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


Marioni, Riccardo E, Chatfield, Mark, Brayne, Carol, Matthews, Fiona E.


BMC Medical Research Methodology, Volume: 11, Pages.: 127-127

Year of Publication



Background: 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.; Methods: 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.; Results: 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.; Conclusion: 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.;

Bibtex Citation

@article{Marioni_2011, doi = {10.1186/1471-2288-11-127}, url = {}, year = 2011, publisher = {Springer Nature}, volume = {11}, number = {1}, pages = {127}, author = {Riccardo E Marioni and Mark Chatfield and Carol Brayne and Fiona E Matthews}, title = {The reliability of assigning individuals to cognitive states using the Mini Mental-State Examination: a population-based prospective cohort study}, journal = {{BMC} Med Res Methodol} }


aged, aged, 80 and over, classification, cognition, dementia, diagnosis, england, epidemiology, female, humans, logistic models, male, mental status schedule, prospective studies, reproducibility of results, wales

Countries of Study


Types of Study

Cohort Study, Instrument development and testing (cross walking of measures, etc.)

Type of Interventions

Diagnostic Target Identification

Diagnostic Targets

Cognition testing (inc. task driven tests such as clock drawing)