Affiliations: [a] Geriatric Neurology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing China | [b] Research Center of Clinical Epidemiology, Peking University Third Hospital, Haidian District, Beijing, P.R. China | [c] Neurology Department of The First Medical Center, Chinese PLA General Hospital, Beijing China
Correspondence:
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Correspondence to: Professor Yiming Zhao, Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, 100191, P.R. China. Tel.: +86 10 82266577; E-mail: E-mail: yimingzhao115@163.com; Profesor Lu-Ning Wang, Geriatric Neurology Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing road, Haidian District, Beijing, China. Tel.: +86 10 66876268; Fax: +86 10 68229325; E-mail: lnw_301@163.com.
Note: [1] These authors contributed equally to this work.
Abstract: Background:Over time, improved cognitive abilities in elderly individuals lead to an overall increase in performance on widely used cognitive screening tests (e.g., Mini-Mental State Examination, MMSE) and impact screening efficacy. Objective:We aimed to examine the epoch effect on cognitive function measured using MMSE, in addition to the influence of demographic characteristics on MMSE. We also evaluated the ability of the MMSE in detecting dementia and examined the discrimination ability and measurement precision of the MMSE. Methods:In a cross-sectional survey, Chinese veterans aged ≥60 years were interviewed. Multiple linear regression analysis was applied to explore the factors affecting the MMSE. The expected MMSE score was calculated to examine the epoch effect. The diagnostic accuracy of the MMSE was determined via receiver operating characteristic curve analyses. Item response theory methods were implemented using Stata 16.0. Results:The MMSE score increased with higher education and decreased with advancing age. The observed MMSE score in this study (26.9) was higher than the expected MMSE score (24.9). It demonstrated 78.3% /84.1% /89.9% sensitivity and 85.8% /79.5% /66.8% specificity in detecting dementia using the cut-off score 25/26/27. The MMSE showed reduced discrimination and provided little information for ability level of −1 and above. Conclusion:Improved cognitive ability over time may increase the performance on cognitive screening tests (e.g., MMSE). This impact of epoch in cognitive function emphasizes the importance of regularly updating cognitive screening tests.
Keywords: Dementia, epoch effect, item response theory, Mini-Mental State
Examination
