Healthy and clinical meta-data and aggregated mini-mental status exam scores for the Persian speaking population

Abstract

The Mini-Mental Status Examination (MMSE) is a widely used cognitive screening measure. The MMSE is used with diverse cultures, yet multiple factors may impact test performance, interpretation, and normative statistics. The current study observes factors specific to Iranians’ that influence performances on the Persian MMSE. A literature review compiled studies of the Persian MMSE administered to both healthy and clinical groups. Out of 1008 articles found, 45 met inclusion criteria. Meta-analysis of aggregate data was used to develop global means, standard deviations, and cutoff scores for both clinical and healthy groups. Iranian MMSE normative mean and standard deviation values were 27 and 2.2, respectively. Iranian MMSE clinical mean and standard deviation values were 22 and 5.7, respectively. An MMSE cut-off score of 22.6, or any score below 23 (e.g., <23 or 22 and lower), would represent 2 standard deviations below the mean and closely resemble a clinical population. This is consistent with Ansari, et al. (2010) cut of score of 23 and Seyedian et al. (2007) cut-off score of 22. Therefore, an Iranian patient who scores below 23 would be suspected of having potential cognitive decline. Demographic adjusted normative and clinical regressions equations were also generated. However, gender and age did not show significant correlations while education showed the largest and most significant correlation in healthy samples. Therefore, higher educated Iranians cut-off score will likely be higher than 23. Clinicians may use the global normative mean and standard deviation to calculate z-scores. This helps clinician to better assess cognition in Iranian patients.

Appendix

Article Excluded:

• 1. Rashedi et al., 2014;

• 2. Hassani et al., 2012;

• 3. Oskoei et al., 2013;

• 4. Chabok et al., 2012;

• 5. Emsaki et al., 2011;

• 6. Mehri et al., 2009;

• 7. Seyfaddini, 2006;

• 8. Moradi et al., 2013;

• 9. Manavifar & Karimooy, 2013;

• 10. Kormi-Nouri et al., 2012;

• 11. Baluch, 1996;

• 12. Allahyari et al., 2014;

• 13. Jobson & Cheraghi, 2016;

• 14. Thorell et al., 2013;

• 15. Amani et al., 2012;

• 16. Salehi et al., 2014;

• 17. Karamshaii et al., 2015

• 18. Gharaeipour & Andrew, 2013

Modified MMSE Versions Excluded

• 1. Modified MMSE

• 2. 3 MMSE,

• 3. Farsi Version of 3MS or F-3MS