The aim of the study was to investigate the value of the Mini-Mental State Examination (MMSE) for use by general practitioners (GPs) in a group of elderly patients in whom the GPs are considering a dementia diagnosis. The study population consisted of 533 elderly patients (aged 65 and older) judged by 36 GPs as suering from minimal to severe' dementia. Cross-sectional data were used to determine the criterion validity of separate items, a set of items and the total MMSE. The GMS/AGECAT diagnosis was used as an external criterion. MMSE items were analysed and two items testing general knowledge were added. The most eective set of items was determined using a stepwise logistic regression analysis. Adjusted for age, sex and education, the dierentiating ability of the set of items was compared to that of the total MMSE score. The total MMSE score was divided into three categories (cutos 21/22 and 26/27) and into two categories (cuto 23/24). In total, 114 patients (21%) were diagnosed as having an organic syndrome' by the GMS/AGECAT. The dierentiating ability of separate items was poor. The following combination of items had the best predictive ability: items concerning the date, the day of the week, the patient's address and the current prime minister. This set of items was just as adequate in dierentiating dementia from non-dementia as the total MMSE score (sensitivity 64.9% and 64.8% respectively, speci®city 96.4% and 93.3%). The value of the MMSE in diagnosing dementia in general practice is limited. The score on cognitive test items can be one aspect of the individual's overall clinical picture, on which the diagnosis should be based. KEY WORDS ÐMMSE; dementia; general practice; GMS Dementia is an increasing social problem. The growing number of (very old) senior citizens, and with regard to The Netherlands the shift from institutional to home care, confront general practitioners (GPs) more frequently with problems concerning dementia. Early detection is essential for adequate support and future treatment (Wilcock et al., 1994).
Diagnostic procedures include a cognitive test, in addition to anamnesis, heteroanamnesis and