authors.lastname: García-Peña
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D012720:Severity of Illness Index