Mini Mental State Examination and the Addenbrooke's Cognitive Examination: Effect of education and norms for a multicultural population

Objective: To derive population norms on the Malayalam adaptation of Addenbrooke′s Cognitive Examination (M-ACE) and the inclusive Malayalam mini mental state examination (M-MMSE).
Materials and Methods: Education-stratified norms were obtained on randomly selected cognitively unimpaired community elders (n = 519).
Results: Valid data on norms was available on 488 subjects (age 68.5 ± 7.1 and education 7.9 ± 5.4). Education and age, but not gender had a significant effect on both M-ACE and M-MMSE. When compared to the effect of age, the effect of education was sevenfold more on the M-ACE and ninefold more on the M-MMSE. The mean composite score on the M-ACE (and the M-MMSE) was 42.8 ± 9.8 (14.9 ± 3.1) for those with 0 (n = 72), 55.9 ± 12.5 (19.7 ± 4.1) with 1-4 (n = 96), 62.6 ± 11.4 (21.9 ± 3.7) with 5-8 (n = 81), 77 ± 10.2 (25.7 ± 2.4) with 9-12 (n = 136) and 83.4 ± 7.2 (26.7 ± 1.6) with> 12 (n = 103) years of formal education.
Conclusions: Education has the most potent effect on performance on both M-ACE and M-MMSE in the Indian cohort. Education-stratified scores on the M-ACE and the M-MMSE, will provide a more appropriate means of establishing the cognitive status of patients. It is also our feeling that these cut-off scores will be useful across India.

Keywords
Addenbrooke′s cognitive examination, dementia, developing countries, elderly, mini mental status examination, scale, screening