The role of education in Mini-Mental State Examination - A study in northeast Brazil

Background: There is evidence that schooling can influence performance in cognitive assessement tests. In developing countries, formal education is limited for most people. The use of tests such as Mini-Mental State Examination (MMSE), could have an adverse effect on the evaluation of illiterate and low education individuals. Objective: To propose anew version of MMSE as a screening test to assess Illiterate and low education people. Method., A study was carried out enrolling 232 individuals, aged 60 or more of low and middle socio-economic classes. Three groups were studied: Illiterate;1-4 schooling years; 5-8 schooling years. The new version (MMSE-mo) consisted of modifications in copy and calculation items of the adapted MMSE (MMSE-ad) to Portuguese language. The maximum possible score was the same in the two versions: total, 30; copy, 1 and calculation, 5. Results: In the total test score ANOVA detected main effects for education and test, as well as an interaction between these factors: higher schooling individuals performed better than lower schooling ones in both test versions; scores in MMSE-mo were higher than in MMSE-ad in every schooling group. Conclusion. Higher schooling levels improve the perfomance in both test versions, the copy and calculation items contributing to this improvement. This might depend on cultural factors. The use of MMSE-mo in illiterate and low school individuals could prevent false positive and false negative cognitive evaluations.