Influencias de la edad y de la escolaridad en el examen breve del estado mental (Mini-Mental State Examination) en una poblacion hispano-hablante Foggy Ostrosky-Solis" Gabriela Lopez-Arango” Alfredo Ardila” ‘Summary “The Spanish translation ofthe Minimental State Examination (MAMSE), was applied to a sample of 430 neurologically intact subjects from 16 to 85 years of age. Three age groups were Used: 16 1050 years, 51 to 65 years, and 66 to 89 years andin ch age range four diferent educational levels were taken: iterates (zero years of schoo), low educational level (1-4 years of schoo), middle aducational level (6-9 years of schoo!) {nd high educational level (more then 10 yeors of formal education). Educatonal level had a significant effect on the {otal score. The sample of iterate but normal functional independent subjects obtained scores that classified them within severe cognitive alterations (X = 17.67) whereas Subjects with low education (1 to 4 years) classified within ‘moderate cognitive alteraion (X = 20.61), The sensitivity and Spectfty of the MMSE was established lsing a sample of 40 Patients with moderate to severe cognitive impairment that ‘were matched according to age and educational level withthe Sample of normal subjects. Using the 23/24 cutoff point Suggested by Fisiein et al (1975), low sensitivity anc ‘Specticity were found in subjects with era and low schooling, 72.7 % and 50 % respectively. inthe low educational group (1-4 years) the adjustment ofthe cutfl valve according tothe average performance for the neurologically inlact group increased the specificity (90 %) but decreased the sensitivity (27.27%), The scale achieves a nigh sensitivity at the ‘expenses of an extremely high faise positive rate. In subjects With more than 5 years of education the specificity (86.36 %) ‘and sensitivity (86:36 %) of the scale were higher In Spanish Speaking subjects the MMSE can be used to confirm the presence of severe cognitive alterations in subjects with more {han 5 years of education but i should not be considered for the etecton of sight cognitive impaimant. The MMSE is an Inetrument wth ite utty 8s 8 clagnostie tot In subjects with low level of education, ‘specking people, education Departamento de Pslcotsioiogia. Divisiin de Estudios de Posgra. Facuted de Peicclopia, Unvereiied Necionel Autonome ‘so nico ia inte of Peycholoay. Ccorespondencn: Dra, Feggy Ostoshy Sols. Depo, Pacoisieogia, ‘Fecutns de Paco, EC, Jer piso. Au Unvesided 300%, Cops Covoaeun, México, 04510. e-mail Toggyt@servisorunam me 20 Resumen ‘Se apliog el Examen Brave del Estado Mental (Mini-Mental ‘State Examination o MMSE) 2 430 sujelos neurologicamente intactos entre 18 y 85 afos de edad. La muesira se estraticd {de acuerdo a la edad en tes grupos: 16:60 afos, 51-65 afos 'y 66-89 afios y dentro de cada rango de edad so considora- fon 4 niveles educativos: nulo (cero aos de estudio), bajo ( 4 afios de estudio), medio (5-9 hos) y alto (100 mas afios de ‘estudio) Elnivel de escolaridad most un electo significative ‘0n 8 puntaje total. Los individuos sanos y funconalmente in- Atencién y céteulo Pda al pactente que susiraiga 7 de 100 cinco veces, puntuando una correcta por cada ocasién bien realizada, Total § puntos: o> Evocacion ida el pacionte que repite las 3 palabras que se le dijo, Un punto por cada palabra corrects. Total 3 puntos oo Lenguaje ‘Bos puntos por cada objeto bien nombrado: (el), plz). otal 2 puntos: o> Un punto ste siguiente oracion es repetida correctamente. “NO IRE, SITU NO LLEGAS TEMPRANO™ Total t punto oo Un punto por las 3 6rdenes bien ejecutadas. "Con el dedo derecho, toque la punta de eu nariz y luego su oldo izqulerdo ‘tome este pedazo de papel con su mano derecha, ddbieo ytirelo al suelo” ‘Total 3 puntos a) Un punto por obedecer la orden escrta: “CIERRE SUS OJOS" Total 1 punto oo Un punto por escribir una oracion que incuya verbo y sujelo y tenga sentido, Total 1 punto oo {Un punto por la copia de 2 pentagonas (2 om cade lado) interceptados. Total 1 punto oo Puntuacion obtenida ‘Puntuacién maxima 30 puntos.REFERENCIAS ANTHONY JC, LERESCHE L, NIAZU, VON KORFF MR, FOLSTEIN ME: Limits of the "Mini-Mental Stato" as a ‘screening test for dementia and deliium among hospital patents. Psychol Med, 12:397-408, 1982, BECERRA B, ORTEGA-SOTO HA, TORNER C: Valdez ¥ reproducibiidad dal examen cognoscitivo breve (Mini- ‘mental State Examination) en una unidad de culdados especiales de un hospital psiquiatrico. Salud Mental, 18(4):41-45, 1982. BERTOLUCCI PHF, BRUCK! S, CAMPACCI SR, JULIANO YEO Miniexame do estado mental em uma populagao oral. Impacto da scolaridade. Arq Neuropsiquiatr, 52(1}:1- 7, 1984. BIRD RH, CANINO G, RUBIO SM, SHROUT P: Use of the Mini: Mental State Examination ina probably eample ‘of @ hispanic population. J Nerv Ment Dis, 175(12)731- 737, 1987. CHATELLIER G, LANCOMBLEZ L: Tacrine (tetra-H- hhidroaminocridine: THA) and lecithin in treatment of ‘dementia ofthe Alzheimer’ type. Amuticentr study. BM, '300:495-498, 1900, ‘GRUM RIM, ANTHONY JC, BASSETT SS, FOLSTEIN MF: Population based norms for the Mini-Mental State by age and educational level. JAMA, 269(18), 1093. DEPAULO JR, FOLSTEIN MF, GORDON 8: Psychiatric screening on a neurological ward. Psychol Med, 10:125- 4132, 1980, DICK JP, GUILOFF RJ, STEWART A, BLACKSTOCK J, BIELAWSKA C, PAUL EA, MARSDEN CD: Mini-Mental + State Examination in neurological patients. J Neurol 10. 1" 12, cr “4 6. 6 7 26 ‘Neurosurg Psychiatry, 47:496-469, 1984. ESCOBAR JI, BURNAM A, KARNO M, FORSYTHE A, LANDSVERK'J, GOLDING JM: Use of the Mini-Mental ‘State Examination (MMSE) in a community population of ‘mined athniclty. J Nerv Ment Dis, 174:607-614, 1986, FINLAYSON NA, JONHSON KA, REINTAN RM: Relation ‘of level of education to neuropsychological measures in brain damaged and non-brain damaged adults. J Consu- {ing Clinica! ng, 45:536-542, 1977. FOLSTEIN MF, FOLSTEIN SE, MC HUGH PR: Mini-Men tal State. practical method for grading the cognitive state Cf patients forthe clinician. J Psychiatr Res, 12:189-198, 497s. FILLENBAUM G, HEYMAN A, WILLIANS K, PROSNITZ B, BURCHETT B: Sensitivity and specificity of standar- dized screens of cognitive Impairment and dementia ‘among eldery blacks and white community residents. J ‘Glin Epicemiol, 43:651-650, 1990. GEORGE Lk, LANDERMAN R, BLAZER DG, ANTHONY JC: Cognitive impairment. En: Robbins LN, Regier DA {eds). Paychiatne Disorders at America: the Epidemiologic Eatchment Area Study. Free Press, Nuova York, 287-281, 991 GURLAND BJ, WILDER DE, CROSS P, TERESI J, BARRETT VW: Screening scales for dementia: toward Feconeilation of coaflicting cross-cultural findings. nt J Geriatr Psychiatry, 7:105-113, 1982. HANLEY JA, McNEIL BJ: The meaning and use of the ‘rea under a Receiver Operating Characteristic (ROC) ‘curve. Diagnostic , 143:28-36, 1982. HILL LR, KLAUBER MR, SALMON DP y cols: Funtional ‘Status, education, and the diagnosis of dementia In the ‘Shanghai survey 43:138-145, 1993, KATZMAN R, ZHANG M, GU OY, WANG Z. LIU WT, YU E, WONG S, SALMON DP, GRANTR I:A Chinese version. 18, 20, 25. 26. 27. 3 32 33 of te Mini-Mental State Examination: impact of iliteracy ina Shanghai dementia survey. J Clin Epidemiol, 41:971- 978, 1988. LAUNER LJ, DINKGREVE MA, JONKERG, HOOMER C, LINDEBOOM J: Are age and education independent ‘correlates ofthe Mini-Mental Stato Exam performance of ‘community-dweling elderly? J) Gerontol, 48:271-277, ‘8s. LECOURS AR, MEHLER J, PARENTE MA: literacy and brain damage |: aphasia testing in culturally contrasted Baputaions con ubzects), Neuropsyehoote, 25:231- 45, LECOURS RL, MEHLER J, PARENTE MA, AGUIAR LR, ‘DA SILVA AB, CAETANO M, CAMAROTH H, CASTRO MJ, DEHAUT F, DUMAIS C, GAUTHIER L, GURD J. LETTAO 0, MACIEL J, MACHADO S, MELARAGNO R, ‘OLIVEIRALM, PACIORNIK J, SANVITO W, DASILVAES, ‘SILIFRANDI Ne, TORNI CH literacy and brain damage 2: Manifestations of unilateral neglect in testing auditory ‘comprehension” with iconographic material. Brain Cogn, 16:243-268, 19870, LEZAK MD: Neuropsychologicel Assessment. Tercera ‘dici6n. Oxford University Press, Nuova York, 1996. L1G, SHEN YC, CHEN CH, ZHAO YW. LI SR, LU M: An ‘epidemiological survey of age-related dementia in an Lutban area of Bejing. Acta Psy Scand, 79:557-563, 1960. MORRIS HC, HEYMAN A, MOHS RO, HUGHES JP, VAN. BELLE G, FILLENBAUM'G, MELLITS ED, CLARK C y Cols: The Consortium to establish a registry for Alzheimer's disease (CERAD): Part 1. Clinical ana neuropsychob ‘assessment of Alzheimer's disease, Nourology, 38:1159- ‘166, 1988. MUNGAS D y cols: Age and education correction of Mini- Mental State Examination for English and Spanish- spoaking eldarty. Neurology, 48:700-708 1996. MURDEN RA, MCRAE TD, KANER S, BUCKNAM ME: Mini-Mental Siate Exam scores with education in blacks ‘and whites. J Am Geriatr Soc, 43:138-145, 1991. NELSON A, FOOEL BS, FAUST D: Bedside cognitive ‘screening instruments in riical assessment. J Norv Ment Dis, 174(2):73-83, 1966. ‘O'CONNOR DW; POLIITT PA, TREASURE FP: Tho influence of education and social class on the diagnosis. ‘of dementia in a community population. Psycho! Med, 21:210-224, 1901, ‘OSTROSKY F,, CANSECO E, QUINTANAR L, NAVARRO E,ARDILA A: Sociocultural effects in neuropsychological assessment, Int J Nourosc, 27:53-66, 1985. ‘OSTROSKY F, QUINTANAR L, CANSECO E, MENESES 'S, NAVARRO E, ARDILAA Actividad cognosctva y nivel Sociocultural. Revista de Investigacion Clinica, 38:37-42, 1908, OSTROSKY:SOLIS F, ARDILA A, CHAYO Fi Rehab Planeta, México, 1996, PRERTER Fu, KOROSAN! TT HARRAH CH y cols: A survey diagnostic tool for senile dementia. Am J Epidernol, 114:515-527, 1981 ROVNER BW, KAFONEK S, FILIPP L, FOLSTEIN MP: Prevalence of mental ilness in @ community nursing home, ‘Amn J Peyohiatry. 147:1446-1448, 1990. SRIVASTAV PK, AGARWAL K, KUMAR S: Effects of ‘education and sex on some common clinical tesis sed in ‘mental status examinatons, Indian J Psychiatry, 31:134- 138, 1989,