One test used to screen for dementia is the Mini-Mental State Examination (MMSE), which provides an assessment of cognitive functioning. The traditional cutoff point that has been used to trigger further testing for symptoms of dementia is a score of 24 on the MMSE. In the July issue of the Archives of Neurology, investigators reported the results of a new study which suggests that older, more highly-educated white patients should be sent for cognitive evaluation for MMSE scores less than 27.

The researchers analyzed data from 1141 participants enrolled in the Mayo Clinic Alzheimer Disease Research Center and Alzheimer Disease Patient Registry. These participants had at least 16 years of education and had an average age of almost 76 years. Of this group, 307 patients had dementia, 176 had mild cognitive impairment, and 658 did not have dementia. The researchers found that using an MMSE cutoff score of 27 optimizes the statistical probability of correctly diagnosing dementia in patients who have dementia and ruling out dementia in patients who have normal cognitive function.

It seems that college graduates might have more of a cognitive reserve, which could potentially mask symptoms of dementia and allow them to appear to function normally for a longer period of time after cognition begins to decline. Using a higher threshold for dementia screening could lead to earlier detection and treatment of dementia before the cognitive impairment is too severe. As a caveat, 93% of the patients evaluated in this study were white, so it is not known how these results might apply to other ethnicities.