Contribution of informant and patient ratings to the accuracy of the mini-mental state examination in predicting probable Alzheimer's disease

J Am Geriatr Soc. 2003 Jun;51(6):813-8. doi: 10.1046/j.1365-2389.2003.51262.x.


Objectives: To determine whether the accuracy of the Mini-Mental State Examination (MMSE) in predicting future Alzheimer's disease (AD) could be improved by the addition of patient and informant ratings of cognitive difficulties.

Design: An inception cohort of nondemented patients followed longitudinally for 2 years.

Setting: Patients referred to a university teaching hospital research investigation by their family physicians because of concerns about memory impairment.

Participants: One hundred sixty-five community-residing patients were included who did not have dementia or any identifiable cause for memory impairment. After 2 years, 29 met criteria for AD, and 95 were not demented.

Measurements: Baseline assessments included MMSE, an Informant Rating Scale, and a Patient Rating Scale of cognitive difficulties. After 2 years, patients were diagnosed following the reference standard for probable AD. Diagnosticians were blind to baseline scores.

Results: Age and education were included in all analyses as covariates. The best logistic regression model included the Informant Rating Scale and the MMSE (sensitivity = 83%, specificity = 79%). An empirically reduced six-item model that included two items each from the MMSE, the Patient Rating Scale, and the Informant Rating Scale produced a significantly better model than the one with the full test scores (sensitivity = 90%, specificity = 94%).

Conclusion: Results indicate that inclusion of informant ratings with the MMSE significantly improved its accuracy in the prediction of probable AD. Replication in a new prospective cohort of nondemented patients is necessary to confirm these findings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Alzheimer Disease / diagnosis*
  • Alzheimer Disease / psychology
  • Cohort Studies
  • Family / psychology*
  • Friends / psychology*
  • Geriatric Assessment*
  • Humans
  • Neuropsychological Tests / standards*
  • Predictive Value of Tests
  • Reproducibility of Results