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An alphabetical `WORLD'

A new version of an old test

From the Department of Medicine, Division of Neurology, Crozer-Chester Medical Center, Upland, PA.

Address correspondence and reprint requests to Dr. Norman A. Leopold, Parkinson Disease and Movement Disorder Center, Lewis House, Crozer-Chester Medical Center, Upland, PA 19013.

The Mini-Mental State Examination (MMSE) is a standardized test used by neurologists to screen patients for impaired cognition. Despite its ease of use, one major limitation of the MMSE is a possible ceiling effect or a lower sensitivity in patients with advanced education. Patients (n = 97) undergoing diagnostic neuropsychological testing also completed one subtest of the MMSE, the spelling of "world." In addition to its forward and backward spelling, patients were asked to reorder these letters in alphabetical sequence. Our preliminary data indicate that our modified WORLD test is a rapid and simple test to identify patients with cognitive impairment. When measured against the diagnosis of dementia as determined by neuropsychological testing, the modified WORLD test has a sensitivity of 85%, a specificity of 88%, and a positive predictability value of 95%. Other variables examined include patient age, sex, education, and cutoff scores on the Mattis Dementia Rating Scale.

Presented in part at the 49th annual meeting of the American Academy of Neurology, Boston, MA, April 1997.

Received May 30, 1997. Accepted in final form July 2, 1997.

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