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Mini-Mental State exam scores vary with education in blacks and whites
Murden RA, McRae TD, Kaner S, Bucknam ME.. Journal of the American Geriatrics Society, 1991-02-01
Topic: Risk, prevention and care in population studies
Plain-language summary
Previous studies have suggested that education and race may affect performance on standardized mental status tests. In order to more clearly define these relationships, a prospective longitudinal study was devised to answer two questions: (1) whether race or level of education affects scores on the Mini-Mental State (MMS) exam in non-demented people and (2) what numerical cutpoints maximize the sensitivity and specificity of utilizing the MMS to help diagnose dementia in blacks of varying educational attainment. A total of 100 white and 258 black individuals, recruited from two city hospital primary care geriatric clinics, were evaluated and subsequently followed longitudinally over a 2 1/2 year period in order to assess accurately the presence or absence of dementia. In the non-demented, total MMS scores and performance on each item of the MMS were analyzed, revealing that people with an 8th grade or less education consistently had significantly (P less than .01) worse results than the better educated (9th grade or better) on borough, attention items, recall of table and dog, copying, sentence writing, phrase repeating, and total score. Furthermore, a total of 25% of the lower education group had an MMS score in the 18-23 range, traditionally thought to suggest dementia. There were no consistently significant differences between blacks and whites of equal education. In the better educated groups, using a score of 23 or less to define dementia maximizes the sensitivity and specificity of using the MMS in this diagnosis at 93% and 100%, respectively. In the lower education group, using 17 or less to define dementia maximizes sensitivity and specificity at 81% and 100%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
What this study adds
Evidence grade: Moderate
This is a follow-up (cohort) study of 100 participants. This study found that non-demented people with an 8th grade education or less scored significantly worse on the Mini-Mental State exam than those with more education, and that a quarter of the lower education group scored in a range traditionally thought to suggest dementia. It also found no consistently significant differences between black and white participants of equal education.
Taken from this record’s own fields, not from reading the paper. The grade is assigned from the abstract’s wording; what that means.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Murden, R. A., McRae, T. D., Kaner, S., & Bucknam, M. E. (1991). Mini-Mental State exam scores vary with education in blacks and whites. Journal of the American Geriatrics Society. https://doi.org/10.1111/j.1532-5415.1991.tb01617.x
Vancouver
Murden RA, McRae TD, Kaner S, Bucknam ME. Mini-Mental State exam scores vary with education in blacks and whites. Journal of the American Geriatrics Society. 1991. doi:10.1111/j.1532-5415.1991.tb01617.x. PMID: 1991947.
BibTeX
@article{murden1991-1991947,
author = {Murden, R. A. and McRae, T. D. and Kaner, S. and Bucknam, M. E.},
title = {{Mini-Mental State exam scores vary with education in blacks and whites}},
journal = {Journal of the American Geriatrics Society},
year = {1991},
doi = {10.1111/j.1532-5415.1991.tb01617.x},
pmid = {1991947},
url = {https://doi.org/10.1111/j.1532-5415.1991.tb01617.x}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- Previous studies have suggested that education and race may affect performance on standardized mental status tests.
- In the non-demented, total MMS scores and performance on each item of the MMS were analyzed, revealing that people with an 8th grade or less education consistently had significantly (P less than .01) worse results than the better educated (9th grade or better) on borough, attention items, recall of table and dog, copying, sentence writing, phrase repeating, and total score.
- There were no consistently significant differences between blacks and whites of equal education.
Why it matters
This study found that non-demented people with an 8th grade education or less scored significantly worse on the Mini-Mental State exam than those with more education, and that a quarter of the lower education group scored in a range traditionally thought to suggest dementia. It also found no consistently significant differences between black and white participants of equal education.
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Study details
- Study designlongitudinal study
- Participants100
- Evidence strengthModerate
How this study scored 60/100
Published in a peer-reviewed journal, and it is a longitudinal study following the same people over time. Scored zero for effect reported and randomized / blinded because the record does not state it. We have no data on senior author's track record, so that was left out: it earned 58 of the 96 points we could judge it on, which is 60 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of the American Geriatrics Society) |
| Journal's citation record | 3 / 4 | Journal of the American Geriatrics Society: journal h-index 344 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1991 — older than 20 years, still counted |
| Sample size | 2 / 4 | 100 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 301 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 8.1 citations a year over 37 year(s) since 1991 |
| Impact for its field and year | 4 / 6 | Cited 8.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 17 other studies in this library |
| Still being cited | 1 / 4 | Cited 5 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | OpenAlex's profile for last-listed author Mary E. Bucknam holds only 2 work(s), too few to judge a track record — left out of this score |
| Institution's track record | 2 / 3 | New York University: institution h-index 1,612 (OpenAlex) |
| Multicenter collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 1991947) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 58 / 96 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 58 of the 96 points we could judge it on is 60 out of 100. |
| Total | 60 / 100 | — |
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