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Cross-cultural comparisons of the Mini-mental State Examination between Japanese and U.S. cohorts

Published online by Cambridge University Press:  17 October 2008

Hiroko H. Dodge ,
Kenichi Meguro ,
Hiroshi Ishii ,
Satoshi Yamaguchi ,
Judith A. Saxton  and
Mary Ganguli
Hiroko H. Dodge*
Affiliation:
Department of Public Health, College of Health and Human Sciences, Oregon State University, U.S.A. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, U.S.A. Department of Neurology, Oregon Health and Science University, U.S.A.
Kenichi Meguro
Affiliation:
Tohoku University Graduate School of Medicine, Sendai, Japan
Hiroshi Ishii
Affiliation:
Tohoku University Graduate School of Medicine, Sendai, Japan
Satoshi Yamaguchi
Affiliation:
The Osaki-Tajiri SKIP Center, Tajiri, Japan
Judith A. Saxton
Affiliation:
Department of Neurology, University of Pittsburgh School of Medicine, U.S.A.
Mary Ganguli
Affiliation:
Department of Psychiatry, Department of Epidemiology, University of Pittsburgh School of Medicine, U.S.A.
*
Correspondence should be addressed to: Dr. Hiroko Dodge. 260 Waldo Hall, Department of Public Health, Oregon State University, Corvallis, OR 97401, U.S.A. Phone: +1 541-737-2686; Fax: +1 541-737-4001. Email: Dodgeh@ohsu.edu.
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Abstract

Background: The Mini-mental State Examination (MMSE) is widely used in Japan and the U.S.A. for cognitive screening in the clinical setting and in epidemiological studies. A previous Japanese community study reported distributions of the MMSE total score very similar to that of the U.S.A.

Methods: Data were obtained from the Monongahela Valley Independent Elder's Study (MoVIES), a representative sample of community-dwelling elderly people aged 65 and older living near Pittsburgh, U.S.A., and from the Tajiri Project, with similar aims in Tajiri, Japan. We examined item-by-item distributions of the MMSE between two cohorts, comparing (1) percentage of correct answers for each item within each cohort, and (2) relative difficulty of each item measured by Item Characteristic Curve analysis (ICC), which estimates log odds of obtaining a correct answer adjusted for the remaining MMSE items, demographic variables (age, gender, education) and interactions of demographic variables and cohort.

Results: Median MMSE scores were very similar between the two samples within the same education groups. However, the relative difficulty of each item differed substantially between the two cohorts. Specifically, recall and auditory comprehension were easier for the Tajiri group, but reading comprehension and sentence construction were easier for the MoVIES group.

Conclusions: Our results reaffirm the importance of validation and examination of thresholds in each cohort to be studied when a common instrument is used as a dementia screening tool or for defining cognitive impairment.

Keywords

MMSEcross-cultural comparisoncommunity-based study
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 1 , February 2009 , pp. 113 - 122
Copyright
Copyright © International Psychogeriatric Association 2008

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