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Open Access Research article

The reliability of assigning individuals to cognitive states using the Mini Mental-State Examination: a population-based prospective cohort study

Riccardo E Marioni1*, Mark Chatfield1, Carol Brayne1, Fiona E Matthews2 and Medical Research Council Cognitive Function and Ageing Study

Author Affiliations

1 Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK

2 Medical Research Council Biostatistics Unit, Cambridge CB2 0SR, UK

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BMC Medical Research Methodology 2011, 11:127  doi:10.1186/1471-2288-11-127

Published: 6 September 2011



Previous investigations of test re-test reliability of the Mini-Mental State Examination (MMSE) have used correlations and statistics such as Cronbach's α to assess consistency. In practice, the MMSE is usually used to group individuals into cognitive states. The reliability of this grouping (state based approach) has not been fully explored.


MMSE data were collected on a subset of 2,275 older participants (≥ 65 years) from the population-based Medical Research Council Cognitive Function and Ageing Study. Two measurements taken approximately two months apart were used to investigate three state-based categorisations. Descriptive statistics were used to determine how many people remained in the same cognitive group or went up or down groups. Weighted logistic regression was used to identify predictive characteristics of those who moved group.


The proportion of people who remained in the same MMSE group at screen and follow-up assessment ranged from 58% to 78%. The proportion of individuals who went up one or more groups was roughly equal to the proportion that went down one or more groups; most of the change occurred when measurements were close to the cut-points. There was no consistently significant predictor for changing cognitive group.


A state-based approach to analysing the reliability of the MMSE provided similar results to correlation analyses. State-based models of cognitive change or individual trajectory models using raw scores need multiple waves to help overcome natural variation in MMSE scores and to help identify true cognitive change.

MMSE; reliability; test-retest; ageing; elderly