Alzheimer's Disease Education and Referral Center

New scoring on dementia screening recommended for more highly educated people

April 15, 2009

A recent study by researchers from the Texas Tech University Health Science Center and the Mayo Clinic Department of Medicine shows that raising the Mini-Mental State Examination (MMSE, a standard screening tool for dementia) "cut score" for more highly educated people increases the early accuracy of results for this group. Earlier identification of cognitive decline could aid in their treatment.

Scores on the MMSE decrease with advanced age and less education. The standard MMSE cut score is 24, meaning that a score of 23 or below indicates possible dementia. However, a review of data for 4,248 people, including 1,141 with 16 or more years of education, suggests that a more appropriate cut score for college-educated individuals is 27. Raising the MMSE cut score for this group to 27 increased the accuracy of the classification rate from 89 to 90 percent and provided an "optimal balance" of sensitivity and specificity, the study results reveal. A cut score of 27 identified 70 of the 104 college-educated patients with dementia who were missed when a cut score of 24 was used.

The researchers conclude that older, more highly educated patients who complain of cognitive decline and score below 27 on the MMSE should be referred for a comprehensive dementia evaluation.


O'Bryant, S.E., et al. Detecting dementia with the mini-mental state examination in highly educated individuals. Arch Neurol. 2008 July. 65(7):963-67.

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