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Norms for the Mini-Mental State Examination in a healthy population

From the Institute of Hygiene (Dr. Grigoletto), University of Padua, Italy; Division of Neurology (Dr. Zappalà), Garibaldi Hospital, Catania, Italy; and Biometry and Field Studies Branch (Dr. Anderson), National Institute of Neurological Disorders and Stroke, and Interventions Research Branch (Dr. Lebowitz), National Institute of Mental Health, National Institutes of Health, Bethesda, MD.

Address correspondence and reprint requests to Professor Francesco Grigoletto, Institute of Hygiene, University of Padua, Via Loredan 18, Padova 35131, Italy.

BACKGROUND: Although the Mini-Mental State Examination (MMSE) is widely used in clinical practice, few norms exist for healthy populations covering a broad range of ages.

OBJECTIVE: To obtain MMSE norms specific for age, gender, and education in healthy adults.

METHODS: From the population registers of seven communities across Italy, we selected a proportionate random sample of residents age 20 to 79 years to evaluate their health status with respect to conditions affecting cognitive performance. This sample yielded 908 persons who were deemed to be without cognitive impairment and who were then given the MMSE. We calculated fifth percentile norms and presented them as step functions. We then validated the norms as a screening tool for dementia in persons age 65 to 79 years. The validation was based on unpublished data from a separate study and involved estimates of sensitivity and specificity.

RESULTS: The norms declined with advancing age, especially for less educated women. Given any age and sex, the norms were higher for individuals with higher educational levels. In screening for dementia, the norms had a sensitivity of 85% and a specificity of 89%.

CONCLUSIONS: When using MMSE scores, it is important to account for age, gender, and education, especially in populations where the educational level is low. Expressing MMSE norms as step functions provides an easy-to-use tool for neurologists and other clinicians.

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