A Combined Index Using the Mini-Mental State Examination and Lawton Index to Discriminate Between Clinical Dementia Rating Scores of 0.5 and 1: A Development and Validation Study

Kazuaki Uchida, PhD; Taiki Sugimoto, PhD; Kenta Murotani, PhD; Masashi Tsujimoto, MD, PhD; Yoshinobu Kishino, MD; Yujiro Kuroda, PhD; Nanae Matsumoto, PhD; Kosuke Fujita, PhD; Keisuke Suzuki, MD, PhD; Rei Ono, PhD, MPH; Toshihiro Akisue, MD, PhD; Hidenori Arai, MD, PhD; Kenji Toba, MD, PhD; Takashi Sakurai, MD, PhD

J Clin Psychiatry. 2024;85(2):23m15101

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Author Affiliations

Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan
Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Obu, Japan
Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
Department of Cognitive and Behavioral Science, Graduate School of Medicine, Nagoya University, Nagoya, Japan
Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Obu, Japan
Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Settu, Japan
Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
National Center for Geriatrics and Gerontology, Obu, Japan
Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Japan
Department of Cognitive and Behavioral Science, Graduate School of Medicine, Nagoya University, Nagoya, Japan
Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan
Corresponding Author: Takashi Sakurai, MD, PhD, Research Institute, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi 474-8511, Japan ([email protected]).

References (37)

Risk Reduction of Cognitive Decline and Dementia [WHO Guidelines]. World Health Organization; 2019.
GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7(2):e105–e125. PubMed CrossRef
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
Petersen RC. Clinical practice. Mild cognitive impairment. N Engl J Med. 2011;364(23):2227–2234. PubMed CrossRef
Canevelli M, Grande G, Lacorte E, et al. Spontaneous reversion of mild cognitive impairment to normal cognition: a systematic review of literature and meta analysis. J Am Med Dir Assoc. 2016;17(10):943–948. PubMed CrossRef
Manly JJ, Tang MX, Schupf N, et al. Frequency and course of mild cognitive impairment in a multiethnic community. Ann Neurol. 2008;63(4):494–506. PubMed CrossRef
Petersen RC, Roberts RO, Knopman DS, et al. Mild cognitive impairment: ten years later. Arch Neurol. 2009;66(12):1447–1455. PubMed CrossRef
Farias ST, Mungas D, Reed BR, et al. Progression of mild cognitive impairment to dementia in clinic- vs community-based cohorts. Arch Neurol. 2009;66(9):1151–1157. PubMed CrossRef
Tsujimoto M, Suzuki K, Saji N, et al. Organized Registration for the Assessment of dementia by the Nationwide General consortium toward Effective treatment (ORANGE) registry: current status and perspectives of mild cognitive impairment. J Alzheimers Dis. 2022;88(4):1423–1433. PubMed CrossRef
Ward A, Tardiff S, Dye C, et al. Rate of conversion from prodromal Alzheimer’s disease to Alzheimer’s dementia: a systematic review of the literature. Dement Geriatr Cogn Dis Extra. 2013;3(1):320–332. PubMed CrossRef
Ngandu T, Lehtisalo J, Solomon A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015;385(9984):2255–2263. PubMed CrossRef
van Dyck CH, Swanson CJ, Aisen P, et al. Lecanemab in early Alzheimer’s disease. N Engl J Med. 2023;388(1):9–21. PubMed
Hughes CP, Berg L, Danziger WL, et al. A new clinical scale for the staging of dementia. Br J Psychiatry. 1982;140:566–572. PubMed CrossRef
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993;43(11):2412–2414. PubMed CrossRef
Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198. PubMed
Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699. PubMed CrossRef
Tsoi KKF, Chan JYC, Hirai HW, et al. Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Intern Med. 2015;175(9):1450–1458. PubMed
Creavin ST, Wisniewski S, Noel-Storr AH, et al. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016;2016(1):CD011145. PubMed CrossRef
Arevalo-Rodriguez I, Smailagic N, Roqué-Figuls M, et al. Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev. 2021;7(7):CD010783. PubMed CrossRef
McKhann GM, Knopman DS, Chertkow H, et al. 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. Alzheimers Dement. 2011;7(3):263–269. PubMed CrossRef
Jekel K, Damian M, Wattmo C, et al. Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review. Alzheimers Res Ther. 2015;7(1):17. PubMed CrossRef
Cloutier S, Chertkow H, Kergoat MJ, et al. Trajectories of decline on instrumental activities of daily living prior to dementia in persons with mild cognitive impairment. Int J Geriatr Psychiatry. 2021;36(2):314–323. PubMed CrossRef
Saji N, Sakurai T, Suzuki K, et al; ORANGE investigators. ORANGE’s challenge: developing wide-ranging dementia research in Japan. Lancet Neurol. 2016;15(7):661–662. PubMed CrossRef
Morris JC, Ernesto C, Schafer K, et al. Clinical dementia rating training and reliability in multicenter studies: the Alzheimer’s disease Cooperative Study experience. Neurology. 1997;48(6):1508–1510. PubMed CrossRef
Burke WJ, Miller JP, Rubin EH, et al. Reliability of the Washington University clinical dementia rating. Arch Neurol. 1988;45(1):31–32. PubMed
Berg L, McKeel DW Jr, Miller JP, et al. Neuropathological indexes of Alzheimer’s disease in demented and nondemented persons aged 80 years and older. Arch Neurol. 1993;50(4):349–358. PubMed CrossRef
Morris JC, McKeel DW Jr, Storandt M, et al. Very mild Alzheimer’s disease: informant-based clinical, psychometric, and pathologic distinction from normal aging. Neurology. 1991;41(4):469–478. PubMed CrossRef
Morris JC, Storandt M, McKeel DW Jr, et al. Cerebral amyloid deposition and diffuse plaques in ‘normal’ aging: evidence for presymptomatic and very mild Alzheimer’s disease. Neurology. 1996;46(3):707–719. PubMed
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–186. PubMed
Graf C. The Lawton instrumental activities of daily living scale. Am J Nurs. 2008;108(4):52–63; quiz 62–63. PubMed CrossRef
Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–65.
Pepe MS. The Statistical Evaluation of Medical Tests for Classification and Prediction. Oxford University Press; 2003.
Anthony M, Holden SB. Cross-validation for binary classification by real-valued functions: theoretical analysis. COLT. 1998:218–229.
Anguita D, Ghio A, Ridella S, et al. K-fold cross validation for error rate estimate in support vector machines. Proceedings of the 2009 International Conference on Data Mining; July 13–16, 2009; Las Vegas, NV.
Awata S, Sugiyama M, Ito K, et al. Development of the dementia assessment sheet for community-based integrated care system. Geriatr Gerontol Int. 2016;16(suppl 1):123–131. PubMed CrossRef
Reisberg B, Ferris SH, Anand R, et al. Functional staging of dementia of the Alzheimer type. Ann N Y Acad Sci. 1984;435:481–483.
Holthoff VA, Ferris S, Ihl R, et al. Validation of the relevant outcome scale for Alzheimer’s disease: a novel multidomain assessment for daily medical practice. Alzheimers Res Ther. 2011;3(5):27. PubMed CrossRef