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Applicability of the Mini-mental State Examination (MMSE) and the Hindi Mental State Examination (HMSE) to the urban elderly in India: a pilot study

Published online by Cambridge University Press:  05 November 2008

S. C. Tiwari ,
Rakesh Kumar Tripathi  and
Aditya Kumar
S. C. Tiwari*
Affiliation:
Department of Geriatric Mental Health, C.S.M. Medical University (Uttar Pradesh), Lucknow, India
Rakesh Kumar Tripathi
Affiliation:
Department of Geriatric Mental Health, C.S.M. Medical University (Uttar Pradesh), Lucknow, India
Aditya Kumar
Affiliation:
Department of Geriatric Mental Health, C.S.M. Medical University (Uttar Pradesh), Lucknow, India
*
Correspondence should be addressed to: Dr. S. C. Tiwari, Professor and Head, Department of Geriatric Mental Health, C. S. M. Medical University UP, Lucknow-226 003, India. Phone: +91-522-2268857; Fax: +91-9415011977. Email: [email protected], [email protected].
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Abstract

Background: The Mini-mental State Examination (MMSE) is a globally used instrument for cognitive screening, which nevertheless has a bias with respect to education and language. The Indo-U.S. Cross National Epidemiology Study developed a modified version of MMSE, the Hindi Mental State Examination (HMSE), to counter this bias in India among rural and illiterate elderly. Thus, two parallel tests are available for screening the population. This study was conducted to explore and compare the applicability of MMSE and HMSE when scanning for cognitive impairment among urban elderly people.

Methods: The sample consisted of 40 subjects (20 illiterate and 20 literate) aged 60 years and above drawn from the urban community who met the inclusion criteria. A systematically translated Hindi version of MMSE (HVMMSE) was administered to both groups. After one month, HMSE was administered to the same groups. χ2 with Yate's correction, percentage, rank order correlation and qualitative analysis were used to analyze data.

Results: All illiterate subjects scored below the cut-off on translated HVMMSE while only four of them scored below the cut-off on HMSE. Among literate subjects, the translated HVMMSE and HMSE classified three subjects and one subject respectively as having possible cognitive impairment among urban elderlies.

Conclusion: The two instruments are not in agreement with regard to classifying elderly people as having possible cognitive impairment or not. This disagreement is more pronounced in the case of illiterate subjects. The study emphasizes the need to develop a fair cognitive screening instrument for elderly people in India.

Keywords

MMSEHMSEcognitive impairmenturban elderlyIndia
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 1 , February 2009 , pp. 123 - 128
Copyright
Copyright © International Psychogeriatric Association 2008

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References

Berk, R. A. (1982). Handbook of Methods for Detecting Test Bias. Baltimore: Johns Hopkins University Press.Google Scholar
Das, S. K. et al. (2006). An urban community-based study of cognitive function among non-demented elderly populations in India. Neurology Asia, 6 (11), 37–48.Google Scholar
Diniz, B. S. O., Yassuda, M. S., Nunes, P. V., Radanovic, M. and Forlennza, O. V. (2007). Mini-mental State Examination performance in mild cognitive impairment subtypes. International Psychogeriatrics, 19, 647–656. DOI: 10.1017/S104161020700542X.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 789–798.Google Scholar
Ganguli, M. et al. (1995). A Hindi version of the MMSE: the development of a cognitive screening instrument for a largely illiterate rural elderly population in India. International Journal of Geriatric Psychiatry, 10, 367–377.CrossRefGoogle Scholar
Hall, K. S. et al. (1993). The development of a dementia screening interview in two distinct languages. International Journal of Methodology Psychiatry, 3, 1–28.Google Scholar
Hendrie, H. (1992). Indianapolis-Ibadan Dementia Project. In Curb, J. D. and Graves, A. B. (eds.), Multi-national Epidemiological Studies of Dementia (symposium abstract). Gerontologist, 32 (Suppl. 2), 219.Google Scholar
Jones, R. N., and Gallo, J. J. (2001). Education bias in the Mini-mental State Examination. International Psychogeriatrics, 13, 299–310.CrossRefGoogle ScholarPubMed
Jorm, A. F., Scott, R., Henderson, A. S., and Kay, D. W. (1988). Educational level differences on the Mini-Mental State: the role of test bias. Psychological Medicine, 18, 727–731.CrossRefGoogle ScholarPubMed
Larson, E. (1992). The Ni-Hon-Sea Project: an overview. In Curb, J. D. and Graves, A. B. (eds.), Multi-national Epidemiological Studies of Dementia (symposium abstract). Gerontologist; 32 (Suppl. 2), 219.Google Scholar
Loewonstein, D. A., Arguelles, T., Barker, W. W., and Duara, R. (1993). A comparative analysis of neuropsychological test performance of Spanish-speaking and English-speaking patients with Alzheimer's disease. Journal of Gerontology, 48, 142–149.CrossRefGoogle Scholar
Nakasujja, N., Musisi, S., Walugembe, J. and Wallace, D. (2007). Psychiatric disorders among the elderly on non-psychiatric wards in an African setting. International Psychogeriatrics, 19, 691–704. DOI 10.1017/S1041610207005418.CrossRefGoogle Scholar
Park, J. H. and Kevon, Y. C. (1990). Modification of the MMSE for use in the elderly in a non-Western society. Part I. Development of Korean version of MMSE. International Journal of Geriatric Psychiatry, 5, 381–387.CrossRefGoogle Scholar
Reilly, S., Challis, D., Burns, A. and Hughes, J. (2004). The use of assessment scales in Old Age Psychiatry Services in England and Northern Ireland. Aging and Mental Health, 8, 249–255.CrossRefGoogle ScholarPubMed
Salmon, D. P., Riekkinen, P. J., Katzman, R., Zhang, M., Jin, H. and Yu, E. (1989). Cross-cultural studies of dementia: a comparison of MMSE performance in Finland and China. Archive Neurology, 46, 769–772.CrossRefGoogle Scholar
Shaji, S., Bose, S. and Verghese, A. (2005). Prevalence of dementia in an urban population in Kerala, India. British Journal of Psychiatry, 186, 136–140.CrossRefGoogle Scholar
Shulman, K. I. et al. (2006). IPA survey of brief cognitive screening instruments. International Psychogeriatrics, 18, 281–294.CrossRefGoogle ScholarPubMed