Effect of education on the mini-mental state examination as a screening test for dementia

J Am Geriatr Soc. 1991 Sep;39(9):876-80. doi: 10.1111/j.1532-5415.1991.tb04454.x.


We studied whether Mini-Mental State Examination (MMSE) norms for detecting dementia in elderly outpatients vary according to educational attainment. Subjects were 109 elderly outpatients with Alzheimer's dementia and 100 non-demented outpatient controls. Receiver operating characteristics (ROC) of the MMSE were examined among three strata of educational attainment: middle school, high school, and college/graduate school. MMSE ROC curve areas were .95-.96 in the three educational strata. Assuming a dementia prevalence of 10%-30%, the most accurate lower limits of normal for MMSE scores and their attendant sensitivities and specificities were 21 for middle school (.82/.94), 23 for high school (.79/.97), and 24 for college/graduate school (.83/1.00) attainment. These norms accurately classified over 90% of subjects in all three educational strata. We conclude that education-specific norms optimize performance of the MMSE as a screening test for Alzheimer's dementia in elderly outpatients.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Alzheimer Disease / diagnosis*
  • Case-Control Studies
  • Educational Status*
  • Female
  • Humans
  • Male
  • Mass Screening / methods*
  • Mental Status Schedule
  • Psychiatric Status Rating Scales*
  • ROC Curve
  • Regression Analysis
  • Sensitivity and Specificity
  • Washington