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Assessment of an Arabic version of the Mini-Mental State Examination

Assessment of an Arabic version of the Mini-Mental State Examination. Dr Adnan Awada Associate Professor of Neurology Hôtel-Dieu de France & St. Joseph University Beirut, Lebanon. Mini-Mental State Examination (MMSE).

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Assessment of an Arabic version of the Mini-Mental State Examination

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  1. Assessment of an Arabic version of the Mini-Mental State Examination Dr Adnan Awada Associate Professor of Neurology Hôtel-Dieu de France & St. Joseph University Beirut, Lebanon

  2. Mini-Mental State Examination(MMSE) • One of the most used instruments for quantitative assessment of cognitive functions & dementia screening • It assesses many cognitive domains including orientation, memory, language, calculation & visual construction

  3. MMSE (2): Total 30 points • Orientation: • Year, Season, Date, Day of week, Month (5 points) • State, county, town or city, hospital or clinic & floor (5 points) • Registration of 3 items (3 points) • Attention & calculation: spell WORLD backward (5 points) • Recall of 3 items (3 points) • Language (9 points) • Name 2 objects (2) • Repeat a meaningless sentence (1) • Follow 3-stage command (3) • Read and obey (1) • Write a sentence (1) • Copy a figure (1)

  4. Norms for the MMSE in USA (Crum et al, 1993) years

  5. MMSE (2) • MMSE seems to be more suitable for western population with standard education • Its use in other languages entails translation into the specific language, modification/substitution of some items with culturally relevant ones, and testing these for sensitivity & specificity

  6. Priliminary Assessment of an Arabic version of the MMSE Co-investigators Saad Al-Rajeh, Adesola Ogunniyi, AbdelKader Daif, Radwan Zaidan

  7. Arabic version of MMSE • The MMSE was translated into Arabic • Most items were left unchanged • Some items were changed to fit the language or the culture • The Arabic version was then translated blindly into English to ensure consistency

  8. Arabic MMSE: modified Items • Orientation: • Year, Season, Date, Day of week, Month (5 points) • State, county, town or city, hospital or clinic & floor (5 points) • Registration of 3 items (3 points) [adapted local objects] • Attention & calculation: spell WORLD backward(5 points) • Recall of 3 items (3 points) • Language (9 points) • Name 2 objects (2) • Repeat a meaningless sentence: No ifs ands or buts (1) • Follow 3-stage command (3) • Read and obey (1) • Write a sentence (1) • Copy a figure (1)

  9. Arabic MMSE: modified Items • State, county, town or city, hospital or clinic & floor: Region, city, part of city, hospital or clinic & floor (5 points) • Attention & calculation: spell WORLD backward: Count backward from 100, 3 by 3 (5 points) • Repeat a meaningless sentence: No ifs ands or buts: Man Maa Man La Bala(1)

  10. Testing the Arabic MMSE • The questionnaire was administered to: • Educated normal individuals: 14 (12 M, 2 F, mean age 40 years) • Uneducated normal individuals: 19 (15 M, 4 F; mean age 57 years) • Demented individuals: 4 (3M, 1 F; mean age 68 years)

  11. Statistics • Because of the small sample size, we used non-parametric statistics including Kruskall-Wallis analysis of variance and Spearman correlations of variance

  12. Results

  13. Results • Demented: mean score 8 ± 3.4 • Normal individuals: mean 22.3 ± 6.3 • Non-Educated: 17.9 ± 6 • Educated: 28.3 ± 4

  14. Results (mean ± SD)

  15. Sensitivity & specificity for Dementia of different scores

  16. Norms for the MMSE in USA (Crum et al, 1993) years

  17. Conclusions 1 • The usual cut-off score of 24, used in western countries, would have 100% sensitivity but only 51% specificity (half of normal persons would have been suspected to be demented) • A cut-off point of 10 would detect all normal persons (100% specificity) but would give many false negative (demented with higher scores)

  18. Conclusions 2 • Our results suggested that any subject who scores below 11 is demented • One could use the conventional cut-off point of 24 that is used in western countries, but only for educated individuals • For uneducated persons, it would be reasonable to suggest a cut-off score of 19, knowing that the specificity of this score is only 64%

  19. Thank You

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