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Correlation between age and MMSE in schizophrenia

Published online by Cambridge University Press:  15 April 2015

Jean-Robert Maltais ,
Geneviève Gagnon ,
Marie-Pierre Garant  and
Jean-François Trudel
Jean-Robert Maltais*
Affiliation:
Centre de Santé et de Services Sociaux, Institut Universitaire de Gériatrie de Sherbrooke, University of Sherbrooke, Quebec, Canada
Geneviève Gagnon
Affiliation:
Department of Geriatric Psychiatry, Douglas Mental Health University Institute, Montreal, Quebec, Canada
Marie-Pierre Garant
Affiliation:
Centre de Recherche du CHUS, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
Jean-François Trudel
Affiliation:
Centre de Santé et de Services Sociaux, Institut Universitaire de Gériatrie de Sherbrooke, University of Sherbrooke, Quebec, Canada
*
Correspondence should be addressed to: Dr Jean-Robert Maltais, MD, FRCPC, CSSS – IUGS, 375 Argyll, Sherbrooke (Quebec), J1J 3H5, Canada. Phone: +1(819) 821-5103; Fax: +1(819) 829-7137. Email: jean-robert.maltais@usherbrooke.ca.
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Abstract

Background:

The Mini-Mental State Examination (MMSE) is widely used in schizophrenia, although normative data are lacking in this population. This review and meta-regression analysis studies the effect of aging on MMSE scores in schizophrenic patients.

Methods:

We entered the search terms schizophrenia and MMSE in PubMed and PsychInfo. Bibliographies of pertinent articles were also examined. We included every study presenting the MMSE scores in schizophrenic patients along with a corresponding mean age. We conducted our analyses using simple linear regression weighted for the inverse of within-trial variance of the age variable, thus conferring more importance to studies with narrower age groups.

Results:

We identified 56 articles (n = 5,588) published between 1990 and 2012. The MMSE scores of schizophrenic patients decline by approximately 1 point for every four years (y = 34.939−0.247x, 95% Confidence Interval (CI) [−0.304, −0.189], R2 = 0,545), which is five times the rate in the general population. Institutionalized patients account for a large proportion of this decline (y = 37.603–0.308x, 95% CI [−0.349, −0.267], R2 = 0.622) whereas community-dwelling patients are relatively stable throughout aging (y = 27.591–0.026x, 95% CI [−0.074, 0.023], R2 = 0.037).

Conclusions:

Subgroup analyses show different trajectories between institutionalized and outpatients with schizophrenia. The deterioration observed in institutionalized patients may have to do with greater illness severity, heavier medication load, vascular risk factors, and lack of stimulation in institutional settings. Studies documenting the role of these variables would be useful. Cognitive screening tools that assess executive functions would be interesting to study in schizophrenics, as they may reveal more subtle age-related cognitive changes not measured by the MMSE.

Keywords

Mini-Mental State Examinationschizophreniacognition (neuro-cognitive functions)agingreview
Type
Review Article
Information
International Psychogeriatrics , Volume 27 , Issue 11 , November 2015 , pp. 1769 - 1775
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

Bozikas, V. P., Kosmidis, M. H., Gamvrula, K., Hatzigeorgiadou, M., Kourtis, A. and Karavatos, A. (2004). Clock Drawing Test in patients with schizophrenia. Psychiatry Research, 121, 229–238.Google Scholar
Crum, R. M., Anthony, J. C., Bassett, S. S. and Folstein, M. F. (1993). Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA, 269, 2386–2391.CrossRefGoogle ScholarPubMed
Cuffel, B. J., Alford, J., Fischer, E. P. and Owen, R. R. (1996a). Awareness of illness in schizophrenia and outpatient treatment adherence. The Journal of Nervous and Mental Disease, 184, 653–659.Google Scholar
Cuffel, B. J., Jeste, D. V., Halpain, M., Pratt, C., Tarke, H. and Patterson, T. L. (1996b). Treatment costs and use of community mental health services for schizophrenia by age cohorts. The American Journal of Psychiatry, 153, 870–876.Google Scholar
Davidson, M., Harvey, P. and Powchik, P. (1995). Severity of symptoms in chronically institutionalized geriatric schizophrenic patients. American Journal of Psychiatry, 152, 197–207.Google Scholar
Davidson, M., Harvey, P., Welsh, K. A., Powchik, P., Putnam, K. M. and Mohs, R. C. (1996). Cognitive functioning in late-life schizophrenia: a comparison of elderly schizophrenic patients and patients with Alzheimer's disease. The American Journal of Psychiatry, 153, 1274–1279.Google ScholarPubMed
Dubois, B., Slachevsky, A., Litvan, I. and Pillon, B. (2000). The FAB: a frontal assessment battery at bedside. Neurology, 55, 1621–1626.Google Scholar
Elie, D., Poirier, M., Chianetta, J., Durand, M., Grégoire, C. and Grignon, S. (2010). Cognitive effects of antipsychotic dosage and polypharmacy: a study with the BACS in patients with schizophrenia and schizoaffective disorder. Journal of Psychopharmacology (Oxford, England), 24, 1037–1044.Google Scholar
Fioravanti, M., Fioravanti, M., Bianchi, V., Bianchi, V., Cinti, M. E. and Cinti, M. E. (2012). Cognitive deficits in schizophrenia: an updated metanalysis of the scientific evidence. BMC Psychiatry, 12, 64.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Freedman, R. (2003). Schizophrenia. New England Journal of Medicine, 349, 1738–1749.CrossRefGoogle ScholarPubMed
Friedman, J. I. et al. (2001). Six-year follow-up study of cognitive and functional status across the lifespan in schizophrenia: a comparison with Alzheimer's disease and normal aging. American Journal of Psychiatry, 158, 1441–1448.Google Scholar
Frisoni, G. B. et al. (2009). In vivo neuropathology of cortical changes in elderly persons with schizophrenia. Biological Psychiatry, 66, 578–585.Google Scholar
Ganguli, R. et al. (1998). Mini-Mental State Examination (MMSE) performance of partially remitted community-dwelling patients with schizophrenia. Schizophrenia Research, 33, 45–52.Google Scholar
Goffman, E. (1961). Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York, NY: Anchor Books/Doubleday.Google Scholar
Green, M. F., Kern, R. S., Braff, D. L. and Mintz, J. (2000). Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”? Schizophrenia Bulletin, 26, 119–136.Google Scholar
Han, L., Cole, M., Bellavance, F., McCusker, J. and Primeau, F. (2000). Tracking cognitive decline in Alzheimer's disease using the Mini-Mental State Examination: a meta-analysis. International Psychogeriatrics, 12, 231–247.Google Scholar
Harvey, P. D., Bowie, C. R. and Friedman, J. I. (2001). Cognition in schizophrenia. Current Psychiatry Reports, 3, 423–428.Google Scholar
Harvey, P. D., Leff, J., Trieman, N., Anderson, J. and Davidson, M. (1997). Cognitive impairment in geriatric chronic schizophrenic patients: a cross-national study in New York and London. International Journal of Geriatric Psychiatry, 12, 1001–1007.Google Scholar
Harvey, P. D., Parrella, M., White, L., Mohs, R. C., Davidson, M. and Davis, K. L. (1999). Convergence of cognitive and adaptive decline in late-life schizophrenia. Schizophrenia Research, 35, 77–84.Google Scholar
Herrmann, N. et al. (1999). The use of clock tests in schizophrenia. General Hospital Psychiatry, 21, 70–73.Google Scholar
Howard, R., Rabins, P. V., Seeman, M. V. and Jeste, D. V. (2000). Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. The International Late-Onset Schizophrenia Group. American Journal of Psychiatry, 157, 172–178.Google Scholar
Irani, F., Kalkstein, S., Moberg, E. A. and Moberg, P. J. (2011). Neuropsychological performance in older patients with schizophrenia: a meta-analysis of cross-sectional and longitudinal studies. Schizophrenia Bulletin, 37, 1318–1326.Google Scholar
Kay, S. R., Fiszbein, A. and Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.Google Scholar
Kelly, C., Sharkey, V., Morrison, G., Allardyce, J. and McCreadie, R. G. (2000). Nithsdale schizophrenia surveys. 20. Cognitive function in a catchment-area-based population of patients with schizophrenia. The British Journal of Psychiatry: The Journal of Mental Science, 177, 348–353.Google Scholar
Kraepelin, E. (1984). Introduction à la psychiatrie clinique, Paris: Navarin.Google Scholar
Kurtz, M. M. (2005). Neurocognitive impairment across the lifespan in schizophrenia: an update. Schizophrenia Research, 74, 15–26.CrossRefGoogle ScholarPubMed
Leon, J., Baca Garcia, E. and Simpson, G. (1998). A factor analysis of the Mini Mental State Examination in schizophrenic disorders. Acta Psychiatrica Scandinavica, 98, 366–368.Google Scholar
Leon, J., Ellis, G., Rosen, P. and Simpson, G. M. (1993). The test-retest reliability of the Mini Mental State Examination in chronic schizophrenic patients. Acta Psychiatrica Scandinavica, 88, 188–192.Google Scholar
Lindenmayer, J.-P. et al. (2012). Relationship between metabolic syndrome and cognition in patients with schizophrenia. Schizophrenia Research, 142, 171–176.Google Scholar
Mueser, K. T. and McGurk, S. R. (2004). Schizophrenia. Lancet, 363, 2063–2072.Google Scholar
Nasreddine, Z. S. et al. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695–699.Google Scholar
Palmer, B. W. et al. (2005). Assessment of capacity to consent to research among older persons with schizophrenia, Alzheimer disease, or diabetes mellitus: comparison of a 3-item questionnaire with a comprehensive standardized capacity instrument. Archives of General Psychiatry, 62, 726–733.Google Scholar
Powchik, P. et al. (1998). Postmortem studies in schizophrenia. Schizophrenia Bulletin, 24, 325–341.Google Scholar
Rund, B. R. (2009). Is schizophrenia a neurodegenerative disorder? Nordic Journal of Psychiatry, 63, 196–201.Google Scholar
Seno, H., Shibata, M., Fujimoto, A., Koga, K., Kanno, H. and Ishino, H. (1998). Evaluation of Mini Mental State Examination and brief psychiatric rating scale on aged schizophrenic patients. Psychiatry and Clinical Neurosciences, 52, 567–570.CrossRefGoogle ScholarPubMed
Stern, Y. (2009). Cognitive reserve. Neuropsychologia, 47, 2015–2028.CrossRefGoogle ScholarPubMed
Thompson, S. G. and Higgins, J. P. T. (2002). How should meta-regression analyses be undertaken and interpreted? Statistics in Medicine, 21, 1559–1573.Google Scholar
Thompson, W. K. et al. (2013). Characterizing trajectories of cognitive functioning in older adults with schizophrenia: does method matter? Schizophrenia Research, 143, 90–96.CrossRefGoogle ScholarPubMed
Tombaugh, T. N. and McIntyre, N. J. (1992). The Mini-Mental State Examination: a comprehensive review. Journal of the American Geriatrics Society, 40, 922–935.CrossRefGoogle ScholarPubMed
Wilk, C. M., Gold, J. M., McMahon, R. P., Humber, K., Iannone, V. N. and Buchanan, R. W. (2005). No, it is not possible to be schizophrenic yet neuropsychologically normal. Neuropsychology, 19, 778–786.Google Scholar
Wing, J. K. and Brown, G. W. (2009). Institutionalism and Schizophrenia. Cambridge, UK: Cambridge University Press. Available at: http://books.google.ca/books?id=mj-UPwAACAAJ&dq=wing+((brown+1970)+institutionalism)&hl=&cd=1&source=gbs_api.Google Scholar
Zipursky, R. B., Reilly, T. J. and Murray, R. M. (2013). The myth of schizophrenia as a progressive brain disease. Schizophrenia Bulletin, 39, 1363–1372.Google Scholar