Mild dementia or cognitive impairment: The Modified Mini-Mental State Examination (3MS) as a screen for dementia

Objective: To examine the Modified Mini-Mental State Examination (3MS) as a screen for dementia. Method: A group of 1092 elderly Edmonton community residents completed the 3MS and the Geriatric Mental State Examination (GMS). 3MS sensitivity and specficity were determined by comparing positive 3MS screens (score less than or equal to 77) with those classified as GMS "organic" (severity level 3, equivalent to a clinical diagnosis). In the Canadian Study of Health and Aging (CSHA), 2914 subjects received the 3MS and a clinical examination. A group described as having cognitive impairment but no dementia (CIND)" was identified. Results: In Edmonton, the 3MS showed 88% sensitivity, 90% specificity, 29% positive predictive value (PPV), and 99% negative predictive value (NPV). In the CSHA, 30% of subjects receiving both the 3MS and a clinical examination were classified as CIND. One-half of these were classified as having "age associated memory impairment (AAMI)" or as "unspecified." Conclusions. The 3MS with a cutting score of 77/78 proved a reasonable screening instrument; 1 case in 3 screening "positive" has dementia, butfew (0. 64%) will be missed by screening "negative. " CIND, account ngfor 2 out of 3 cases screened positive by the 3MS in the Edmonton study, is a substantial, heterogeneous group that is not necessarily "predementia" but that in many cases merits further investigation.