Education does not equally influence all the Mini Mental State Examination subscales and items: inferences from a Brazilian community sample.
OBJECTIVE
Mini-Mental State Examination cutoffs have been presented for schooling levels to screen cognitive impairment. However, items may behave differently with regards to education. The objective of this study was to examine the impact of education on MMSE subscales and items.


METHODS
Community-dwelling participants aged 65 years or more (n = 990, females = 637, age = 74.1 years, range 65-108) were stratified as illiterate (n = 373), 1-8 (n = 540), 9-12 (n = 63), and more than 12 years of schooling (n = 14) and were screened with MMSE and Pfeffer Functional Activities Questionnaire. To make the Mini-Mental State Examination items comparable, each item was transformed into z scores. Multiple linear regression was used to estimate the effect of schooling on MMSE subs and items controlling for age, sex, and activities of daily life.


RESULTS
Temporal and space orientation, attention/calculation, repetition, reading, writing, and drawing scores improved as education increased, but not memory registration, three step command, and naming. Reading and writing displayed the largest coefficients, whereas education exerted no influence on naming and three step command tasks.


CONCLUSIONS
Education does not exert an important effect on naming, three step command, memory registration, and delayed recall. As memory is a key factor for diagnosing dementia, these items could be considered despite education.
Centre for Alzheimer's disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, RJ, Brazil. jlaks@centroin.com.br
Jerson
J
Laks
Evandro Silva Freire
ES
Coutinho
Washington
W
Junger
Heitor
H
Silveira
Raphael
R
Mouta
Elienai Maria Rubim
EM
Baptista
Ana Lucia Barros
AL
Contino
Maria Lage
ML
Barca
Geir
G
Selbaek
Knut
K
Engedal
Eliasz
E
Engelhardt
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D010054:Brief Psychiatric Rating Scale / Q000592:standards*; D003072:Cognition Disorders / Q000175:diagnosis*; D003704:Dementia / Q000175:diagnosis*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male