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Title: New Criterion May Improve Identification of Dementia Risk in Highly Educated Older Adults
URL: http://www.pslgroup.com/dg/225C36.htm
Doctor's Guide
July 14, 2008

CHICAGO -- July 14, 2008 -- A different cutoff point on an existing mental function assessment may more effectively assess the risk of dementia in highly educated older adults, according to a study in the July issue of Archives of Neurology.

Sid E. O'Bryant, MD, Texas Tech University Health Sciences Center, Lubbock, Texas, and colleagues, reviewed the mini-mental state examination (MMSE) scores of patients in the Mayo Clinic Alzheimer Disease Research Center and Alzheimer Disease Patient Registry who reported having 16 or more years of education.

The study included a total of 1,141 participants (93% white, mean age 75.9 y). This included 307 patients with dementia, 176 patients with mild cognitive impairment, and 658 control group patients without dementia.

With the traditional cut score of 24 on the MMSE, 89% of the participants were accurately classified by dementia status. This score had a sensitivity of 66% and a specificity of 99% for the detection of dementia.

Raising the cut score to 27 changed the sensitivity to 89% and the specificity to 78%, correctly classifying 90% of the participants.

"The current findings are not intended to encourage the diagnosis of cognitive impairment or dementia based on total MMSE scores alone," the authors wrote. "Instead, these results provide practitioners with revised criteria for appropriate management of highly educated older white patients."

"Older patients who present with memory complaints who have attained a college degree or higher level of education and who score below 27 on the MMSE are at increased risk of cognitive dysfunction and dementia, and should be referred for a comprehensive evaluation, including formal neuropsychological studies."

The authors suggest that use of this new cut point may help facilitate early detection of dementia in highly educated individuals. Timely treatment may be particularly important in this population, since individuals with more education tend to decline and die more quickly after they are diagnosed with Alzheimer's disease, the authors wrote.


SOURCE: Archives of Neurology

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