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Use of the Mini-Mental State Exam in Middle-Aged and Older Outpatients With Schizophrenia

Cognitive Impairment and Its Associations

Received April 12, 2004; revised April 30, 2004; accepted May 4, 2004. From the University of California, San Diego (UCSD), Department of Psychiatry (DJM,BWP,DVJ), the VA San Diego Healthcare System (DVJ), and the UCSD Stein Institute for Research on Aging (DVJ). Address correspondence to Barton W. Palmer, Ph.D., Department of Psychiatry, University of California, San Diego VA San Diego Healthcare System, 116A-1, 3350 La Jolla Village Drive, San Diego, CA 92161. e-mail: bpalmer{at}ucsd.edu
© 2004 American Association for Geriatric Psychiatry

Objective: The authors examined cognitive impairment with a commonly used cognitive screening tool (the Mini-Mental State Exam [MMSE]) and its relationship to psychopathology, functional status, and other clinically relevant participant characteristics in 161 middle-aged and older outpatients with schizophrenia and 86 normal-comparison participants (NCs). Methods: Participants completed the MMSE and standardized rating scales of psychopathology and motor symptoms. Other aspects of daily functioning were also evaluated. Results: Patients had worse mean MMSE scores than NCs; 23% of the patients, but no NCs, had MMSE totals 24 (a commonly used cutoff score to define impairment). Examination of the individual cognitive domains assessed by the MMSE showed that schizophrenia patients had the greatest impairment on tasks of word recall and attention. Among the patients, impaired MMSE performance was associated with lower education, living in a structured setting, being unmarried, and more severe negative symptoms. Conclusion: The MMSE was useful in detecting functionally relevant cognitive deficits among middle-aged and older schizophrenia patients who scored in the impaired range; however, those patients in the unimpaired range may still have subtle cognitive deficits that were not detected with the MMSE.

Key Words: Neuropsychology • Clinical Assessment • Schizophrenia • Cognition

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