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Year : 2007  |  Volume : 55  |  Issue : 2  |  Page : 106--110

Mini Mental State Examination and the Addenbrooke's Cognitive Examination: Effect of education and norms for a multicultural population

1 Cognition and Behavioral Neurology Center, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
2 Department of Biostatistics and Epidemiology, Achutha Menon Center for Health Science Studies, Trivandrum, Kerala, India

Correspondence Address:
P S Mathuranath
CBNC, Department of Neurology, SCTIMST, Trivandrum - 695 011
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.32779

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Objective: To derive population norms on the Malayalam adaptation of Addenbrooke's Cognitive Examination (M-ACE) and the inclusive Malayalam mini mental state examination (M-MMSE). Materials and Methods: Education-stratified norms were obtained on randomly selected cognitively unimpaired community elders (n = 519). Results: Valid data on norms was available on 488 subjects (age 68.5 ± 7.1 and education 7.9 ± 5.4). Education and age, but not gender had a significant effect on both M-ACE and M-MMSE. When compared to the effect of age, the effect of education was sevenfold more on the M-ACE and ninefold more on the M-MMSE. The mean composite score on the M-ACE (and the M-MMSE) was 42.8 ± 9.8 (14.9 ± 3.1) for those with 0 (n = 72), 55.9 ± 12.5 (19.7 ± 4.1) with 1-4 (n = 96), 62.6 ± 11.4 (21.9 ± 3.7) with 5-8 (n = 81), 77 ± 10.2 (25.7 ± 2.4) with 9-12 (n = 136) and 83.4 ± 7.2 (26.7 ± 1.6) with >12 (n = 103) years of formal education. Conclusions: Education has the most potent effect on performance on both M-ACE and M-MMSE in the Indian cohort. Education-stratified scores on the M-ACE and the M-MMSE, will provide a more appropriate means of establishing the cognitive status of patients. It is also our feeling that these cut-off scores will be useful across India.


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