Association between baseline Mini-Mental State Examination score and dementia incidence in a cohort of oldest old

HAYASHIDA, Débora Yumi; JACINTO, Alessandro Ferrari; ARAÚJO, Lara Miguel Quirino; ALMADA FILHO, Clineu de Mello; DI TOMMASO, Ana Beatriz; CENDOROGLO, Maysa Seabra

doi:10.1590/0004-282X-ANP-2020-0543

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ARTICLE • Arq. Neuro-Psiquiatr. 79 (12) • Dec 2021 • https://doi.org/10.1590/0004-282X-ANP-2020-0543 copy

Association between baseline Mini-Mental State Examination score and dementia incidence in a cohort of oldest old

Associação entre a pontuação inicial do Miniexame do Estado Mental e a incidência de demência em uma coorte de longevos

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background: The Brazilian population has aged rapidly. The oldest old, defined as persons aged 80 years or older, is the fastest growing segment of the Brazilian population. Several instruments have been used to assess the cognitive performance of the older people and predict dementia. One of the most commonly used is the Mini-Mental State Examination (MMSE). Objective: The aim of this study was to investigate the relationship between baseline MMSE score and the incidence of dementia in a Brazilian cohort of independent oldest old. Methods: Sociodemographic data and serial cognitive assessment of 248 older adults were analyzed. Results: Mean follow-up time of subjects was 4.0(±1.9) years, 71.4% were women, and mean MMSE score at entry was 25(±3.5). Mean MMSE scores at baseline were significantly higher (p=0.001) in the cognitively intact group than in those who developed dementia. The logistic regression showed that for a one point increase in MMSE score at baseline there was a 10% reduction in the probability of dementia. Conclusions: In the Brazilian scenario of a rapidly growing population of oldest old, the extensive use of the MMSE gives rise to the need not only to determine its effectiveness for screening dementia, but also to interpret its score in terms of future conversion to dementia.

Keywords:
Dementia; Incidence; Aged; 80 and over

Gender — females, n (%)		177 (71.4)
Age, n (%)	80–84 years	134 (54.0)
	85–89 years	71 (28.7)
	≥90 years	43 (17.3)
Education — years (mean±SD)		4.9±4.3
Number of chronic diseases, n (%)	0–5	185 (74.6)
Number of chronic diseases, n (%)	≥6	63 (25.4)
Number of medications at baseline (mean±SD)		5.6±2.7
Use of anti-depressants at baseline, n (%)		58 (23.5)
History of stroke, n (%)		11 (4.4)
History of TIA, n (%)		12 (4.8)
MMSE (mean±SD)		25.0±3.5
Follow-up time (years) (mean±SD)		4.0±1.9

	Cognitive Outcome				Total		p-value*
	Cognitively intact		With dementia				p-value*
	n	%	n	%	n	%
Sex	206	100.0	42	100.0	248	100.0	0.993
Male	59	28.6	12	28.6	71	28.6
Female	147	71.4	30	71.4	177	71.4
Age	206	100.0	42	100.0	248	100.0	<0.001
80–84 years	123	59.7	11	26.2	134	54.0
85–89 years	52	25.2	19	45.2	71	28.6
≥90 years	31	15.0	12	28.6	43	17.3
Number of chronic diseases	206	100.0	42	100.0	248	100.0	0.069
0–5	149	72.3	36	85.7	185	74.6
≥6	57	27.7	6	14.3	63	25.4
Use of antidepressants (baseline)	205	100.0	42	100.0	247	100.0	0.393
Yes	46	22.4	12	28.6	58	23.5
No	159	77.6	30	71.4	189	76.5
History of stroke	206	100.0	42	100.0	248	100.0	0.404
Yes	8	3.9	3	7.1	11	4.4
No	198	96.1	39	92.9	237	95.6
History of TIA	206	100.0	42	100.0	248	100.0	0.433
Yes	9	4.4	3	7.1	12	4.8
No	197	95.6	39	92.9	236	95.2

	Mean	Standard deviation	Minimum	Maximum	n	p-value*
Education (years)	4.9	4.3	0.0	32.0	248	0.103
Cognitively intact	5.0	4.5	0.0	32.0	206
Demented	4.1	3.1	0.0	12.0	42
MMSE	25.0	3.5	11.0	30.0	248	0.001
Cognitively intact	25.4	3.4	14.0	30.0	206
Demented	23.5	3.6	11.0	29.0	42
Number of medications (baseline)	5.6	2.7	0.0	14.0	248	0.857
Cognitively intact	5.6	2.8	0.0	13.0	206
Demented	5.5	2.4	0.0	14.0	42

	Initial model (n=247)		Final model (n=248)
	Adjusted Odds Ratio (95%CI)	p-value	Adjusted Odds Ratio (95%CI)	p-value
MMSE	0.90 (0.81–1.01)	0.084	0.90 (0.82–0.99)	0.034
Female gender (ref.=male)	0.93 (0.40–2.17)	0.873	–	–
Age (ref =80–84 years)		0.001		0.003
85–89 years	4.50 (1.88–10.78)	0.001	3.96 (1.71–9.18)	0.001
≥90 years	4.84 (1.69–13.88)	0.003	4.01 (1.50–10.74)	0.006
Education (years)	1.02 (0.91–1.13)	0.791	–	–
≥6 chronic diseases (ref.=0–5)	0.28 (0.10–0.83)	0.022	0.32 (0.11–0.90)	0.031
Number of medications (baseline)	1.00 (0.86–1.15)	0.954	–	–
Use of antidepressants at baseline (ref.=no)	2.17 (0.87–5.40)	0.095	–	–
History of stroke (ref.=no)	2.76 (0.33–22.80)	0.345	2.35 (0.29–19.22)	0.426
History of TIA (ref.=no)	1.42 (0.17–11.88)	0.746	1.49 (0.18–12.30)	0.714

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[1] Correspondence: Alessandro Ferrari Jacinto; Email: alessandrojacinto@uol.com.br.