Mini-Mental State Examination norms in a community-dwelling sample of elderly with low schooling in Brazil Normas do Mini-Exame do Estado Mental para uma amostra de idosos com baixa escolaridade residentes na comunidade no Brasil

The objective of this study was to assess MiniMental State Examination norms of a functionally normal sample of community-dwelling elderly. Illiterate and low-educated subjects who scored less than 5 on the Pfeffer Functional Activities Questionnaire (PFAQ) [n = 397; female = 269; mean age = 72.15 (SD = 7.24) years] had the 5th, 25th, 50th, and 75th percentiles calculated according to age (65-74; 75-84 years). Overall MMSE score was 21.97 (SD = 4.48). Mean MMSE for illiterate younger individuals was 19.46 (SD = 3.47), and the quartile distribution was 14, 17, 19, and 21. MMSE of subjects with 1-8 years of schooling was 23.90 (3.87), and the distribution was 15, 22, 24, and 27. MMSE of older illiterate subjects was 18.11 (SD = 3.63), and the distribution of scores was 13, 16, 18, and 20, whereas subjects with 1-8 years of schooling scored 23.81 (SD = 4.01) and the distribution was 15, 22, 24, and 27. These MMSE normative data may help improve the detection of cognitive impairment in Brazil, mainly in the primary clinical setting. Aged; Educational Status; Cognition Introduction The Mini-Mental State Examination (MMSE) 1 is widely used as a screening test for dementia and other cognitive disorders 2,3. However, the role of education in MMSE performance, considered controversial by some authors, may make it difficult to assess some specific populations 4,5,6. According to some studies, MMSE specificity and sensibility are limited when the test is applied to subjects with little or no formal education, thus limiting its appropriateness as a screening instrument for dementia in populations with high illiteracy rates 2,4,5,6. Inversely, the MMSE is a good instrument when applied to adults (18-60 years of age) who are well-educated (defined as having more than nine years of formal schooling). MMSE sensitivity and specificity rates for detecting dementia in well-educated adults are 100% and 92%, respectively, whereas in subjects over 60 years of age with less than 8 years of schooling, sensitivity is 63.3% and specificity 65.2% 5. A common strategy to minimize the effects of educational level is to adjust the MMSE cutoff scores according to schooling. This procedure reduces the number of false-negatives in samples with more schooling and the number of false-positives in the less educated, especially the illiterate 4,2,5. Following the same procedure, several studies have attempted to present MMSE cutoffs adjusted to education in the Brazilian elARTIGO ARTICLE