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Open Access Research article

The factorial structure of the mini mental state examination (MMSE) in Japanese dementia patients

Kenta Shigemori1*, Shohei Ohgi1, Eriko Okuyama2, Takaki Shimura3 and Eric Schneider4

Author Affiliations

1 Graduate School of Health Sciences, Seirei Christopher University, 3453 Mikatahara-Cho, Hamamatsu-City Shizuoka, 433-8558, Japan

2 Hamamatsu Human Science Laboratory Ltd, 2254-10, Tomitsuka-Cho, Hamamatsu-City Shizuoka, 432-8002, Japan

3 Research Laboratory on Bionics, Sanaruko Parktown 4-204 1864-1, Tomitsuka-Cho, Naka-ku, Hamamatsu-City Shizuoka, 432-8002, Japan

4 Johns Hopkins School of Medicine, Center for Surgical Clinical Trials and Outcomes Research, 600 N. Wolfe St., Baltimore, MD 21205, USA

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BMC Geriatrics 2010, 10:36  doi:10.1186/1471-2318-10-36

Published: 9 June 2010

Abstract

Background

The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments in the evaluation of global cognitive status. Few studies have investigated the relationship among its components in terms of factorial structure in Japanese individuals suffering from dementia. The aims of this study were: 1) to analyze the factorial structure of MMSE in Japanese dementia patients, 2) to clarify the MMSE static structure in identifying different cognitive profiles and understanding how these profiles are related to levels of dysfunction in subsets of dementia patients.

Methods

30,895 consecutive outpatients with dementia were evaluated. The 11 subtests composing the MMSE and the global MMSE score were analyzed. Factor analysis based on principal component analysis with Promax rotation was applied to the data representing the frequency of failures in each subtest as identified by the MMSE.

Results

Factor analysis identified three factors that explained approximately 44.57% of the total variance. The first factor, immediate memory, essentially constituted a simple index of the reading and writing subtests. The second factor, orientation and delayed recall, expressed the ability to handle new information. The third factor, working memory, was most closely related to the severity of dementia at the time of test administration.

Conclusions

Japanese dementia patients appear to develop difficulty handling new information in the early stages of their disease. This finding, and our finding that there is a factor associated with disease severity, suggest that understanding the specific factors related to subtest items, which underlie the total MMSE score may be useful to clinicians in planning interventions for Japanese patients in the early stages of dementia.