Educational bias in the assessment of severe dementia: Brazilian cutoffs for severe Mini-Mental State Examination.
Cognitive assessment in advanced stages of Alzheimer's disease (AD) is limited by the imprecision of most instruments.


OBJECTIVE
To determine objective cognitive responses in moderate and severe AD patients by way of the Severe Mini-Mental State Examination (SMMSE), and to correlate performances with Mini-Mental State Examination (MMSE) scores.


METHODS
Consecutive outpatients in moderate and severe stages of AD (Clinical Dementia Rating 2.0 or 3.0) were evaluated and compared according to MMSE and SMMSE scores.


RESULTS
Overall 400 patients were included, 67.5% females, mean age 76.6±6.7 years-old. There was no significant impact of age or gender over MMSE or SMMSE scores. Mean schooling was 4.4±2.5 years, impacting SMMSE scores (p=0.008). Scores on MMSE and SMMSE were significantly correlated (F-ratio=690.6325, p<0.0001).


CONCLUSIONS
The SMMSE is influenced by schooling, but not by age or gender, and is an accurate test for assessment of moderate and severe AD.
Departamento de Medicina Comportamental, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil.
José Roberto
JR
Wajman
Departamento de Medicina Comportamental, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil.
Fabricio Ferreira de
FF
Oliveira
Departamento de Medicina Comportamental, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil.
Rodrigo Rizek
RR
Schultz
Departamento de Medicina Comportamental, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil.
Sheilla de Medeiros Correia
Sde M
Marin
Departamento de Medicina Comportamental, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil.
Paulo Henrique Ferreira
PH
Bertolucci
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000503:physiopathology*; D001938:Brazil; D003072:Cognition Disorders / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D011594:Psychometrics; D012016:Reference Values; D012720:Severity of Illness Index; D012737:Sex Factors