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Effects of Sociodemographic and Health Variables on Mini-Mental State Exam Scores in Older Australians

From the School of Psychiatry, University of New South Wales (TMA, PSS, HB, JNT, GA); the Clinical Research Unit for Anxiety and Depression, St. Vincent's Hospital (TMA, GA); the Neuropsychiatric Institute, Prince of Wales Hospital (PSS, JNT); the Primary Dementia Collaborative Research Centre, University of New South Wales (PSS, HB); and the Academic Department for Old Age Psychiatry, Prince of Wales Hospital (HB); New South Wales, Australia.

Objective: This article examines the influence of sociodemographic, biological, and health variables on Mini-Mental State Exam (MMSE) performance, and assesses how the diversity of the population should be reflected in the MMSE cutoff scores used for screening.

Methods: The sociodemographic profiles and MMSE scores of adults aged 65-years and over who participated in the Australian National Mental Health and Well-being Survey were assessed (N = 1,792).

Results: The regression models showed that older age, education levels, language spoken at home and in country of birth, socioeconomic status (SES), occupation, sex, and presence of a mood disorder made significant and unique contributions to performance on the MMSE. The individual (univariate) influence of each factor ranged from –2.61 to 0.09 points, with non-English speaking background (NESB) making the biggest impact. Based on a MMSE score of 23 points, 7.7% of the Australian elderly population screened positive for cognitive impairment that may be indicative of dementia. In those scoring 23 points, the multivariate model accounted for 24.61% of the variance.

Conclusion: Many sociodemographic variables and the presence of a mood disorder influence MMSE performance. Using conventional cutoff scores for screening will lead to a high rate of false positives in older adults (75+ years), those with NESB, and those with low SES, and is insensitive for those with high education. The authors suggest simple rules for the correction of the impact of these variables.

Key Words: Mini-Mental State Exam • cutoff scores • population-based study • dementia

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