title: [Mini-Mental State Examination: Screening and Diagnosis of Cognitive Decline, Using New Normative Data].
abstract: BACKGROUND
  The Mini-Mental State Examination is the most commonly used cognitive screening test. In Portugal, the cut-off scores are defined according to literacy groups, but different proposals have been recommended by more representative studies. We therefore propose to confirm the influence of demographical variables, such as age and education, in the subjectâs performance; evaluating the discriminant ability of the new normative data; and to further examine the diagnostic acuity of the validated cut-off scoring for mild cognitive impairment and for the most prevalent types of dementia.
  
  
  METHODS
  Our study includes 1 441 educated subjects, divided into seven subgroups: Mild cognitive impairment, Alzheimer's disease, frontotemporal dementia, vascular dementia, dementia with Lewy bodies, community-controls and memory clinic-controls.
  
  
  RESULTS
  Altogether age and education explain 10.4% of the Mini-Mental State Examination results variance, with both variables contributing significantly to the resultsâ prediction. The diagnostic acuity based on the most recent normative data was always higher than the one obtained through the validation cut-off scoring, revealing an overall excellent specificity (superior to 90%) and different sensitivity values: excellent for mild Alzheimer's disease (91%), good for dementia with Lewy Bodies (78%) and low for mild cognitive impairment (65%), frontotemporal dementia and vascular dementia (55%).
  
  
  CONCLUSIONS
  The performance on the Mini-Mental State Examination is influenced by age and education, supporting the use of normative data that consider those variables. With this approach, the Mini-Mental State Examination could be a sensitive and specific instrument for the Alzheimer's disease screening among all healthcare levels. Nevertheless, its diagnostic acuity is limited in other conditions frequently seen in memory clinics, such as Mild Cognitive Impairment and other types of dementia.
authors.affiliation: Centro de Neurociências e Biologia Celular. Universidade de Coimbra. Coimbra. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Consulta de Demência, Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra.
authors.forename: Isabel
authors.initials: I
authors.lastname: Santana
authors.affiliation: Faculdade de Medicina. Universidade de Coimbra. Coimbra. Consulta de Demência, Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra.
authors.forename: Diana
authors.initials: D
authors.lastname: Duro
authors.affiliation: Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra. Instituto Biomédico de Investigação da Luz e Imagem. Universidade de Coimbra. Coimbra.
authors.forename: Raquel
authors.initials: R
authors.lastname: Lemos
authors.affiliation: Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Costa
authors.affiliation: Consulta de Demência, Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pereira
authors.affiliation: Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra. Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental. Universidade de Coimbra. Coimbra. Laboratório de Avaliação Psicológica. Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra.
authors.forename: Mário R
authors.initials: MR
authors.lastname: Simões
authors.affiliation: Centro de Neurociências e Biologia Celular. Universidade de Coimbra. Coimbra. Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra. Centro de Investigação do Núcleo de Estudos e Intervenção Cognitivo Comportamental. Universidade de Coimbra. Coimbra. Laboratório de Avaliação Psicológica. Faculdade de Psicologia e de Ciências da Educação. Universidade de Coimbra. Coimbra.
authors.forename: Sandra
authors.initials: S
authors.lastname: Freitas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests