Screening for Early Alzheimer's Disease: Is There Still a Role for the Mini-Mental State Examination?

Background: The objective of this study was to compare the performance of the Mini-Mental State Examination (MMSE) total score as well as item scores in separating 4 groups of elderly (55-85 years of age) subjects-normal controls, subjects with mild cognitive impairment (MCI), subjects with mild Alzheimer's disease, and subjects with depression.Method: The MMSE scores of 86 subjects (25 normal elderly controls, 26 subjects with MCI, 10 subjects with mild Alzheimer's disease, and 25 subjects with depression) were analyzed. Statistically significant differences between groups in both overall MMSE score and individual item scores were documented. Receiver operating characteristic curves were constructed to yield further data.Results: The overall MMSE scores of the mild Alzheimer's disease group were significantly below those of subjects in the control, MCI, and depression groups (p < .001). The overall MMSE scores of MCI subjects were significantly lower than those of control subjects (p = .005) but not different from those of subjects with depression. Furthermore, individual item responses were not significantly different between MCI subjects and controls. The delayed recall item scores were statistically lower in the mild Alzheimer's disease group versus the other 3 groups but did not separate the control, MCI, and depression groups from each other.Conclusion: The MMSE effectively separates those with mild Alzheimer's disease from the other 3 groups and MCI from normal aging, but it is relatively ineffective in separating normal elderly individuals from those with depression and individuals with MCI from those with depression. Measures other than the MMSE may need to be implemented to evaluate mental status to more effectively separate MCI from depression and depression from normal aging.