Cross-cultural adaptation of the Moroccan version of the Mini-Mental State Examination: A preliminary study

Abstract

Introduction

The Mini-Mental State Examination (MMSE) is widely used for dementia screening. The purpose of this study was twofold. First, to cross-culturally adapt the Moroccan Arabic version of MMSE (MA-MMSE) to screen dementia among literate and illiterate elderly Moroccans, and second to analyze its psychometric properties.

Methods

The MA-MMSE was administered to 80 elderly patients, 28 were females and 52 were males. Among all the participants, 22 showed evidence of dementia. Receiver Operator Characteristic (ROC), internal consistency, and test–retest reliability were investigated. The test–retest reliability was assessed by Spearman correlation analysis. Cronbach’s α coefficients for internal consistency between total scores and subscores of the test were calculated.

Results

Areas under the ROC curve in literate and illiterate elderly Moroccans participants corresponded to 0.932 and 0.936, respectively. The cutoff point of 21/22 on the MA-MMSE in literate elderly had the highest sensitivity (85.7%), specificity (94.7%), and a positive likelihood ratio of (16.29%), whereas the cutoff point of 18/19 of the screening test in illiterate elderly yielded the highest sensitivity (92.9%), specificity (95.0%), and a positive likelihood ratio of (18.57%). The Cronbach’s α values of the MA-MMSE for literate and illiterate elderly Moroccans were higher than 0.7. Thirty subjects were randomly selected for participation in the test–retest protocol. Participants were retested after an interval of 4–6 weeks. The test–retest reliability for total scores was significant 0.78 (p < 0.01).

Conclusion

The findings provide preliminary evidence that the MA-MMSE is a feasible instrument for dementia screening.

Keywords:

• Cognitive screening
• cutoff point
• dementia
• MMSE
• Morocco
• reliability

Acknowledgments

We thank professors Abdellah Elhaloui and Abdelkader Marrah from the English department of the Faculty of Arts and Humanities, Cadi Ayyad, for their contribution to the translation of the test. We also wish to thank Dr. Asmae Boudanga and all the neurologists from the University Hospital Mohammed VI in Marrakech who contributed to data collection. Finally, we also deem it necessary to express our sincere gratitude to the speech therapist, Layane Boumanne, for her support and insights.

Disclosure statement

No potential conflict of interest was reported by the author(s).