한국판 Mini-Mental State Examination-2의 타당화 및 임상적 유용성 연구

Abstract

The Mini-Mental State Examination, 2nd edition (MMSE-2) (Folstein et al., 2010) is developed to secure the disadvantages of the Mini-Mental State Examination (MMSE) (Folstein et al., 1975), the one of the most widely used cognitive screening test in clinical trials, including the story memory test that allows more detailed evaluation of verbal memory than the MMSE, and the processing speed test that can measure the executive function of the frontal lobe. Therefore, it is expected to be more sensitive than the MMSE in discriminating patients with MCI or early stage of dementia. The purpose of this study is to investigate the reliability and validity of the MMSE-2 by translating into Korean and also to investigate the usefulness of the MMSE-2 in Korea through five studies. In study 1, the MMSE-2 developed by Folstein et al. (2010) was translated into Korean and then investigated the reliability and validity of the MMSE-2 whether this test is reliable in distinguishing between healthy older adults and patients with MCI or AD. The results showed that the MMSE-2 can be used as a valid and reliable screening measure for assessing cognitive impairment in clinical settings in a Korean population, but its ability to distinguish patients with MCI from healthy older adults may not be as highly sensitive as expected. In study 2, based on the results of the study 1, the usefulness of the MMSE-2 and the K-MMSE (Korean version of the Mini-Mental State Examination) (Kang et al., 1997) was compared to determine which test is more sensitive in discriminating between healthy older adults and patients with MCI or AD. The results showed that the MMSE-2:SV (MMSE-2:Standard version) and MMSE-2:EV (MMSE-2:Expanded version) were more sensitive and accurate to detect early cognitive decline than the K-MMSE or the MMSE-2:BV (MMSE-2:Brief version), but as the dementia progressed, the K-MMSE or the MMSE-2:BV might be more useful for group discrimination than the MMSE-2:SV and the MMSE-2:EV. Thus, the MMSE-2 appears to be more useful as a cognitive screening test in clinical settings than the K-MMSE. In study 3, by using brain MRI, the results of the K-MMSE and the MMSE-2 and brain atrophy in healthy older adults, patients with MCI, and patients with AD were compared. In particular, the relationship between various variables of each test and the areas with brain atrophy would be investigated. Moreover, the brain area associated with the newly added story memory test and processing speed test in the MMSE-2 would be examined. The results showed that the MMSE-2 was more related to the degree of atrophy of the general brain area than to the K-MMSE. In particular, the MMSE-2:EV can be more useful as a cognitive screening test in clinical settings because the MMSE-2:EV has the highest correlation with overall brain area and can measure the frontal lobe function which cannot be measured by the K-MMSE. In study 4, the reliability and validity of the MMSE-2 was investigated whether this test is reliable in distinguishing between healthy older adults and patients with VaMCI or VD. The results showed that as in the study 1, the MMSE-2 is also found to be clinically useful in distinguishing patients with vascular cognitive impairment (VCI) from those of healthy older adults with high validity and reliability. Finally, in study 5, based on the results of study 4, the usefulness of the MMSE-2 and the K-MMSE was compared to determine which test is more sensitive in discriminating between healthy older adults and patients with VaMCI or VD. The results showed that as in the study 2, when discriminating between healthy older adults and the group of the patients with VCI, the MMSE-2:SV and the MMSE-2:EV were more sensitive and accurate to detect early cognitive decline than the K-MMSE or the MMSE-2:BV, but as the dementia progressed, the K-MMSE or the MMSE-2:BV might be more useful than the MMSE-2:SV and the MMSE-2:EV. Therefore, the MMSE-2 can be useful as a cognitive screening test for measuring cognitive function of patients in clinical settings not only for the patients with AD but also for the patients with VCI. Through this present study, we showed that the newly developed MMSE-2 (Folstein et al., 2010) is more sensitive and clinically useful for differentiating patients with MCI or early stage of dementia from healthy older adults than the MMSE. Therefore, if the MMSE-2 is widely used as a primary cognitive screening test in primary hospitals, public health centers, and elderly welfare centers, it is expected that it will be helpful for early detection of dementia.