Literacy and performance on the mini-mental state examination

OBJECTIVE: Mini-Mental State Examination (MMSE) scores are associated with age, education, and ethnicity. The objective of this research was to determine the relationship between MMSE and literacy. DESIGN: Cross- sectional. SETTING: A Community population in Tucson, Arizona. PARTICIPANTS: Senior citizens in public assistance housing. MEASUREMENTS: MMSE score, reading level, and socio demographic variables. MAIN RESULTS: A total of 214 subjects were tested. The mean age was 72.3 (±8.01), and the mean education level was 10.3 years (range 0-20 years). Reading levels ranged from grade 0 (non-reader) to 8 (maximum value for the test used), with a mean of 4.8 (±2.8). MMSE scores ranged from a mean of 21.9 (±4.6) for non-readers to a mean of 28.0 (±2.0) for subjects with ≥8th grade reading skills. Multiple regression using reading level, education, age, and ethnicity as independent variables, and MMSE score as the dependent variable, showed the highest correlation was between MMSE and reading level (R² = .265). Education level made only a small additional contribution; age and ethnicity did not enter the regression equation. Correlations between reading level and individual MMSE subsections were highest between reading level and MMSE language items (r = .499). CONCLUSIONS: The correlation between MMSE score and reading skills is stronger than the correlation with other sociodemographic variables. Proper interpretation of MMSE scores requires knowledge of patients' reading levels.