title: Mini-Mental State Examination sentence writing among community-dwelling elderly adults in Brazil: text fluency and grammar complexity.
abstract: BACKGROUND
  In normal aging, the decrease in the syntactic complexity of written production is usually associated with cognitive deficits. This study was aimed to analyze the quality of older adults' textual production indicated by verbal fluency (number of words) and grammatical complexity (number of ideas) in relation to gender, age, schooling, and cognitive status.
  
  
  METHODS
  From a probabilistic sample of community-dwelling people aged 65 years and above (n = 900), 577 were selected on basis of their responses to the Mini-Mental State Examination (MMSE) sentence writing, which were submitted to content analysis; 323 were excluded as they left the item blank or performed illegible or not meaningful responses. Education adjusted cut-off scores for the MMSE were used to classify the participants as cognitively impaired or unimpaired. Total and subdomain MMSE scores were computed.
  
  
  RESULTS
  40.56% of participants whose answers to the MMSE sentence were excluded from the analyses had cognitive impairment compared to 13.86% among those whose answers were included. The excluded participants were older and less educated. Women and those older than 80 years had the lowest scores in the MMSE. There was no statistically significant relationship between gender, age, schooling, and textual performance. There was a modest but significant correlation between number of words written and the scores in the Language subdomain.
  
  
  CONCLUSIONS
  Results suggest the strong influence of schooling and age over MMSE sentence performance. Failing to write a sentence may suggest cognitive impairment, yet, instructions for the MMSE sentence, i.e. to produce a simple sentence, may limit its clinical interpretation.
authors.affiliation: State University of Campinas, Campinas - SP - Brazil. anitalbn@uol.com.br
authors.forename: Anita Liberalesso
authors.initials: AL
authors.lastname: Neri
authors.forename: Lia Lopes
authors.initials: LL
authors.lastname: Ongaratto
authors.forename: Mônica Sanches
authors.initials: MS
authors.lastname: Yassuda
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D001938:Brazil / Q000453:epidemiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006236:Handwriting; D006801:Humans; D057187:Independent Living; D007361:Intelligence Tests / Q000706:statistics & numerical data*; D007807:Language Tests; D016014:Linear Models; D008297:Male; D016743:Mental Competency; D012737:Sex Factors