Is the Folstein's Mini-Mental Test an Aphasia Test?

Abstract

The Mini-Mental State Examination (MMSE) is recognized as a valid screening for dementia. It consists of 29 verbal items from a total of 30. The Brief Aphasia Evaluation (BAE) includes 10 aphasia and 12 orientation items, which are similar to most of the MMSE items. It was studied whether those BAE items (MMSE-like): (a) correlate with the rest of the BAE items (BAE-rest), and (b) differentiate patients with left cerebral lesions (LC) from both patients with right cerebral lesions (RC) and healthy participants (HP). A sample of 109 right-handed volunteers (38 HP, 37 LC, and 34 RC) was studied. The three groups were matched according to gender, age, and education. Patients were similar in multiple variables. The correlation between MMSE-like and BAE-rest was .90. MMSE-like showed a sensitivity and specificity of .81 or above to identify the LC from the other two groups. There is a risk for misdiagnosing aphasia as dementia with the MMSE.

Key words:

• aphasia
• concurrent validity
• dementia
• differential diagnosis
• mental status
• methodology
• verbal dominant hemisphere

ACKNOWLEDGEMENTS

The authors are grateful to Cecilia Actis for her English assistance.

Notes

¹Maybe for this reason patients with aphasia usually suffer from apraxia. In addition, the verbal-dominant hemisphere is usually (but not always) the motor-dominant one.

²The concept of dementia is defined here as a general (global) cognitive dysfunction.

³Only the Spanish version was empirically studied. The English version is offered for research. By using the informatics version, automatic empirical definitions are calculated to assess the percentage of accuracy in all the studied functions. A formal registration (with a username and a password) is required to encourage a responsible use of the test. Patients have no access to the test, which is only offered to professionals.

⁴It is well known that if a patient presents failures in personal orientation, most likely he/she will present failures in place and time orientation.

Note. Analyses carried out according to the Kolmogorov-Smirnov test.

*Significant differences between LC and RC and between LC and HP.

**Significant differences between all pairwise comparisons among LC, RC, or HP.

⁵The residual ability of the BAE-rest to discriminate between LC and RC after subtracting the MMSE-like was verified.

⁶Correlations could not be calculated for all the MMSE-like aphasia items due to the lack of variance in the HP and RC samples.

⁷All of the MMSE-like aphasia items also revealed significant differences between LC and the other two groups according to the Kolmogorov-Smirnov test (results available upon request).

TABLE 2 Distribution of Frequencies for LC and RC Diagnosed With the MMSE-Like

TABLE 3 Distribution of Frequencies for LC and HP Diagnosed With the MMSE-Like

Note. X ²  = 36.58; df = 1; p < .001 (common median = 34). Sensitivity, 32/37 = .86; specificity, 29/34 = .85. Positive predictive value, 32/37 = .86; negative predictive value, 29/34 = .85.

Note. X ²  = 47.68; df = 1; p < .001 (common median = 39). Sensitivity, 36/37 = .97; specificity, 31/38 = .81. Positive predictive value, 36/43 = .84; negative predictive value, 31/32 = .97.

This study was supported by funds from the National Council of Scientific and Technological Research in Argentina, where Vigliecca is an employee, and with a grant from the Ministry of Science and Technology of Cordoba Province. The authors state that there are no conflicts of interest that could have inappropriately influenced the work submitted.