title: [Effectiveness of the Mini-Mental State for detection of cognitive impairment in primary care].
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy (DA) of the Mini-Mental State (MMS) for the detection of cognitive impairment (CI) in Primary Care (PC) and to determine the best conditions of use for that purpose.
  
  
  METHODS
  Pooled analysis of two prospective, double blind, studies on the evaluation of diagnostic tools with complete verification that were conducted in Madrid and Granada (Spain).
  
  
  METHODS
  The MMS was administered in PC and the final cognitive diagnosis (gold standard) was made in Specialized Care.
  
  
  METHODS
  Subjects with cognitive complaints or suspected of having CI were consecutively recruited in the PC clinic.
  
  
  METHODS
  The DA of the MMS was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The best cut-off point was selected according to the ratio of cases correctly classified (RCC) and to the kappa index. Direct (MMSd) and age- and education-adjusted (MMSa) total scores were analyzed separately.
  
  
  RESULTS
  In the total sample of 360 subjects (214 CI), the DA of the MMSd was significantly superior to that of the MMSa (0.84±0.02 vs 0.82±0.02, p≤.001). The yield obtained by the best cut-off point of the MMSd (22/23) was modest (RCC 0.77, kappa 0.52±0.05) and was not improved by any MMSa cut-off point.
  
  
  CONCLUSIONS
  The DA of the MMS for detection of CI in PC was modest and did not improve with adjustment of the score by age and education. The best cut-off point was 22/23, inferior to the usually recommended cut-off.
authors.affiliation: Unidad de Neurología Cognitiva y Conductual, Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España; FIDYAN Neurocenter, Granada, España. Electronic address: ccarnero@neurocenter.es.
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Carnero Pardo
authors.forename: Isabel
authors.initials: I
authors.lastname: Cruz Orduña
authors.forename: Beatriz
authors.initials: B
authors.lastname: Espejo Martínez
authors.forename: Salvador
authors.initials: S
authors.lastname: Cárdenas Viedma
authors.forename: Pedro
authors.initials: P
authors.lastname: Torrero García
authors.forename: Javier
authors.initials: J
authors.lastname: Olazarán Rodríguez
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011446:Prospective Studies; D015203:Reproducibility of Results
keywords: Brief cognitive tests; Cognitive impairment; Cribado; Detección; Detection; Deterioro cognitivo; Diagnostic usefulness; Mini-Mental; Screening; Test cognitivos breves; Utilidad diagnóstica