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A Mini-Mental Status Examination for the hearing impaired

from Age and Ageing

SIR—The Folstein Mini-Mental State Examination (MMSE), developed in 1975 as a bedside test of cognitive function, has been extensively used in clinical practice and research and is widely accepted as a clinical tool for diagnosing and monitoring dementia [1]. Despite its low sensitivity and specificity (0.56 and 0.73, respectively, in one recent study) [2], comparable tools, including the Modified MMSE of Teng and Chui [3] have not received such widespread acceptance.
It contains 11 questions that test orientation, registration, attention, calculation, recall, language and visuospatial functioning, with a maximum score of 30. It takes minutes to administer and is practical for routine clinical use. Most questions are administered verbally. Hearing loss reduces performance on the verbal parts of the examination even in cognitively intact patients, with potential diagnostic error and alteration of management [4]. This is of concern, as hearing impairment affects over one-fourth of people over 65 years of age, and half of those over 75 years in most industrialised nations [5].

Uhlmann [6] tested 71 Alzheimer’s disease subjects with varying levels of hearing, using both written and standard versions of the MMSE. Paradoxically, they found that hearing-impaired subjects scored higher in the standard than the written version, while subjects with normal hearing performed better using the written version, although these findings were not statistically significant.

We (M.M.) developed a written version of the MMSE, found it clinically useful, and report here an evaluation of its performance in a hospital-based population of older people.