Folstein vs modified Mini-Mental State Examination in geriatric stroke. Stability, validity, and screening utility

J. Grace, J. D. Nadler, D. A. White, T. J. Guilmette, A. J. Giuliano, A. U. Monsch and M. G. Snow
Brown University School of Medicine, Providence, RI, USA.

OBJECTIVE: Two studies were conducted with the Folstein Mini-Mental State Examination (MMS) and the Modified Mini-Mental State Examination (3MS) to examine whether the expanded version is a more useful screening tool in stroke populations. DESIGN: Clinical utility of screening tests (MMS and 3MS) was evaluated in reference to neuropsychological performance and functional outcome in rehabilitation. SETTING: Medical rehabilitation unit of university-affiliated hospital. PATIENTS: Two groups (n = 77, and n = 70) of patients who were admitted consecutively. MAIN OUTCOME MEASURES: Neuropsychological performance and functional outcome (functional independence measure). RESULTS: The reliability, stability, and validity of the 3MS were established in the stroke population. Classification accuracy did not differ between the MMS and 3MS, although the 3MS had higher sensitivity. In detecting cognitive impairment when compared with the extended neuropsychological battery, both instruments were adequate in patients with left-sided cerebrovascular accidents and were ineffective in patients with right-sided cerebrovascular accidents. The 3MS correlated with some cognitive domains missed by the MMS, thus adding useful clinical information. Finally, the 3MS was a significantly better predictor of functional outcome than the MMS. CONCLUSIONS: The 3MS was found to be a reliable, valid, and stable cognitive screening instrument in the stroke population. Classification accuracy indicates that both screening instruments are not strong in their ability to detect cognitive impairment in patients with stroke, especially in right-sided cerebrovascular accidents. The 3MS does have some advantages over the MMS; the expanded version of the screen not only provides additional cognitive information but also allows for better predicting of functional outcome.