Skip to main content Accessibility help

Mapping modified Mini-Mental State Examination (MMSE) scores to dementia stages in a multi-ethnic Asian population

  • Xin Ying Chua (a1), Robin Wai Munn Choo (a1), Ngoc Huong Lien Ha (a1), Chin Yee Cheong (a2), Shiou Liang Wee (a1) (a3) and Philip Lin Kiat Yap (a1) (a2)...


The MMSE is used to screen for cognitive impairment and estimate dementia severity. In clinical settings, conventional cut-off scores have been used to distinguish between dementia stages. However, these scores have not been validated for different populations. This study maps scores from the modified version of the MMSE to dementia stages delineated by the Diagnostic and Statistical Manual of Mental Disorders-3rd revised edition (DSM-III-R), the Clinical Dementia Rating (CDR) and Functional Assessment Staging Test (FAST). We used cross-sectional data from a tertiary hospital memory clinic. Subjects were stratified into “primary education and below” (PE) or “secondary education and above” (SE). Receiving operating characteristic (ROC) analyses and Cohen's κ were performed to determine MMSE cut-off scores for dementia stages. Our derived cut-off scores were lower compared to the conventional scores. Scores also differed between subjects of different education levels. MMSE cut-off scores were 19, 15, and 9 for CDR stages 1, 2, and 3 respectively in PE subjects, and 23, 17, and 10 for SE subjects. Cut-off scores were comparable for staging by DSM-III-R Criteria and FAST. There is a need for locally derived stage-specific MMSE cut-off scores for the Asian population adjusted for education.


Corresponding author

Correspondence should be addressed to: Yap Lin Kiat Philip, A/Professor, Senior Consultant Geriatrician, Department of Geriatric Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore768828, Phone: 65-66022154. Email:


Hide All
Alzheimer's Association. (2017). Tests for Alzheimer's disease and dementia. Retrieved March 27, 2018, from
Auer, S. and Reisberg, B. (1997). The GDS/FAST staging system. International Psychogeriatrics, 9, 167171.
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.
Diniz, B. S. O., Yassuda, M. S., Nunes, P. V., Radanovic, M. and Forlenza, O. V. (2007). Mini-mental State Examination performance in mild cognitive impairment subtypes. International Psychogeriatrics, 19, 647.
Feng, L., Chong, M. S., Lim, W. S. and Ng, T. P. (2012). The modified mini-mental state examination test: normative data for Singapore Chinese older adults and its performance in detecting early cognitive impairment. Singapore Medical Journal, 53, 458462.
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.
Han, L., Cole, M., Bellavance, F., McCusker, J. and Primeau, F. (2000). Tracking cognitive decline in Alzheimer's disease using the mini-mental state examination: a meta-analysis. International Psychogeriatrics, 12, 231247.
Juva, K., Sulkava, R., Erkinjuntti, T., Ylikoski, R., Valvanne, J. and Tilvis, R. (1994). Staging the severity of dementia: comparison of clinical (CDR, DSM-III-R), functional (ADL, IADL) and cognitive (MMSE) scales. Acta Neurologica Scandinavica, 90, 293298.
Landis, J. R. and Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159174.
Lim, W. S., Chin, J. J., Lam, C. K., Lim, P. P. and Sahadevan, S. (2005). Clinical dementia rating: experience of a multi-racial Asian population. Alzheimer Disease and Associated Disorders, 19, 135142.
McKhann, G. M. et al. (2011). The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's & Dementia, 7, 263269.
Mitchell, A. (2013). The mini-mental state examination (MMSE): an update on its diagnostic validity for cognitive disorders. In Larner, A. J. (ed.), Cognitive Screening Instruments. A Practical Approach (pp. 1546). London: Springer.
Morris, J. C. (1993). The clinical dementia rating (CDR): current version and scoring rules. Neurology, 43, 24122414.
Na, H.-R. et al. (2010). Functional assessment staging (FAST) in Korean patients with Alzheimer's disease. Journal of Alzheimer's Disease : JAD, 22, 151158.
Ng, T.-P., Niti, M., Chiam, P.-C. and Kua, E.-H. (2007). Ethnic and educational differences in cognitive test performance on mini-mental state examination in Asians. The American Journal of Geriatric Psychiatry, 15, 130139.
Ng, T.-P., Niti, M., Chiam, P.-C. and Kua, E.-H. (2017). Ethnic and educational differences in cognitive test performance on mini-mental state examination in Asians. The American Journal of Geriatric Psychiatry, 15, 130139.
Perneczky, R., Wagenpfeil, S., Komossa, K., Grimmer, T., Diehl, J. and Kurz, A. (2006). Mapping scores onto stages: mini-mental state examination and clinical dementia rating. The American Journal of Geriatric Psychiatry, 14 (2), 139144.
Roman, G. C. et al. (1993, February). Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology. United States.
Sclan, S. G. and Reisberg, B. (1992). Functional assessment staging (FAST) in Alzheimer's disease: reliability, validity, and ordinality. International Psychogeriatrics, 4, 5569.



Altmetric attention score

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