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Mini-Mental State Examination sentence writing among community-dwelling elderly adults in Brazil: text fluency and grammar complexity

Published online by Cambridge University Press:  05 July 2012

Anita Liberalesso Neri ,
Lia Lopes Ongaratto  and
Mônica Sanches Yassuda
Anita Liberalesso Neri*
Affiliation:
Faculty of Education and Faculty of Medical Sciences – State University of Campinas, Campinas – SP – Brazil
Lia Lopes Ongaratto
Affiliation:
Faculty of Education – State University of Campinas – SP – Brazil
Mônica Sanches Yassuda
Affiliation:
Department of Gerontology, School of Arts, Sciences and Humanities – University of São Paulo, São Paulo – SP – Brazil
*
Correspondence should be addressed to: Prof. Dr. Anita Liberalesso Neri, PhD, Graduate Program of Gerontology, Faculty of Medical Sciences, State University of Campinas UNICAMP. Avenida Tessália Vieira de Camargo, 126, Cidade Universitária “Zeferino Vaz”, Distrito de Barão Geraldo Campinas SP, CEP. 13.083-887, Brazil. Phone: +55-19-3521-9087; Fax: +55-19-3521-9087. e-mail: anitalbn@uol.com.br.
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Abstract

Background: In normal aging, the decrease in the syntactic complexity of written production is usually associated with cognitive deficits. This study was aimed to analyze the quality of older adults' textual production indicated by verbal fluency (number of words) and grammatical complexity (number of ideas) in relation to gender, age, schooling, and cognitive status.

Methods: From a probabilistic sample of community-dwelling people aged 65 years and above (n = 900), 577 were selected on basis of their responses to the Mini-Mental State Examination (MMSE) sentence writing, which were submitted to content analysis; 323 were excluded as they left the item blank or performed illegible or not meaningful responses. Education adjusted cut-off scores for the MMSE were used to classify the participants as cognitively impaired or unimpaired. Total and subdomain MMSE scores were computed.

Results: 40.56% of participants whose answers to the MMSE sentence were excluded from the analyses had cognitive impairment compared to 13.86% among those whose answers were included. The excluded participants were older and less educated. Women and those older than 80 years had the lowest scores in the MMSE. There was no statistically significant relationship between gender, age, schooling, and textual performance. There was a modest but significant correlation between number of words written and the scores in the Language subdomain.

Conclusions: Results suggest the strong influence of schooling and age over MMSE sentence performance. Failing to write a sentence may suggest cognitive impairment, yet, instructions for the MMSE sentence, i.e. to produce a simple sentence, may limit its clinical interpretation.

Keywords

text productionfluencysyntactical complexitycognitive statusaging
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 11 , November 2012 , pp. 1732 - 1737
Copyright
Copyright © International Psychogeriatric Association 2012

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