International Psychogeriatrics

Performance on MMSE sub-items and education level in presenilin-1 mutation carriers without dementia

John M. Ringman a1c1, Yaneth Rodriguez a2, Claudia Diaz-Olavarrieta a2, Mireya Chavez a2, Michael Thompson a3, Lynn Fairbanks a4, Francisco Paz a2, Arousiak Varpetian a5, Hector Chaparro a6, Miguel Angel Macias-Islas a7, Jill Murrell a8, Bernardino Ghetti a8 and Claudia Kawas a9
a1 Alzheimer's Disease Center, UCLA Department of Neurology, Los Angeles, CA, U.S.A.
a2 National Institute of Neurology and Neurosurgery, Mexico
a3 Wayne State School of Medicine, Detroit, MI, U.S.A.
a4 Psychiatry and Biobehavioral Science, University of California, Los Angeles, CA, U.S.A.
a5 Department of Neurology, Keck School of Medicine, University of Southern California, Downey, CA, U.S.A.
a6 Department of Neurology, Mexicali General Hospital, Mexico
a7 Department of Neurosciences, CUCS, University of Guadalajara, Mexico
a8 Department of Pathology and Laboratory Medicine, Indianapolis, IN, U.S.A.
a9 Departments of Neurology, Neurobiology and Behavior, University of California, Irvine Gillespie Neuroscience Research Facility, Irvine, CA, U.S.A.

Article author query
ringman jm   [PubMed][Google Scholar] 
rodriguez y   [PubMed][Google Scholar] 
diaz-olavarrieta c   [PubMed][Google Scholar] 
chavez m   [PubMed][Google Scholar] 
thompson m   [PubMed][Google Scholar] 
fairbanks l   [PubMed][Google Scholar] 
paz f   [PubMed][Google Scholar] 
varpetian a   [PubMed][Google Scholar] 
chaparro h   [PubMed][Google Scholar] 
macias-islas m   [PubMed][Google Scholar] 
murrell j   [PubMed][Google Scholar] 
ghetti b   [PubMed][Google Scholar] 
kawas c   [PubMed][Google Scholar] 


Background: Spanish-language screening tests that are sensitive to the early cognitive changes of Alzheimer's disease (AD) are needed. Persons known to be at 50% risk for young-onset AD due to presenilin-1 (PSEN1) mutations provide the opportunity to assess which measures on the Mini-mental State Examination (MMSE) are most sensitive to these early changes.

Methods: We performed genetic and Spanish-language cognitive testing on 50 Mexican persons without dementia at risk for inheriting PSEN1 mutations. We then compared the performance on sub-items of the MMSE between PSEN1 mutation carriers (MCs) and non-carriers (NCs) using t-tests and Fisher's exact tests. Exploratory multiple logistic regression analyses were also performed.

Results: Twenty-nine persons were MCs and 21 NCs. NCs tended to achieve higher levels of education (p = 0.039) than did MCs. MCs tended to perform more poorly when spelling “MUNDO” backwards and on Orientation, particularly regarding the date. In multiple regression analyses the ability of backwards spelling to predict PSEN1 mutation status was reduced when education was included as an independent variable.

Conclusion: Subjects in the earliest stage of PSEN1-related AD showed deficits on orientation to date and in divided attention when spelling backwards. It is unclear if educational level should be considered an associated feature or a con-founding variable in this population although it should be taken into account when considering performance on the MMSE task of divided attention. The relative lack of deficits on delayed recall of three words probably represents the insensitivity of this measure in early AD. This study supports the utility of autosomal dominant AD as a model of the more common sporadic form of the disorder.

(Received December 6 2005)
(returned for revision January 31 2006)
(revised version received April 19 2006)
(Accepted April 20 2006)
(Published Online June 29 2006)

Key Words: Alzheimer's disease; presenilin; cognition; preclinical; Mini-mental State Examination; screening test; Spanish; education.

c1 Correspondence should be addressed to: John M. Ringman, Alzheimer's Disease Center, UCLA Department of Neurology, 710 Westwood Plaza, Suite 2-238, Los Angeles, CA 90095-1769, U.S.A. Phone: +1 310 206 2687; Fax: +1 310 206 5287. Email: