Psychometric properties of the Mini-Mental State Examination in patients with acquired brain injury in Turkey

Objective: To evaluate the psychometric properties of Mini-Mental State Examination (MMSE) in patients with acquired brain injury in Turkey. Methods: A total of 207 patients with acquired brain injury were assessed. Reliability was tested by internal consistency and the person separation index; internal construct validity by Rasch analysis; external construct validity by correlation with cognitive disability; and cross-cultural validity by differential item functioning analysis compared with Italian MMSE data. Results: Reliability was adequate with a Cronbach's alpha of 0.75 and person separation index of 0.76. After collapsing some categories, and adjustment for differential item functioning, internal construct validity was supported by fit of the data to Rasch model. Differential item functioning for culture was found in 2 items and after adjustment, data could be pooled between Turkey and Italy. External construct validity was supported by expected associations. Conclusion: The Turkish version of the Mini-Mental State Examination can be used as a cognitive screening tool in acquired brain injury. Cross-cultural validity between Italy and Turkey is supported, given appropriate adjustment for differential item functioning. However, shortfalls in reliability at the individual level, as well as the presence of differential item functioning suggest that a better instrument should be developed to screen for cognitive deficits following acquired brain injury.