Abstract
Cognitive scales are used frequently in geriatric research and practice. These instruments are constructed with underlying
assumptions that are a part of their validation process. A common measurement scale used in older adults is the Folstein Mini
Mental State Exam (MMSE). The MMSE was designed to screen for cognitive impairment and is used often in geriatric research.
This paper has three aims. Aim one was to explore four potential threats to validity in the use of the MMSE: (1) administering
the exam without meeting the underlying assumptions, (2) not reporting that the underlying assumptions were assessed prior
to test administration, (3) use of variable and inconsistent cut-off scores for the determination of presence of cognitive
impairment, and (4) failure to adjust the scores based on the demographic characteristics of the tested subject. Aim two was
to conduct a literature search to determine if the assumptions of (1) education level assessment, (2) sensory assessment,
and (3) language fluency were being met and clearly reported in published research using the MMSE. Aim three was to provide
recommendations to minimalize threats to validity in research studies that use cognitive scales, such as the MMSE. We found
inconsistencies in published work in reporting whether or not subjects meet the assumptions that underlie a reliable and valid
MMSE score. These inconsistencies can pose threats to the reliability of exam results. Fourteen of the 50 studies reviewed
reported inclusion of all three of these assumptions. Inconsistencies in reporting the inclusion of the underlying assumptions
for a reliable score could mean that subjects were not appropriate to be tested by use of the MMSE or that an appropriate test administration of the MMSE was not clearly reported. Thus, the research literature could have threats
to both validity and reliability based on misuse of or improper reported use of the MMSE. Six recommendations are provided
to minimalize these threats in future research.
assumptions that are a part of their validation process. A common measurement scale used in older adults is the Folstein Mini
Mental State Exam (MMSE). The MMSE was designed to screen for cognitive impairment and is used often in geriatric research.
This paper has three aims. Aim one was to explore four potential threats to validity in the use of the MMSE: (1) administering
the exam without meeting the underlying assumptions, (2) not reporting that the underlying assumptions were assessed prior
to test administration, (3) use of variable and inconsistent cut-off scores for the determination of presence of cognitive
impairment, and (4) failure to adjust the scores based on the demographic characteristics of the tested subject. Aim two was
to conduct a literature search to determine if the assumptions of (1) education level assessment, (2) sensory assessment,
and (3) language fluency were being met and clearly reported in published research using the MMSE. Aim three was to provide
recommendations to minimalize threats to validity in research studies that use cognitive scales, such as the MMSE. We found
inconsistencies in published work in reporting whether or not subjects meet the assumptions that underlie a reliable and valid
MMSE score. These inconsistencies can pose threats to the reliability of exam results. Fourteen of the 50 studies reviewed
reported inclusion of all three of these assumptions. Inconsistencies in reporting the inclusion of the underlying assumptions
for a reliable score could mean that subjects were not appropriate to be tested by use of the MMSE or that an appropriate test administration of the MMSE was not clearly reported. Thus, the research literature could have threats
to both validity and reliability based on misuse of or improper reported use of the MMSE. Six recommendations are provided
to minimalize these threats in future research.
- Content Type Journal Article
- Category Commentary
- Pages 1-10
- DOI 10.1007/s10433-012-0234-8
- Authors
- Todd Monroe, John A. Hartford Foundation & Atlantic Philanthropies Claire M. Fagin Fellow, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA
- Michael Carter, The University of Tennessee Health Science Center, Memphis, TN, USA
- Journal European Journal of Ageing
- Online ISSN 1613-9380
- Print ISSN 1613-9372