A Normative Study of the Mini-Mental State Examination for Dementia Screening (MMSE-DS) and Its Short form(SMMSE-DS) in the Korean Elderly

OBJECTIVES: This study aimed to present the normative information of the Mini-Mental State Examination-Dementia Screening (MMSE-DS) and its short form (SMMSE-DS) in the Korean elderly. METHODS: The MMSE-DS was administered in a standardized manner to 1,008 healthy volunteers aged 60 years or over recruited from participants in the Korean Longitudinal Study on Health and Aging or from volunteers in the National Dementia Screening and Registry Program. The SMMSE-DS was consisted of 13 items from the MMSE-DS based on the diagnostic accuracy of individual items for dementia. RESULTS: Age and educational level were found to have significant effect on the SMMSE-DS score, but sex was not. Based on this result, overlapping age normative table (60 to 74, 70 to 84, and 75 to 90 years of age) with 4 educational strata (0 to 3 years, 4 to 6 years, 7 to 12 years and 13 years and more) was developed for the SMMSE-DS. For resulting 12 normative units, 5 percentile, lower quartile, median, upper quartile, mean, standard deviation and -1.5standard deviation were calculated. CONCLUSION: The normative data from this study can be widely used as reference values to objectively interpret the MMSE-DS and SMMSE-DS scores of the Korean elderly.

A Normative Study of the Mini-Mental State Examination for Dementia Screening (MMSE-DS) and Its Short form(SMMSE-DS) in the Korean Elderly

OBJECTIVES: This study aimed to present the normative information of the Mini-Mental State Examination-Dementia Screening (MMSE-DS) and its short form (SMMSE-DS) in the Korean elderly. METHODS: The MMSE-DS was administered in a standardized manner to 1,008 healthy volunteers aged 60 years or over recruited from participants in the Korean Longitudinal Study on Health and Aging or from volunteers in the National Dementia Screening and Registry Program. The SMMSE-DS was consisted of 13 items from the MMSE-DS based on the diagnostic accuracy of individual items for dementia. RESULTS: Age and educational level were found to have significant effect on the SMMSE-DS score, but sex was not. Based on this result, overlapping age normative table (60 to 74, 70 to 84, and 75 to 90 years of age) with 4 educational strata (0 to 3 years, 4 to 6 years, 7 to 12 years and 13 years and more) was developed for the SMMSE-DS. For resulting 12 normative units, 5 percentile, lower quartile, median, upper quartile, mean, standard deviation and -1.5standard deviation were calculated. CONCLUSION: The normative data from this study can be widely used as reference values to objectively interpret the MMSE-DS and SMMSE-DS scores of the Korean elderly.

Korean Version of Mini Mental Status Examination for Dementia Screening and Its' Short Form

OBJECTIVE: We developed a Korean version of Mini-Mental Status Examination (MMSE) optimized for screening dementia (MMSE-DS) and its' short form (SMMSE-DS). METHODS: We constructed the MMSE-DS using the items of the two current Korean versions of MMSE and then construct the SMMSE-DS consisted of 13 items from the MMSE-DS based on the diagnostic accuracy of individual items for dementia. We investigated reliability and validity of MMSE-DS and SMMSE-DS on 1,555 subjects (1,222 nondemented controls, 333 dementia patients). We compared the diagnostic accuracy of the SMMSE-DS with that of the three full Korean versions of MMSE, and examined its' age- and education-specific optimal cutoff scores for dementia. RESULTS: The internal consistency obtained by Cronbach's coefficient alpha was 0.826. The inter-rater reliability and test-retest reliability were 0.968 (p<0.001) and 0.825 (p<0.001), respectively. It showed significant correlation with the Clinical Dementia Rating (CDR) (r=-0.698, p<0.05) and the three full Korean versions of MMSE (r=0.839-0.938, p<0.001). The area under the receiver operator curve for dementia of the SMMSE-DS was larger than those of the three full Korean versions of MMSE (p<0.001). Age, education and gender explained 19.4% of the total variance of SMMSE-DS scores. The optimal cutoff scores for dementia of the SMMSE-DS were estimated differently by age and educational attainment of the subjects. CONCLUSION: The SMMSE-DS was found to be accurate, brief and portable instrument for screening dementia in Korean elders, and may be particularly useful for screening dementia in elderly populations with wide variation in educational levels.

A Normative Study of an Executive Clock Drawing Task(CLOX) in Korean Elderly / 신경정신의학

OBJECTIVES: The CLOX (an executive clock drawing task) consists of an unprompted task that is sensitive to executive function (CLOX1) and a copied version that is more dependent on visuoconstructive function (CLOX2). This study aimed to explore the effects of age, education, and gender on the performance of the CLOX and to provide normative information on the test in the Korean elderly. METHODS: We administered the CLOX to 608 community-dwelling healthy volunteers aged 60-90, excluding people with serious neurological, medical, and psychiatric disorders, including dementia. Multiple linear regression analysis was performed to assess the relative contributions of the demographic factors to the CLOX scores. RESULTS: Education had a considerable influence on performance of both CLOX1 and CLOX2. Age and gender also had significant effect on both. There were significant interactions between education and gender for both CLOX1 and CLOX2. We also found interactions between education and age on CLOX2. Based on these results, we created normative data for the CLOX, stratified by age (60-74 and 75-90 years), education (0-3, 4-9, and 10+ years), and gender. CONCLUSION: Our normative data, based on a large, healthy elderly population, provides accurate reference information on CLOX performance and should be very useful for proper interpretation of CLOX scores in the Korean elderly.

Reliability and Validity of the Korean Version of Severe Mini-Mental Status Examination (SMMSE-K) / 신경정신의학

OBJECTIVES: We developed the Korean version of Severe Mini-Mental Status Examination (SMMSE-K) which is a brief cognitive test for the severely demented patients. METHODS: The translation was carried out keeping the basic structure of the English version Severe Mini-Mental Status Examination (SMMSE). The SMMSE-K, Korean version of Mini Mental State Examination (MMSE-KC), and Clinical Dementia Rating (CDR) were administered to 84 Alzheimer's disease (AD) patients and 36 cognitively normal elderly subjects. For evaluating the reliability of the SMMSE-K, Cronbach alpha coefficient, inter-rater reliability, and test-retest reliability were examined. For confirming the validity of the SMMSE-K, the correlations of the SMMSE-K with MMSE-KC and CDR were examined, and factor analysis was performed using principal component analysis with Varimax rotation. RESULTS: SMMSE-K was found to have a high internal consistency (Cronbach alpha coefficient=0.906, p<0.01), inter-rater reliability (Pearson correlation coefficient=0.980, p<0.01) and test-retest reliability (Pearson correlation coefficient=0.940, p<0.01). Performances on the SMMSE-K and MMSE-KC were found to correlate significantly in the subjects with CDR of 2 (Pearson correlation coefficient=0.827, p<0.001) and 3 (Pearson correlation coefficient=0.929, p<0.001). In the subjects with CDR of 3, the MMSE-KC showed a floor effect (2.93+/-3.21), whereas the SMMSE-K did not (11.00+/-8.48). Exploratory factor analysis yielded two factors (automatic informational processing, controlled informational processing) accounting for 76.1% of the total variance. CONCLUSION: The SMMSE-K was found to be a reliable and valid test for assessing the cognition of severely demented patients.

Predictors for Subjective Memory Complaints in the Elderly: The Results from Korean Longitudinal Study on Health and Aging (KLoSHA) / 신경정신의학

OBJECTIVES: We investigated the predictors of subjective memory complaints in the community-dwelling normal elderly. METHODS: This study was conducted as a part of Korean Longitudinal Study on Health and Aging (KLoSHA). 747 nondemented community-dwelling elderly aged 65 years or older were recruited. All participants underwent clinical evaluation for dementia and psychiatric disorder conformed to the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) Clinical Assessment Battery and Korean version of Mini-International Neuropsychiatric Interview, respectively. Word list recall test, frontal assessment battery, Mini Mental Status Examination (MMSE-KC) and Korean version of Geriatric depression scale (GDS-K) were administered to evaluate episodic memory, frontal function, global cognition and depression, respectively. Subjective memory complaint was defined in two different ways: worse than one's past (SMC-P) and worse than others of one's age (SMC-O). RESULTS: In highly educated elderly, minor depressive disorder (OR=7.23, 95% C.I.= 2.29-22.86) and frontal dysfunction (OR=2.48, 95% C.I.=1.29-4.77) significantly increased the risk of SMC-O. However, they did not influence the risk of SMC-P. In low educated elderly, both the minor depressive disorder and frontal dysfunction did not influence the risk of SMC-O as well as that of SMC-P. CONCLUSION: SMC-O can be a sensitive subjective recognition of mild depression and/or frontal dysfunction in highly educated normal elderly.