Psychometric properties of the Folstein Mini-Mental State Examination

Criterion-referenced (Livingston) and norm-referenced (Gilmer-Feldt) techniques were used to measure the internal consistency reliability of Folstein's Mini-Mental State Examination (MMSE) on a large sample (N = 418) of elderly medical patients. Two administration and scoring variants of the MMSE Attention and Calculation section (Serial 7s only and WORLD only) were investigated. Livingston reliability coefficients (rs) were calculated for a wide range of cutoff scores. As necessary for the calculation of the Gilmer-Feldt r, a factor analysis showed that the MMSE measures three cognitive domains. Livingston's r for the most widely used MMSE cutoff score of 24 was .803 for Serial 7s and .795 for WORLD. The Gilmer-Feldt internal consistency reliability coefficient was .764 for Serial 7s and .747 for WORLD. Item analysis showed that nearly all of the MMSE items were good discriminators, but 12 were too easy. True score confidence intervals should be applied when interpreting MMSE test scores.     

Correlates of level and change in the Mini-Mental State Examination

The goal of the current project was to determine (a) the cognitive abilities assessed by the Mini Mental State Examination (MMSE; M. F. Folstein, S. E. Folstein, & P. R. McHugh, 1975), (b) whether the same abilities are associated with MMSE performance among people of different ages, and (c) whether the same abilities are involved in changes within the same people over time. The authors therefore examined whether the initial levels of 5 cognitive ability constructs (vocabulary, reasoning, memory, space, and speed) predicted initial levels of MMSE performance and whether the initial levels or the changes in these 5 cognitive abilities predicted change in the MMSE performance. The major findings were that 3 cognitive constructs (vocabulary, reasoning, and memory) contribute to performance in the MMSE but that their respective contributions to the MMSE vary as a function of age and time. In particular, individual differences and change in the MMSE are primarily related to individual differences in reasoning among adults younger than about 70 years, whereas both initial level of MMSE performance and longitudinal change in MMSE performance primarily related to initial level and change in memory ability among adults older than 70 years. The results therefore imply that both the level of performance on the MMSE at a single point in time and the change in MMSE over time may represent somewhat different cognitive abilities at different ages.     

Neuropsychometric correlates of the Mini-Mental State Examination: preliminary data

The present study investigated the neuropsychometric correlates of the Mini-Mental State Examination. 12 consecutive neurological referrals were administered the Mini-Mental State Examination, the Wechsler Memory Scale, and the WAIS--R. Pearson product-moment correlations suggest moderate association between scores on the Mini-Mental State Examination and Wechsler Memory Scale but less robust relationships between scores on the Mini-Mental State Examination and WAIS--R Full Scale, Verbal, and Performance IQs.     

IQ and scores on the Mini-Mental State Examination (MMSE): controlling for effort and education among geriatric inpatients

The Mini-Mental State Examination (MMSE) and the Peabody Picture Vocabulary Test, Third Edition (PPVT-III) were administered to 76 Extended Care Center inpatients of a Veterans Affairs Medical Center, 56 of whom did not carry a diagnosis associated with brain impairment, and 20 of whom had a diagnosis associated with degenerative or cerebrovascular conditions. MMSE and PPVT-III scores, the latter of which estimates verbal IQ, were significantly correlated in both groups, even when controlling for the effects of education. This correlation was attenuated, but remained significant, in the face of varying levels of patient effort. The findings of this study support earlier findings, which also suggest that interpretation of "impaired" performance on the MMSE for those with IQ scores below 90 should be interpreted with caution. Average MMSE scores for Wechsler IQ classifications are provided.     

IQ and Scores on the Mini-Mental State Examination (MMSE)

The Mini-Mental State Examination (MMSE) and the Peabody Picture Vocabulary Test-Revised (PPVT-R) were administered to 217 Veterans Affairs (VA) Nursing Home patients, 104 of whom did not carry a diagnosis associated with brain impairment, and 113 who had a diagnosis associated with degenerative or cerebrovascular conditions. MMSE and IQ scores were significantly correlated in both groups, even controlling for the effects of education. It is suggested that although previous normative studies of the MMSE may provide good general clinical guidance, interpretation of “impaired” performance on the MMSE for those with IQ scores below 90 should be approached with caution. Average MMSE scores for Wechsler IQ classifications are provided.     

Structure of the Mini-Mental State Examination: a comparison between normal and clinical subjects

The Mini-Mental State Examination was administered to a sample of 133 Italians ranging from 60 to 80 years of age. From a Principal Components Analysis three factors were retained, being results of both varimax and oblimin rotations. These were labeled (1) Memory, (2) Verbal Comprehension, and (3) Attention. These factors are similar to those obtained with normal elderly Americans, but they are different from the factors based on clinical samples. No age differences in the factor scores were found among the normal elderly subjects when education was considered. In contrast, significant differences were found between a group of 25 demented patients and a matched group randomly extracted from the normal sample.     

Minimal brain dysfunction in adolescent and young adult psychiatric inpatients

This paper presents data on a study of 100 consecutive young adult psychiatric admissions to Horsham Hospital, to determine the incidence of minimal brain dysfunction in this population, to define the subcategories of common psychiatric presentation, and to compare these data with those from the companion study conducted by our research group of fifty consecutive adolescent psychiatric admissions, reported by Horowitz, 1981.     

Neuropsychological performance and suicidal behavior in adult psychiatric inpatients.

Although various studies have shown that suicidal persons exhibit greater cognitive deficiencies than both normals and other psychiatric patients, researchers as yet have been unable to account for the source(s) of the differences. Some of these differences (e.g., cognitive rigidity and impaired problem solving) hint of possible organic involvement. This study explored the relationship of neuropsychological functioning to suicidal behavior by comparing 20 suicidal and 27 nonsuicidal psychiatric inpatients on several tests of neuropsychological functioning. Although results showed no significant differences between the two groups on most measures, both groups showed evidence of notably high levels of cortical dysfunction relative to test norms. Thirty-five percent of suicidal patients and 44% of nonsuicidal patients scored in the impaired range. Implications of this high frequency of impairment for the treatment of suicidal and nonsuicidal psychiatric patients are discussed.     

Screening for attention-deficit/hyperactivity disorder in adult inpatients with psychiatric disorders

The purpose was to assess the effectiveness of the adult ADHD Module from the MINI International Neuropsychiatric Interview (MINI) and the Conners' Adult ADHD Rating Scales: Screening Version DSM-IV ADHD Symptoms Total Scale (CAARS-S:SV) in screening for attention-deficit/hyperactivity (ADHD) disorder in patients hospitalized for other psychiatric disorders. Assessment measures were administered to 55 (50%) female and 55 (50%) male adult (>18 yr. old) inpatients. Only six (5%) of the 110 inpatients had been diagnosed with comorbid ADHD according to medical charts. In contrast, 55 (50%) patients met criteria for ADHD according to the MINI, and 39 (36%) patients met criteria on the CAARS-S:SV. The higher rates of prevalence for the MINI and the CAARS-S:SV were attributable to symptom criteria for ADHD being similar to those shared with comorbid disorders.     

Characteristics of readmitted psychiatric inpatients

This study examined sociodemographic, diagnostic, psychological, and episode-based variables in a sample of 130 psychiatric patients admitted to treatment at least twice in a 6-yr. period. Short length of initial hospitalization (r = -.30, p < .01) and younger age on initial admission (r = -.20, p < .05) were significantly correlated with frequent hospital admissions. Scores on four of the subscales of the WAIS-R were significantly correlated with readmission, confirming that patients who have fewer cognitive resources are at risk of frequent admissions. A multiple regression analysis combining variables to predict readmission accounted for only 12% of the common variance (r128 = .34, p < .01), however, indicating that a prediction equation with these variables has limited clinical utility.     

IQ and Scores on the Mini-Mental State Examination (MMSE): Controlling for Effort and Education Among Geriatric Inpatients

ABSTRACT

The Mini-Mental State Examination (MMSE) and the Peabody Picture Vocabulary Test, Third Edition (PPVT-III) were administered to 76 Extended Care Center inpatients of a Veterans Affairs Medical Center, 56 of whom did not carry a diagnosis associated with brain impairment, and 20 of whom had a diagnosis associated with degenerative or cerebrovascular conditions. MMSE and PPVT-III scores, the latter of which estimates verbal IQ, were significantly correlated in both groups, even when controlling for the effects of education. This correlation was attenuated, but remained significant, in the face of varying levels of patient effort. The findings of this study support earlier findings, which also suggest that interpretation of “impaired” performance on the MMSE for those with IQ scores below 90 should be interpreted with caution. Average MMSE scores for Wechsler IQ classifications are provided.     

The factor structure of the Millon Clinical Multiaxial Inventory (MCMI) for psychiatric inpatients

This study examines the factor structure of the Millon Clinical Multiaxial Inventory (MCMI) for a sample of psychiatric inpatients. The results are compared and contrasted with previous studies that have examined the factor structure of the MCMI. Factors identified for the inpatient sample include Interpersonal Withdrawal/Avoidance, Emotional Distress, Impulsivity/Negativism, Paranoid Distrust/Delusions, and Dependency/Submission. In general, results from this study are consistent with previous findings. However, there is evidence that the factor structure for this inpatient sample demonstrated more discrimination between symptoms and personality traits than had been demonstrated in previous studies.     

Religious coping in highly religious psychiatric inpatients

This study among highly religious psychiatric patients in a mental hospital in the Netherlands focused on the following issues: their religious and spiritual beliefs and activities; their religious coping activities, measured using Pargament's three coping styles and a positive religious coping scale; the influence of religious coping on psychological and existential well-being; and the predictive value of general religiousness, as compared with religious coping activities, regarding psychological and existential well-being.

For this population of inpatients, religion had a positive influence on their ways of dealing with mental problems; religious coping was positively correlated with existential and psychological well-being. General religiousness as well as religious coping were positively correlated with existential well-being, whereas psychological well-being primarily was predicted by positive religious coping.

Results are discussed in the context of theoretical notions of religious coping, addressing in particular the positive influence of religious beliefs, relying on God, religious activities and religious social support in psychological and existential times of crisis.     

MMPI predictors of mania among psychiatric inpatients

MMPI data from 64 patients with a diagnosis of manic-depressive illness, manic type, were compared with MMPI data from patients in two comparison groups--64 patients with a psychotic diagnosis other than manic-depressive illness, and 64 patients with a variety of psychiatric diagnoses. Manic patients had higher Ma scale scores for MMPI scales that assess personal distress and interpersonal difficulties (e.g., D and Si). Discriminant analysis, with the Ma, D, and Si scales as predictors, correctly classified as manic or not manic 82.5% of the patients in the derivation sample and 74.2% of the patients in the cross-validation sample. Two high-point pairs, Sc-Ma/Ma-Sc and Pa-Ma/Ma-Pa, occurred in the MMPI profiles of almost half of the manic patients but were rarely found among the profiles of other patients. The results of this study support the use of the MMPI in identifying manic patients, particularly when discriminating between mania and other types of psychosis.     

The efficacy of rational-emotive group therapy in psychiatric inpatients

The impact of rational-emotive theory and therapy upon the practice of clinical psychology has been profound, and many purportedly objective experimental tests of its efficacy as a mode of treatment have been reported. Yet the great majority of these reports have failed to utilize actual clinical populations. This study evaluated rational-emotive group therapy with psychiatric inpatients. Results supported the claim that irrational beliefs are related to emotional disturbance. It was also shown that patients undergoing rational-emotive group therapy changed their self-reported irrational beliefs more than did a control group. Finally, there was a trend for the experimental subjects to be more likely to have been discharged from the hospital during the 90-day follow-up period than were control subjects. However, this study failed to demonstrate that change in irrational beliefs was related to improvement in psychiatric symptoms or rates of discharge from the hospital. Some of the difficulties in conducting treatment evaluation research in a psychiatric hospital setting are discussed with respect to these results.     

WASI profile variability in a sample of psychiatric inpatients

This study examined the variability of Wechsler Abbreviated Scale of Intelligence profiles using the subtest range and profile variability index in a sample of 70 psychiatric inpatients. The subtest range and profile variability index were correlated .93 (p<.001), indicating that either measure may be used to assess profile variance. Comparison of profile variability on this abbreviated scale with other Wechsler intelligence scales in similar populations suggests that variability measures are not comparable across the tests.     

Locus of control and achievement in child psychiatric inpatients

The relationship between the Nowicki-Strickland Locus of Control Scale for Children (Nowicki & Strickland, 1973) and academic achievement was examined in a sample of 66 child psychiatric inpatients. Previous studies had suggested that this measure correlated with achievement in normal samples (Nowicki & Strickland, 1973) but not in populations of male juvenile offenders (Little & Kendall, 1978). The product-moment correlation between the Nowicki-Strickland Scale and the Peabody Individual Achievement Test was significant. However, when the effect of IQ was controlled for in a partial correlation, there was no significant correlation. Discussion focuses on the relationship between these results and other findings in the area of locus of control, intelligence, and achievement.