Effectiveness of the Mini-Mental State for detection of cognitive impairment in Primary Care

Objective: To evaluate the diagnostic accuracy (DA) of the Mini-Mental State (MMS) for the detection of cognitive impairment (a) in Primary Care (PC) and to determine the best conditions of use for that purpose. Design: Pooled analysis of two prospective, double blind, studies on the evaluation of diagnostic tools with complete verification that were conducted in Madrid and Granada (Spain). Setting: The MMS was administered in PC and the final cognitive diagnosis (gold standard) was made in Specialized Care. Participants: Subjects with cognitive complaints or suspected of having Cl were consecutively recruited in the PC clinic. Principal measures: The DA of the MMS was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The best cut-off point was selected according to the ratio of cases correctly classified (RCC) and to the kappa index. Direct (MMSd) and age- and education-adjusted (MMSa) total scores were analyzed separately. Results: In the total sample of 360 subjects (214 Cl), the DA of the MMSd was significantly superior to that of the MMSa (0.84 +/- 0.02 vs 0.82 +/- 0.02, p <= .001). The yield obtained by the best cut-off point of the MMSd (22/23) was modest (RCC 0.77, kappa 0.52 +/- 0.05) and was not improved by any MMSa cut-off point. Conclusion: The DA of the MMS for detection of CI in PC was modest and did not improve with adjustment of the score by age and education. The best cut-off point was 22/23, inferior to the usually recommended cut-off. (C) 2013 Elsevier Espana, S.L. All rights reserved.