Cognitive impairment and survival in very elderly people

doi:10.1136/bmj.316.7145.1673

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Mini-mental state examination may not test cognitive function adequately

Pete Forster, Fourth year medical student,
Emma Heckford, Fourth year medical student,
Claire Huckler, Fourth year medical student,
Nicole Keong, Fourth year medical student,
Ahmed Al-Khabaz, Fourth year medical student

Department of Epidemiology and Public Health, School of Health Sciences, Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH
Medical Unit for the Acute Care of the Elderly, Poliambulanza Hospital, Brescia, Italy
Geriatric Evaluation and Rehabilitation Unit, Richiedei Hospital, Gussago, Brescia
Geriatric Research Group, 25122 Brescia
Section of Gerontology and Geriatrics, Department of General Internal Medicine, University Hospital Leiden, P-3-Q, PO Box 9600, 2300 RC Leiden, Netherlands
Clinical Epidemiology Leiden, University Hospital Leiden, Leiden
Department of Psychiatry, University of Utrecht, Utrecht, Netherlands

EDITOR—Gussekloo et al hypothesised that mild cognitive impairment as determined by the Dutch version of the mini-mental state examination 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 the test is administered by different physicians. In clinical practice the mini-mental state examination is well recognised as being a 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 several variables affecting alertness, such as time of day, timing of drug treatment, stress, and discomfort.

The authors conclude that this test “seems to be useful as a screening instrument for mild cognitive impairment, and its scores may act as an important predictor of survival in very elderly people.”1 Although this conclusion …