Unconditional and Conditional Standards Using Cognitive Function Curves for the Modified Mini-Mental State Exam: Cross-Sectional and Longitudinal Analyses in Older Chinese Adults in Singapore
The conventional practice of assessing cognitive status and monitoring change over time in older adults using normative values of the Mini-Mental State Exam (MMSE) based on age bands is imprecise. Moreover, population-based normative data on changes in MMSE score over time are scarce and crude becau...
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Published in | The American journal of geriatric psychiatry Vol. 23; no. 9; p. 915 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
01.09.2015
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Abstract | The conventional practice of assessing cognitive status and monitoring change over time in older adults using normative values of the Mini-Mental State Exam (MMSE) based on age bands is imprecise. Moreover, population-based normative data on changes in MMSE score over time are scarce and crude because they do not include age- and education-specific norms. This study aims to develop unconditional standards for assessing current cognitive status and conditional standards that take prior MMSE score into account for assessing longitudinal change, with percentile curves as smooth functions of age.
Cross-sectional and longitudinal data of a modified version of the MMSE for 2,026 older Chinese adults from the Singapore Longitudinal Aging Study, aged 55-84, in Singapore were used to estimate quantile regression coefficients and create unconditional standards and conditional standards.
We presented MMSE percentile curves as a smooth function of age in education strata, for unconditional and conditional standards, based on quantile regression coefficient estimates. We found the 5th and 10th percentiles were more strongly associated with age and education than were higher percentiles. Model diagnostics demonstrated the accuracy of the standards.
The development and use of unconditional and conditional standards should facilitate cognitive assessment in clinical practice and deserve further studies. |
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AbstractList | The conventional practice of assessing cognitive status and monitoring change over time in older adults using normative values of the Mini-Mental State Exam (MMSE) based on age bands is imprecise. Moreover, population-based normative data on changes in MMSE score over time are scarce and crude because they do not include age- and education-specific norms. This study aims to develop unconditional standards for assessing current cognitive status and conditional standards that take prior MMSE score into account for assessing longitudinal change, with percentile curves as smooth functions of age.
Cross-sectional and longitudinal data of a modified version of the MMSE for 2,026 older Chinese adults from the Singapore Longitudinal Aging Study, aged 55-84, in Singapore were used to estimate quantile regression coefficients and create unconditional standards and conditional standards.
We presented MMSE percentile curves as a smooth function of age in education strata, for unconditional and conditional standards, based on quantile regression coefficient estimates. We found the 5th and 10th percentiles were more strongly associated with age and education than were higher percentiles. Model diagnostics demonstrated the accuracy of the standards.
The development and use of unconditional and conditional standards should facilitate cognitive assessment in clinical practice and deserve further studies. |
Author | Cheung, Yin Bun Feng, Liang Lim, Wee Shiong Lee, Tih Shih Nyunt, Ma Shwe Zin Yap, Keng Bee Xu, Ying Chong, Mei Sian Ng, Tze Pin Feng, Lei Yap, Philip |
Author_xml | – sequence: 1 givenname: Yin Bun surname: Cheung fullname: Cheung, Yin Bun organization: Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore; Department of International Health, University of Tampere, Finland – sequence: 2 givenname: Ying surname: Xu fullname: Xu, Ying organization: Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore – sequence: 3 givenname: Lei surname: Feng fullname: Feng, Lei organization: Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore – sequence: 4 givenname: Liang surname: Feng fullname: Feng, Liang organization: Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore – sequence: 5 givenname: Ma Shwe Zin surname: Nyunt fullname: Nyunt, Ma Shwe Zin organization: Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore – sequence: 6 givenname: Mei Sian surname: Chong fullname: Chong, Mei Sian organization: Institute of Geriatrics and Active Ageing and Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore – sequence: 7 givenname: Wee Shiong surname: Lim fullname: Lim, Wee Shiong organization: Institute of Geriatrics and Active Ageing and Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore – sequence: 8 givenname: Tih Shih surname: Lee fullname: Lee, Tih Shih organization: Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore – sequence: 9 givenname: Philip surname: Yap fullname: Yap, Philip organization: Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore – sequence: 10 givenname: Keng Bee surname: Yap fullname: Yap, Keng Bee organization: Department of Geriatric Medicine, Alexandra Hospital, Singapore – sequence: 11 givenname: Tze Pin surname: Ng fullname: Ng, Tze Pin email: pcmngtp@nus.edu.sg organization: Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: pcmngtp@nus.edu.sg |
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Copyright | Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved. |
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Keywords | cognitive impairment Mini-Mental State Exam Cognitive function norms |
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SubjectTerms | Aged Aging - psychology Asian Continental Ancestry Group - psychology Cognition Cross-Sectional Studies Female Geriatric Assessment - methods Humans Longitudinal Studies Male Middle Aged Psychiatric Status Rating Scales - standards Reference Standards Singapore |
Title | Unconditional and Conditional Standards Using Cognitive Function Curves for the Modified Mini-Mental State Exam: Cross-Sectional and Longitudinal Analyses in Older Chinese Adults in Singapore |
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