An Arabic Version of the Mini-Mental State Examination for the Lebanese Population: Reliability, Validity, and Normative Data

Article type: Research Article

Authors: El-Hayeck, Rita^{a; j; *} | Baddoura, Rafic^{b; j} | Wehbé, Amine^{a; j} | Bassil, Nazem^c | Koussa, Salam^{d; j} | Abou Khaled, Karine^{e; j} | Richa, Sami^{f; j} | Khoury, Rita^g | Alameddine, Abbas^h | Sellal, Françoisⁱ

Affiliations: [a] Department of Geriatrics, Saint Joseph University School of Medicine, Beirut, Lebanon | [b] Department of Epidemiology and Public Health, Saint Joseph University School of Medicine, Beirut, Lebanon | [c] Department of Geriatrics, University of Balamand, Saint George Hospital Medical Centre, Lebanon | [d] Department of Neurology, Lebanese University, Lebanese Hospital Geitaoui-UMC, Beirut, Lebanon | [e] Department of Neurology, Saint Joseph University School of Medicine, Beirut, Lebanon | [f] Department of Psychiatry, Saint Joseph University School of Medicine, Beirut, Lebanon | [g] Department of Geriatric Psychiatry, Saint Louis University School of Medicine, St. Louis, MO, USA | [h] Department of Psychiatry, Hôtel-Dieu de France Hospital, Beirut and Department of Psychology, University of Balamand, Lebanon | [i] Department of Neurology, Hôpitaux Civils de Colmar and INSERM U-1118, School of Medicine, Strasbourg University, France | [j] Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l’USJ (GTD-USJ)

Correspondence: [*] Correspondence to: Rita El-Hayeck M.D., Department of Geriatrics, School of Medicine, Saint Joseph University of Beirut, B.P.11.5076 Riad El Solh, Beirut, Lebanon. Tel.: +961 3263603; E-mail: rita.elhayeck@usj.edu.lb

Abstract: Background:The Mini-Mental State Examination (MMSE) has not been validated in the Lebanese population and no normative data exist at the national level. Objective:To evaluate the reliability and validity of an Arabic version of MMSE developed by the “Groupe de Travail sur les Démences de l’Université Saint Joseph” (A-MMSE(GTD-USJ)) and to provide normative data by gender, age, and education in adults over 55. Methods:Study design: national cross-sectional survey. Study population: 1,010 literate community-dwelling Lebanese residents aged 55 and above. Outcomes: reproducibility, internal consistency, sensitivity, specificity, predictive values, and area under the curve of the A-MMSE(GTD-USJ) for the detection of cognitive impairment using the Clinical Dementia Rating (CDR) as the gold standard. Normative data were established from 720 healthy adults. A-MMSE(GTD-USJ) scores corresponding to the 5th, 10th, 15th, and 50th percentiles were identified according to gender, age, and education. Results:Intra-rater and inter-rater test-retest score correlations were 0.89 and 0.72, respectively. Cronbach alpha coefficient for internal consistency of the A-MMSE(GTD-USJ) was 0.71. A threshold value of 23 provided a sensitivity of 80% and a specificity of 89.4%. The area under the curve was 0.92. A-MMSE(GTD-USJ) scores increased with education and decreased with age. Women had significantly lower scores than men. Normative data for A-MMSE(GTD-USJ) stratified by gender, age, and education were generated. Conclusion:In reference to the CDR, the A-MMSE(GTD-USJ) is a valid tool to assess cognitive status among Lebanese subjects aged 55 and above. Normative data will help clinicians in detecting cognitive impairment in this population.

Keywords: Arabic version, dementia, Lebanon, mini-mental state examination, normative data, reliability, validity

DOI: 10.3233/JAD-181232

Journal: Journal of Alzheimer's Disease, vol. 71, no. 2, pp. 525-540, 2019