Cognitive impairment and survival in very elderly people

BMJ 1998;316:1673 ( 30 May )

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Cognitive impairment and survival in very elderly people

Mini-mental state examination may not test cognitive function adequately

Decreased survival with cognitive impairment seems not to be related to comorbidity

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Mini-mental state examination may not test cognitive function adequately

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EDITOR $---$ Gussekloo et al hypothesised that mild cognitive impairment as determined by the Dutch version of the mini-mental stateexamination discriminates subjects with a higher risk of mortality.¹

We have concerns about the validity of using the mini-mental state examination as an adequate test of cognitive function.We have doubts about the reproducibility of test scores if thetest is administered by different physicians. In clinical practicethe mini-mental state examination is well recognised as beinga useful guide rather than an absolute measure of cognitive function;it is a subjective test with variable results.

In particular, we think that defining the scores for mild cognitive impairment and normal cognitive function so close together,at 24-27 and 28-30 respectively, is a potential source of bias.A subject could fall into either category, depending on severalvariables affecting alertness, such as time of day, timing ofdrug treatment, stress, and discomfort.

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Impact of mild cognitive impairment on survival in very elderly people: cohort study: J Gussekloo, R G J Westendorp, E J Remarque, A M Lagaay, T J Heeren, and D L Knook
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