ABSTRACT
Abstract The Mini-Mental State Examination (MMSE) is currently used to the track cognitive status of older adults in Brazil. Studies on its psychometric properties are lacking, especially ones that use Item Response Theory. The objective was to assess the difficulty of the items in a Brazilian version of MMSE using the Rasch model and to identify possible differential item functioning (DIF), considering schooling, age and sex of the sample of Brazilian older adults. This study used the answers of 2.734 older adults to the 30 items of MMSE. It was found that four items in the seven series were the most difficult, and items nine, 13, 22 and 23 were the easiest. The skill of respondents was higher than the items' difficulty level. DIF was observed for schooling, sex and age in, respectively, 27, 18 and 16 items. It is concluded that the use of MMSE in Brazilian older adults should be cautious due to the large number of biased items, mainly due to schooling.
Resumo O Miniexame do Estado Mental (MEEM) tem sido utilizado para rastrear status cognitivo de idosos brasileiros. Há poucos estudos sobre suas propriedades psicométricas, especialmente com Teoria de Resposta ao Item. Este estudo teve por objetivo avaliar a dificuldade dos itens de uma versão brasileira do MEEM por meio do modelo de Rasch e identificar possível funcionamento diferencial dos itens (DIF), considerando escolaridade, idade e sexo dos integrantes de amostra de idosos da comunidade. Foram utilizadas as respostas de 2.734 idosos aos 30 itens do MEEM. Constatou-se que quatro itens do sete seriado foram os mais difíceis e os itens nove, 13, 22 e 23, os mais fáceis. O nível de habilidade das pessoas foi maior do que o nível de dificuldade dos itens. Observou-se DIF para escolaridade, sexo e idade, respectivamente 27, 18 e 16 itens. Conclui-se que o uso do MEEM em idosos da comunidade deve ser cauteloso devido ao grande número de itens enviesados, principalmente pela escolaridade.
Resumen El Miniexamen del Estado Mental (MMSE) se ha utilizado para rastrear el estado cognitivo de los ancianos brasileños. Sin embargo, no hay estudios sobre sus propiedades psicométricas, especialmente utilizando la Teoría de Respuesta al Ítem. El objetivo de este estudio fue evaluar la dificultad de los ítems de una versión brasileña del MMSE utilizando el modelo de Rasch, así como identificar el posible funcionamiento diferencial de los ítems (DIF), considerando el nivel de estudios, la edad y el sexo de los ancianos participantes de la muestra. Se utilizaron las respuestas de 2.734 ancianos a los 30 ítems del MMSE. Se evidenció que cuatro ítems de siete series fueron los más difíciles, y los ítems 9, 13, 22 y 23 los más fáciles. El nivel de habilidad de las personas fue más alto que el nivel de dificultad de los ítems. Se observó que el DIF para nivel de estudios, sexo y edad fueron 27, 18 y 16 ítems, respectivamente. Se concluye que el uso del MMSE en los ancianos de la comunidad debe ser cauteloso debido a la gran cantidad de ítems sesgados, principalmente por el nivel de estudios.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aptitude , Psychometrics , Track and Field , Unified Health System , Residence Characteristics , Surveys and Questionnaires , State , Educational Status , Mental Status and Dementia TestsABSTRACT
Introducción: en el proceso del diagnóstico neuropsicológico, los instrumentos de tamizaje cognitivo, son una herramienta útil en la identificación de cambios mentales del sujeto, en momentos puntuales o a través del tiempo. Su uso se fundamenta en el análisis psicométrico. Objetivo: determinar el acuerdo inter e intra-observador en el MoCA test y el MMSE, aplicado por profesores y estudiantes en procesos de entrenamiento de tamización cognitiva. Materiales y métodos: a los estudiantes y profesores en entrenamiento en la puntuación del MoCA test y el MMSE, se les presentó un video en dos sesiones, con un intervalo de 5 meses, mostrando el desempeño de dos adultos mayores, respondiendo el MoCA test y el MMSE, previo consentimiento informado. Se compararon los puntajes dados en las dos sesiones por los sujetos en entrenamiento, con los de ellos mismos (intra-observador), usando el coeficiente de concordancia y correlación de Lin(rho) y con los del grupo restante (inter-observador) usando el coeficiente de correlación intra-clase (ICC). Resultados: participaron 46 evaluadores. Se encontró alta confiabilidad inter-observador para el MoCA (ICC=0.86), pero baja para el MMSE (ICC=0.24) y baja confiabilidad intra-observador tanto para el MoCA (rho paciente 1=0.012 y rho paciente 2=0.152) como para el MMSE (rho paciente 1=0.008 y rho paciente 2=0.012). Aunque los puntajes difirieron, las clasificaciones diagnósticas realizadas por los evaluadores fueron similares a las del patrón de oro. Conclusión: la correcta aplicación del test, requiere varios entrenamientos, y aunque hubo pocas diferencias entre los puntajes, los errores cuando se está cerca del punto de corte propuesto, aumentan el riesgo de sesgo.
Introduction: The instruments for screening cognitive functions, applied to subjects in clinical settings and research, are useful for determining if this person has any trouble in cognition or show changes in the time. The usefulness of these instruments is defined with the evaluation of their psychometrics properties. Objective: This study allows to determine the intra and inter-observer agreement, when the MoCA test and MMSE were applied by a group in training process Materials and methods: The study group who attended two training sessions, with an interval of 5 months, scored the MoCA test and MMSE, from two patients which were filmed responding the tests, previous informed consent signature. We compared how close were the scores of participants among themselves by concordance correlation coefficient of Lin (rho) and with those given from the others by intra-class correlation coefficients (ICC). Results: In total, 46 participants were included. Intra-rater reliability was high for MoCA test (ICC = 0.86), but it was poor for MMSE (ICC=0.24). Inter-rater was poor for MoCA test (rho patient 1= 0.012, rho patient 2= 0.152) and MMSE (rho patient 1 = 0.008, rho patient 2 = 0.012). Although the scores between participants and gold standard were different, the diagnoses were similar. Conclusion:The correct scoring of the test, requires several trainings to clinical and research groups, and although they can be found few differences between scores applied by non-expert personnel, if the scores mistakenly given, are close to the cut-of point proposed for each test, the bias increases.
ABSTRACT
Background: Type 2 diabetes mellitus may be associated with cognitive decline (CD) in older subjects. Aim: To determine if CD is more common among diabetic subjects that their non-diabetic counterparts. Material and Methods: Using a case-control design, 17 diabetic patients with a median age of 73 years (nine females) and 21 non diabetic subjects with a median age of 72 years (17 females), with a similar educational background, were studied. Cognitive status was assessed using the Mini mental State Examination (MMSE), using a cutoff point of 23, and the Frontal Assessment Battery (FAB), that evaluated conceptualization, mental flexibility, motor initiative, sensibility to interference, inhibitory control, and environmental autonomy. The presence of any mental or organic cerebral disease, sensorial impairment or illiteracy were considered exclusion criteria. Results: Fifty nine percent of diabetic subjects and 24 percent of their non-diabetic counterparts, had a MMSE below the cutoff point (p = 0.03). An abnormal FAB was found in 29 and 14 percent of diabetic and non-diabetic subjects, respectively (p = NS). Both tests were abnormal in 29 and 5 percent of diabetic and non-diabetic subjects, respectively (p = 0.05). Conclusions: In this group of subjects, CD was more common among diabetics than their non-diabetic counterparts.