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Mini-Mental State Examination: new normative values on subjects in Southern Italy

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Abstract

Objective

The aims of the present study were: (a) to obtain new normative data of the Italian version of the Mini-Mental Examination State (MMSE) (Measso et al. in Dev Neuropsychol 9:77–85, 1993) by administering the tool to a sample of normal Italian individuals more representative of the current Italian population; (b) to compare the sensitivity of this tool in detecting patients suffering from Alzheimer’s disease (AD according to NIA-AA), as compared to the those reported in previous normative Italian studies.

Methods

MMSE was administered to 314 normal subjects recruited among individuals (and/or their relatives) attending the Offices of General Practitioners (GP) or Memory Clinics in Campania (Italy) by convenience sampling. A group of 47 patients with AD were included into the study. The effect of demographic variables on the raw MMSE scores of normal subjects was checked by multiple linear regression assuming MMSE scores as dependent variable and age, gender and education as the independent one(s). Therefore, a simultaneous regression model was constructed to correct the raw scores according the sensitive variables. Correction grid and equivalent scores were devised to classify subject’s performance.

Results

The mean raw MMSE score was 27.78 (SD = 1.80) (range 22–30/30). There was no significant difference between scores achieved by men or women (p = 0.688). Multiple linear regression analysis showed a significant effect of age and years of school attendance on the MMSE raw score, whereas gender did not show any significant effect. The cutoff score, distinguishing between pathological and normal performances, was fixed at the fifth centile corresponding to 24.9/30, higher than the current score of 23.8/30. The new cutoff value was able to identify 44/47 patients with AD, in contrast to 38/47 subjects detected by currently used norms.

Conclusions

(1) A more updated and representative population sample; (2) a new cutoff threshold able to distinguish between normal and pathological performances; (3) a correction grid that reduces the risk of false-positive and false-negative values due to the influence of the main demographic factors; (4) greater sensitivity, compared to previous Italian normative studies in identifying people with dementia.

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Acknowledgements

Working group: Ferdinando Ivano Ambra (UOC Neurologia, Azienda Ospedaliera dei Colli Monaldi-Cotugno-CTO, Napoli, Italia), Michele Arcopinto (DAI Medicina Interna, AOU “Federico II”, Napoli, Italia), Patrizia Cuccaro (UOS Ricerca e Sviluppo, AOU “Federico II”, Napoli, Italia), Simona De Chiara (G.P. Office, Napoli, Italia), Carmine Del Giudice (UOS Ricerca e Sviluppo, AOU “Federico II”, Napoli, Italia), Gabriella De Joanna (UOC Neurofisiopatologia, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Napoli, Italia), Nicola Ferrara (Dipartimento di Scienze Mediche Traslazionali, Università di Napoli “Federico II”, Napoli, Italia), Iolanda Grimaldi (UOS Ricerca e Sviluppo, AOU “Federico II”, Napoli, Italia), Guido Iaccarino (Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università di Salerno, Italia), Ilaria Liguori (UOS Ricerca e Sviluppo, AOU “Federico II”, Napoli, Italia), Valentino Manzo (UOC Neurologia, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Napoli, Italia), Pietro Mazzeo (Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università di Salerno, Italia), Giovanni Tramontano (UOS Ricerca e Sviluppo, AOU “Federico II”, Napoli, Italia), Francesca Saveria Tripodi (Centro Geriatrico Frullone, ASL Napoli 1 Centro, Napoli, Italia).

Funding

None of the authors received any funding for this work.

Author information

Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy

    Michele Carpinelli Mazzi, Francesco D’Anna & Alfredo Postiglione

  2. Neurological Unit, CTO Hospital, AORN “Ospedali dei Colli”, Naples, Italy

    Alessandro Iavarone, Elisabetta Garofalo & Maria Sannino

  3. Department of Translational Medical Sciences, University of Naples “Federico II”, Naples, Italy

    Gennaro Russo & Pasquale Abete

  4. Italian Association of Alzheimer’s Patients (AIMA Campania), Naples, Italy

    Michele Carpinelli Mazzi & Caterina Musella

  5. Frullone Geriatric Center, ASL Napoli 1 Centro, Naples, Italy

    Graziella Milan

  6. Department of Experimental Medicine, University of Naples “Vanvitelli”, Naples, Italy

    Sergio Chieffi

  7. Health’s Innovation Unit, Naples, Campania, Italy

    Maddalena Illario

  8. UOS Research and Development Unit, AOU “Federico II”, Naples, Italy

    Vincenzo De Luca

Authors
  1. Michele Carpinelli Mazzi
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  2. Alessandro Iavarone
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  3. Gennaro Russo
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  4. Caterina Musella
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  5. Graziella Milan
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  6. Francesco D’Anna
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  7. Elisabetta Garofalo
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  8. Sergio Chieffi
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  9. Maria Sannino
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  10. Maddalena Illario
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  11. Vincenzo De Luca
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  12. Alfredo Postiglione
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  13. Pasquale Abete
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Consortia

with the support of the Working group

  • Ferdinando Ivano Ambra
  • , Michele Arcopinto
  • , Patrizia Cuccaro
  • , Simona De Chiara
  • , Carmine Del Giudice
  • , Gabriella De Joanna
  • , Nicola Ferrara
  • , Iolanda Grimaldi
  • , Guido Iaccarino
  • , Ilaria Liguori
  • , Valentino Manzo
  • , Pietro Mazzeo
  • , Giovanni Tramontano
  •  & Francesca Saveria Tripodi

Corresponding author

Correspondence to Michele Carpinelli Mazzi.

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On behalf of all the authors, the corresponding author states that there is no conflict of interest.

Statement of human and animal rights

This study was carried out according to the Declaration of Helsinki and approved by the local ethics committee.

Informed consent

All subjects gave informed consent to the study.

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Working group members are listed in the Acknowledgements section.

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Carpinelli Mazzi, M., Iavarone, A., Russo, G. et al. Mini-Mental State Examination: new normative values on subjects in Southern Italy. Aging Clin Exp Res 32, 699–702 (2020). https://doi.org/10.1007/s40520-019-01250-2

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  • DOI: https://doi.org/10.1007/s40520-019-01250-2

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