Cochrane Database of Systematic Reviews Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations (Review) Creavin ST, Wisniewski S, Noel-Storr AH, Trevelyan CM, Hampton T, Rayment D, Thom VM, Nash KJE, Elhamoui H, Milligan R, Patel AS, Tsivos DV, Wing T, Phillips E, Kellman SM, Shackleton HL, Singleton GF, Neale BE, Watton ME, Cullum S Creavin ST, Wisniewski S, Noel-Storr AH, Trevelyan CM, Hampton T, Rayment D, Thom VM, Nash KJE, Elhamoui H, Milligan R, Patel AS, Tsivos DV, Wing T, Phillips E, Kellman SM, Shackleton HL, Singleton GF, Neale BE, Watton ME, Cullum S. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD011145. DOI: 10.1002/14651858.CD011145.pub2. www.cochranelibrary.com Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations (Review) Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 3 OBJECTIVES ..................................... 5 METHODS ...................................... 5 Figure1. ..................................... 7 Figure2. ..................................... 11 RESULTS....................................... 12 Figure3. ..................................... 13 Figure4. ..................................... 14 Figure5. ..................................... 16 Figure6. ..................................... 17 Figure7. ..................................... 18 Figure8. ..................................... 19 Figure9. ..................................... 20 Figure10. ..................................... 21 Figure11. ..................................... 22 Figure12. ..................................... 23 Figure13. ..................................... 24 Figure14. ..................................... 25 DISCUSSION ..................................... 28 AUTHORS’CONCLUSIONS . 28 ACKNOWLEDGEMENTS . 29 REFERENCES ..................................... 29 CHARACTERISTICSOFSTUDIES . 51 DATA ........................................ 151 Test1.MMSEat14normality. 151 Test2.MMSEat15normality. 152 Test3.MMSEat16normality. 152 Test4.MMSEat17normality. 153 Test5.MMSEat18normality. 153 Test6.MMSEat19normality. 154 Test7.MMSEat20normality. 155 Test8.MMSEat21normality. 156 Test9.MMSEat22normality. 156 Test10.MMSEat23normality. 157 Test 11. MMSE at 24 normality (23/24). 158 Test12.MMSEat25normality. 159 Test13.MMSEat26normality. 160 Test14.MMSEat27normality. 160 Test15.MMSEat28normality. 161 Test16.MMSEat29normality. 161 Test17.MMSEat30normality. 162 Test 18. MMSE adjusted for education. ....... 162 Test22.MMSEat10normality. 163 Test23.Mainanalysis.. 163 ADDITIONALTABLES. 164 APPENDICES ..................................... 169 WHAT’SNEW..................................... 181 CONTRIBUTIONSOFAUTHORS . 182 Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community i and primary care populations (Review) Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. DECLARATIONSOFINTEREST . 182 SOURCESOFSUPPORT . 182 DIFFERENCES BETWEEN PROTOCOL AND REVIEW . .... 182 INDEXTERMS .................................... 183 Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community ii and primary care populations (Review) Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Diagnostic Test Accuracy Review] Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations Sam T Creavin1, Susanna Wisniewski2, Anna H Noel-Storr3, Clare M Trevelyan4, Thomas Hampton5, Dane Rayment6, Victoria M Thom7, Kirsty J E Nash8, Hosam Elhamoui9, Rowena Milligan10, Anish S Patel11, Demitra V Tsivos12, Tracey Wing13, Emma Phillips 14, Sophie M Kellman15, Hannah L Shackleton16, Georgina F Singleton17, Bethany E Neale18, Martha E Watton19, Sarah Cullum1 1School of Social and Community Medicine, University of Bristol, Bristol, UK. 2Cochrane Dementia and Cognitive Improvement Group, Oxford University, Oxford, UK. 3Radcliffe Department of Medicine, University of Oxford, Oxford, UK. 4Medical Education, Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK. 5ENT, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK. 6Older Adult Psychiatry, Avon and Wiltshire Partnership NHS Trust, Chippenham, UK. 7Forensic Psychiatry, Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK. 8North Bristol NHS Trust, Bristol, UK. 9Psychiatry, Somerset Partnership NHS Trust, Taunton, UK. 10General Practice, Mansion House Surgery, Stone, UK. 11NBT Acute Mental Health Liaison Team, Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK. 12Neuropsychology, North Bristol NHS Trust, Bristol, UK. 13Care of Elderly/ITU/A+E, Taunton and Somerset NHS trust, Bristol, UK. 142gether NHS Foundation Trust, Cheltenham, UK. 15Avon and Wiltshire Mental Health Partnership NHS Trust, Chippenham, UK. 16NHS Forth Valley, NHS Scotland, Falkirk, UK. 17Department of Anaesthetics, West Suffolk Hospital, Bury St Edmunds, UK. 18General Practice, RCGP Severn Faculty, Bristol, UK. 19Bristol, UK Contact address: Sam T Creavin, School of Social and Community Medicine, University of Bristol, Carynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. [email protected]. Editorial group: Cochrane Dementia and Cognitive Improvement Group. Publication status and date: New, published in Issue 1, 2016. Review content assessed as up-to-date: . Citation: Creavin ST, Wisniewski S, Noel-Storr AH, Trevelyan CM, Hampton T, Rayment D, Thom VM, Nash KJE, Elhamoui H, Milligan R, Patel AS, Tsivos DV, Wing T, Phillips E, Kellman SM, Shackleton HL, Singleton GF, Neale BE, Watton ME, Cullum S. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD011145. DOI: 10.1002/14651858.CD011145.pub2. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ABSTRACT Background The Mini Mental State Examination (MMSE) is a cognitive test that is commonly used as part of the evaluation for possible dementia. Objectives To determine the diagnostic accuracy of the Mini-Mental State Examination (MMSE) at various cut points for dementia in people aged 65 years and over in community and primary care settings who had not undergone prior testing for dementia. Search methods We searched the specialised register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), LILACS (BIREME), ALOIS, BIOSIS previews (Thomson Reuters Web of Science), and Web of Science Core Collection, including the Science Citation Index and the Conference Proceedings Citation Index (Thomson Reuters Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community 1 and primary care populations (Review) Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Web of Science). We also searched specialised sources of diagnostic test accuracy studies and reviews: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). We attempted to locate possibly relevant but unpublished data by contacting researchers in this field. We first performed the searches in November 2012 and then fully updated them in May 2014. We did not apply any language or date restrictions to the electronic searches, and we did not use any methodological filters as a method to restrict the search overall. Selection criteria We included studies that compared the 11-item (maximum score 30) MMSE test (at any cut point) in people who had not undergone prior testing versus a commonly accepted clinical reference standard for all-cause dementia and subtypes (Alzheimer disease dementia, Lewy body dementia, vascular dementia, frontotemporal dementia). Clinical diagnosis included all-cause (unspecified) dementia, as defined by any version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); International Classification of Diseases (ICD) and the Clinical Dementia Rating. Data collection and analysis At least three authors screened all citations.Two authors handled data extraction and quality assessment. We performed meta-analysis using the hierarchical summary receiver-operator curves (HSROC) method and the bivariate method. Main results We retrieved 24,310 citations after removal of duplicates. We reviewed the full text of 317 full-text articles and finally included 70 records, referring to 48 studies, in our synthesis. We were able to perform meta-analysis on 28 studies in the community setting (44 articles)