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Cognitive impairment and survival in very elderly people. Mini-mental state examination may not test cognitive function adequately.

1998; National Institutes of Health; Volume: 316; Issue: 7145 Linguagem: Inglês

Pete Forster, Emma Heckford, Claire Huckler, Nicole C. Keong, Ahmed Al-Khabaz,

Nutritional Studies and Diet

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 may be valid, we question the usefulness of such a prognostic indicator in clinical practice.