A Mini-Mental Status Examination for the hearing impaired

A, Delecluse C et al. Habitual level of physical activity and muscle fatigue of the elbow flexor muscles in older men. L et al. Lower extremity performance is associated with daily life physical activity in individuals with and without peripheral arterial disease. Muscle strength in the triceps surae and objectively measured customary walking activity in men and women over 65 years of age. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. The association between physical function and lifestyle activity and exercise in the health, aging and body composition study. Effect of exercise on ease in performing activities of daily living and instrumental activities of daily living from age 70 to 77: the Jerusalem longitudinal study. Rennie KL et al. Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. SIR—The Folstein Mini-Mental State Examination (MMSE), developed in 1975 as a bedside test of cognitive function, has been extensively used in clinical practice and research and is widely accepted as a clinical tool for diagnosing and monitoring dementia [1]. Despite its low sensitivity and specificity (0.56 and 0.73, respectively, in one recent study) [2], comparable tools, including the Modified MMSE of Teng and Chui [3] have not received such widespread acceptance. It contains 11 questions that test orientation, registration, attention, calculation, recall, language and visuospatial functioning, with a maximum score of 30. It takes minutes to administer and is practical for routine clinical use. Most questions are administered verbally. Hearing loss reduces performance on the verbal parts of the examination even in cognitively intact patients, with potential diagnostic error and alteration of management [4]. This is of concern, as hearing impairment affects over one-fourth of people over 65 years of age, and half of those over 75 years in most industrialised nations [5]. Uhlmann [6] tested 71 Alzheimer's disease subjects with varying levels of hearing, using both written and standard versions of the MMSE. Paradoxically, they found that hearing-impaired subjects scored higher in the standard than the written version, while subjects with normal hearing performed better using the written version, although these findings were not statistically significant. We (M.M.) developed a written version of the MMSE, found it clinically useful, and report here an evaluation of its performance in a hospital-based population …