Skip to main content Accessibility help

Interactive influences of demographics on the Mini-Mental State Examination (MMSE) and the demographics-adjusted norms for MMSE in elderly Koreans

  • Jeong Lan Kim (a1), Joon Hyuk Park (a2), Bong Jo Kim (a3), Moon Doo Kim (a2), Shin-Kyum Kim (a4), Yeon Kyung Chi (a5), Tae Hui Kim (a5), Seok Woo Moon (a6), Moon Ho Park (a7), Jae Nam Bae (a8), Jong Inn Woo (a9) (a10), Seung-Ho Ryu (a11), Jong Chul Yoon (a12), Nam-Jin Lee (a13), Dong Young Lee (a9) (a10), Dong Woo Lee (a14), Seok Bum Lee (a15), Jung Jae Lee (a16), Chang-Uk Lee (a17), Sung Man Chang (a16), Ji Won Han (a5), Jin Hyeong Jhoo (a18), Changsu Han (a19), Maeng Je Cho (a9) (a10) and Ki Woong Kim (a5) (a10)...


Background: The influences of demographics, culture, language, and environmental changes on Mini-Mental State Examination (MMSE) scores are considerable.

Methods: Using a sample of 7452 healthy, community-dwelling elderly Koreans, aged 55 to 94 years, who participated in the four ongoing geriatric cohorts in Korea, we investigated demographic influences on MMSE scores and derived normative data for this population. Geropsychiatrists strictly excluded subjects with cognitive disorders according to the protocol of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K) Clinical Assessment Battery (CERAD-K-C).

Results: Education (standardized β = 0.463), age (standardized β = −0.303), and gender (standardized β = −0.057) had significant effects on MMSE scores (p < 0.001). The score of MMSE increase 0.379 point per 1-year education, decrease 0.188 per 1-year older, and decrease 0.491 in women compared to men. Education explained 30.4% of the scores’ total variance, which was much larger than the variances explained by age (8.4%) or gender (0.3%). Accordingly, we present normative data for the MMSE stratified by education (0, 1–3, 4–6, 7–9, 10–12, and ≥ 13 years), age (60–69, 70–79, and 80–89 years), and gender.

Conclusions: We provide contemporary education-, age-, and gender-stratified norms for the MMSE, derived from a large, community-dwelling elderly Korean population sample, which could be useful in evaluating individual MMSE scores.


Corresponding author

Correspondence should be addressed to: Ki Woong Kim, Department of Neuropsychiatry, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu Seongnam-si, Gyeonggi-do 463-707, Korea. Phone. +82 31 787 7439; Fax +82 31 787 4058. Email:


Hide All
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington, DC: American Psychiatric Association.
Anderson, T. M., Sachdev, P. S., Brodaty, H., Trollor, J. N. and Andrews, G. (2007). Effects of sociodemographic and health variables on Mini-Mental State Exam scores in older Australians. American Journal of Geriatric Psychiatry, 15, 467476.
Anthony, J. C., LeResche, L., Niaz, U., von Korff, M. R. and Folstein, M. F. (1982). Limits of the “Mini-Mental State” as a screening test for dementia and delirium among hospital patients. Psychological Medicine, 12, 397408.
Beekman, A. T., Copeland, J. R. and Prince, M. J. (1999). Review of community prevalence of depression in later life. British Journal of Psychiatry, 174, 307311.
Castro-Costa, E., Fuzikawa, C., Uchoa, E., Firmo, J. O. and Lima-Costa, M. F. (2008). Norms for the Mini-Mental State Examination: adjustment of the cut-off point in population-based studies (evidences from the Bambui health aging study). Arquivos De Neuro-Psiquiatria, 66, 524528.
Chiu, H. F. and Lam, L. C. (2007). Relevance of outcome measures in different cultural groups: does one size fit all? International Psychogeriatrics, 19, 457466.
Cobb, J. L., D'Agostino, R. B. and Wolf, P. A. (1993). Norms for the Mini-Mental State Examination. JAMA, 270, 2178.
Crum, R. M., Anthony, J. C., Bassett, S. S. and Folstein, M. F. (1993). Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA, 269, 23862391.
Cullen, B. et al. (2005). Screening for dementia in an Irish community sample using MMSE: a comparison of norm-adjusted versus fixed cut-points. International Journal of Geriatric Psychiatry, 20, 371376.
De Silva, R. et al. (2009). Norms for the Mini-Mental State Examination from a sample of Sri Lankan older people. International Journal Geriatric Psychiatry, 24, 666670.
Escobar, J. I., Burnam, A., Karno, M., Forsythe, A., Landsverk, J. and Golding, J. M. (1986). Use of the Mini-Mental State Examination (MMSE) in a community population of mixed ethnicity: cultural and linguistic artifacts. Journal of Nervous and Mental Disease, 174, 607614.
Feinstein, A. R. (1974). Clinical biostatistics. XXV: a survey of the statistical procedures in general medical journals. Clinical Pharmacology Therapeutics, 15, 97107.
Fillenbaum, G. G., Hughes, D. C., Heyman, A., George, L. K. and Blazer, D. G. (1988). Relationship of health and demographic characteristics to Mini-Mental State Examination score among community residents. Psychological Medicine, 18, 719726.
Folstein, M., Anthony, J. C., Parhad, I., Duffy, B. and Gruenberg, E. M. (1985). The meaning of cognitive impairment in the elderly. Journal of the American Geriatrics Society, 33, 228235.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Ganguli, M. et al. (1991). Effects of age, gender, and education on cognitive tests in a rural elderly community sample: norms from the Monongahela Valley Independent Elders Survey. Neuroepidemiology, 10, 4252.
Grigoletto, F., Zappala, G., Anderson, D. W. and Lebowitz, B. D. (1999). Norms for the Mini-Mental State Examination in a healthy population. Neurology, 53, 315320.
Han, C., Jo, S. A., Kim, N. H., Jo, I. and Park, M. H. (2009). Study design and methods of the Ansan Geriatric Study (AGE study). BMC Neurology, 9, 10.
Han, C., Jo, S. A., Jo, I., Kim, E., Park, M. H. and Kang, Y. (2008). An adaptation of the Korean Mini-Mental State Examination (K-MMSE) in elderly Koreans: demographic influence and population-based norms (the AGE study). Archives of Gerontology and Geriatrics, 47, 302310.
Hudon, C. et al. (2009). Normative date for the Mini-Mental State Examination (MMSE) in a sample of community dwelling French speaking residents from Quebec aged 65 and older. Canadian Journal on Aging, 28, 347357.
Katzman, R. et al. (1988). A Chinese version of the Mini-Mental Status Examination: impact of literacy in a Shanghai dementia survey. Journal of Clinical Epidemiology, 41, 971978.
Katzman, R. et al. (1994). The malignancy of dementia: predictors of mortality in clinically diagnosed dementia in a population survey of Shanghai, China. Archives of Neurology, 51, 12201225.
Kim, K. W. et al. (2005). Diagnostic accuracy of Mini-Mental Status Examination and revised Hasegawa Dementia Scale for Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 19, 324330.
Kim, K. W. et al. (2011). A nationwide survey on the prevalence of dementia and mild cognitive impairment in South Korea. Journal of Alzheimer's Disease, 23, 281291.
Kittner, S. J. et al. (1986). Methodological issues in screening for dementia: the problem of education adjustment. Journal of Chronic Diseases, 39, 163170.
Laks, J., Baptista, E. M., Contino, A. L., de Paula, E. O. and Engelhardt, E. (2007). Mini-Mental State Examination norms in a community-dwelling sample of elderly with low schooling in Brazil. Cadernos De Saude Publica, 23, 315319.
Lee, D. Y. et al. (2002). A normative study of the Mini-Mental State Examination in the Korean elderly. Journal of the Korean Neuropsychiatric Association, 41, 18.
Lee, D. Y. et al. (2004). A normative study of the CERAD neuropsychological assessment battery in the Korean elderly. Journal of the International Neuropsychological Society, 10, 7281.
Magni, E., Binetti, G., Bianchetti, A., Rozzini, R. and Trabucchi, M. (1996). Mini-Mental State Examination: a normative study in Italian elderly population. European Journal of Neurology, 3, 198202.
Malloy, P. F. et al. (1997). Cognitive screening instruments in neuropsychiatry: a report of the Committee on Research of the American Neuropsychiatric Association. Journal of Neuropsychiatry and Clinical Neurosciences, 9, 189197.
Mathuranath, P. S., Cherian, J. P., Mathew, R., George, A., Alexander, A. and Sarma, S. P. (2007). Mini-Mental State Examination and the Addenbrooke's Cognitive Examination: effect of education and norms for a multicultural population. Neurology India, 55, 106110.
Mitrushina, M. N., Boone, K. B. and D'Elia, L. (1999). Handbook of Normative Data for Neuropsychological Assessment. New York: Oxford University Press.
Morgado, J., Rocha, C. S., Maruta, C., Guerreiro, M. and Martins, I. P. (2010). Cut-off scores in MMSE: a moving target? European Journal of Neurology, 17, 692695.
O'Connor, D. W., Pollitt, P. A., Treasure, F. P., Brook, C. P. and Reiss, B. B. (1989). The influence of education, social class and sex on Mini-Mental State scores. Psychological Medicine, 19, 771776.
Park, J. et al. (2007). An overview of the Korean Longitudinal Study on Health and Aging (KLoSHA). Psychiatry Investigation, 4, 8495.
Pauker, J. D. (1988). Constructing overlapping cell tables to maximize the clinical usefulness of normative test data: rationale and an example from neuropsychology. Journal of Clinical Psychology, 44, 930933.
Roos, A. et al. (2010). Normative data for the Tygerberg Cognitive Battery and Mini-Mental Status Examination in a South African population. Comprehensive Psychiatry, 51, 207216.
Stewart, R., Johnson, J., Richards, M., Brayne, C. and Mann, A. (2002). The distribution of Mini-Mental State Examination scores in an older UK African–Caribbean population compared to MRC CFA study norms. International Journal of Geriatric Psychiatry, 17, 745751.
Tombaugh, T. N. and McIntyre, N. J. (1992). The Mini-Mental State Examination: a comprehensive review. Journal of the American Geriatrics Society, 40, 922935.
Uhlmann, R. F. and Larson, E. B. (1991). Effect of education on the Mini-Mental State Examination as a screening test for dementia. Journal of the American Geriatrics Society, 39, 876880.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed