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Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared
McDowell I, Kristjansson B, Hill GB, Hébert R.. Journal of clinical epidemiology, 1997-04-01
Topic: Risk, prevention and care in population studies
The objectives of this study were to assess whether Teng's modification of the Mini-Mental State Examination (MMSE) improves its performance as a screening test for cognitive impairment and dementia, and to replicate this comparison in French and English language groups, and for differing assumptions concerning the relative importance of false negative and false positive errors. Screening interviews were conducted with representative samples of people aged 65 or over, set in 36 communities in 10 Canadian provinces. There were 8900 community participants in the Canadian Study of Health and Aging, of whom 1600 also underwent an extensive clinical and neuropsychological examination. Sensitivity, specificity and areas under the receiver operating characteristic (ROC) curve for the original MMSE and modified version (the 3MS) were the main outcome measures. Results are reported for French and English versions of the tests. The results indicate the alpha internal consistency for the 3MS was 0.87, compared to 0.78 for the MMSE. The area under the ROC curve in identifying dementia was 0.93 for the 3MS and 0.89 for the MMSE (p < 0.001). There was less difference between the two tests in identifying all levels of cognitive impairment (AUC 0.80 versus 0.77, p < 0.01). The superiority of the 3MS appears more due to its extended scoring system than to its additional questions. The validity of the MMSE was comparable in English and French samples; results for the 3MS were inconsistent between the two samples, suggesting possible translation problems. In conclusion, the 3MS was superior to the MMSE, justifying the slightly greater burden for its administration and scoring. Neither test worked well in identifying lower levels of cognitive impairment.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
McDowell, I., Kristjansson, B., Hill, G. B., & Hébert, R. (1997). Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. Journal of clinical epidemiology. https://doi.org/10.1016/s0895-4356(97)00060-7
Vancouver
McDowell I, Kristjansson B, Hill GB, Hébert R. Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. Journal of clinical epidemiology. 1997. doi:10.1016/s0895-4356(97)00060-7. PMID: 9179095.
BibTeX
@article{mcdowell1997-9179095,
author = {McDowell, I. and Kristjansson, B. and Hill, G. B. and Hébert, R.},
title = {{Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared}},
journal = {Journal of clinical epidemiology},
year = {1997},
doi = {10.1016/s0895-4356(97)00060-7},
pmid = {9179095},
url = {https://doi.org/10.1016/s0895-4356(97)00060-7}
}
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Key findings
- Results are reported for French and English versions of the tests.
- The results indicate the alpha internal consistency for the 3MS was 0.87, compared to 0.78 for the MMSE.
- There was less difference between the two tests in identifying all levels of cognitive impairment (AUC 0.80 versus 0.77, p < 0.01).
- The validity of the MMSE was comparable in English and French samples; results for the 3MS were inconsistent between the two samples, suggesting possible translation problems.
- In conclusion, the 3MS was superior to the MMSE, justifying the slightly greater burden for its administration and scoring.
Why it matters
In this community screening study, the modified Mini-Mental State Exam (3MS) had higher internal consistency and a larger area under the ROC curve for identifying dementia than the original MMSE. It compares two screening tests and does not test any treatment, cure, or prevention for Alzheimer's disease.
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Study details
- Effect sizeAUC 0.80
- Evidence strengthLow
How this study scored 47/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of clinical epidemiology) |
| Journal's citation record | 3 / 4 | Journal of Clinical Epidemiology: journal h-index 339 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1997 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 308 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 9.9 citations a year over 31 year(s) since 1997 |
| Impact for its field and year | 2 / 6 | Cited 2.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 15 other studies in this library |
| Still being cited | 1 / 4 | Cited 14 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Réjean Hébert: h-index 59 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Ottawa: institution h-index 908 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 9179095) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 47 / 100 | — |
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