Mini-Mental Parkinson (MMP) as a Dementia Screening Test: Comparison with the Mini-Mental State Examination (MMSE)

Andrew      J. Larner

doi:10.2174/1874609811205020136

Abstract

Background: As populations age, screening instruments for cognitive impairment and dementia will become of increasing importance in clinical practice. Mini-Mental Parkinson (MMP), a derivative of the Mini-Mental State Examination (MMSE), was originally described as a cognitive screening instrument for use in Parkinson’s disease. Its item content addresses some of the acknowledged shortcomings of the MMSE. Pragmatic use of MMP in general cognitive clinics has not previously been examined.

Aim: To compare the performance of two scales, Mini-Mental Parkinson (MMP) and the Mini-Mental State Examination (MMSE), as cognitive screening instruments for dementia in a memory clinic population.

Methods: MMP was administered prospectively to 201 consecutive new patient referrals independent of other tests used to establish dementia diagnosis according to standard diagnostic criteria (DSM-IV). Diagnostic utility of MMP for dementia was measured and compared with MMSE.

Results: MMP proved easy to use and acceptable to patients. Optimal test accuracy (0.86) was at MMP cutoff of ≤ 17/32, with sensitivity 0.51, specificity 0.97, positive predictive value 0.83, negative predictive value 0.87, and area under Receiver Operating Characteristic curve 0.89. Using a higher cutoff (≤ 29/32), MMP sensitivity was 1.00 with specificity 0.70. MMP scores correlated with MMSE (r = 0.93) and diagnostic agreement was high (κ = 0.85).

Conclusions: MMP is a useful screening instrument in the memory clinic setting, with patients who fall below the designated cutoff requiring further investigation to ascertain a cause for their cognitive impairment.

Keywords: Dementia, diagnosis, MMP, MMSE, sensitivity, specificity, diagnostic criteria, subcortical pathology