Utility of Mini-Mental State Exam Scores in Predicting Functional Impairment Among White and African American Dementia Patients

BACKGROUND: The Mini-Mental State Exam (MMSE) is widely used to assess cognitive impairment. Although education and race have been shown to affect the validity of the MMSE in detecting dementia, whether race and education influence the validity of the MMSE in gauging severity of dementia is unknown. METHODS: Patients diagnosed with Alzheimer's and other dementias (59 African American, 112 White) were administered the MMSE, and information was gathered on patient functional impairment, including Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and the Memory and Behavior Problems Checklist (MBPC). Demographic information, including patient and caregiver education, and patient age, was also assessed. RESULTS: African American and White patients did not differ significantly on the MMSE or functional impairment variables, but White patients had higher educational attainment. Hierarchical multiple regression analysis showed that race and education did not predict functional impairment, and MMSE scores were strong predictors of ADL and IADL levels for both African American and White patients. MMSE predicted variability in MBPC scores for White patients only, perhaps related to racial differences in subjective caregiver report of behavioral problems. CONCLUSIONS: While race and education may affect the validity of the MMSE in detecting the presence of cognitive impairment, the MMSE can be a useful predictor of degree of ADL and IADL impairment in patients diagnosed with dementia, regardless of race.