Objective: To evaluate the influence of education level in the Mini-Mental Status Examination (MMSE) score in Parkinson’s Disease (PD) patients in a northeast Brazilian sample.

Background: There is an estimate of 20% to 60% of mild cognitive impairment in patients after the diagnosis of PD¹. The MMSE is a useful and frequent measure for identifying mild cognitive impairment and dementia. Specific items of the MMSE are influenced by education. Most of the Brazilian population has less than 8 years of schooling. The northeast region of the country has worse socioeconomic and educational conditions than the regions where the validations researches are usually conducted².

Method: A cross-sectional study was conducted with 198 PD patients attending the Movement Disorders Clinic at a hospital in the northeast region of Brazil. The patients underwent: a structured interview to collect sociodemographic and clinical information, the modified Hoehn and Yahr (HY) to assess the severity of PD, and the MMSE to screen cognition. For MMSE, we used schooling cutoffs according to Brucki’s³ criteria: 20 for illiterates; 25 for 1 to 4 years of education, 26.5 for 5 to 8, 28 for 9 to 11, and 29 for more than 11. All patients were evaluated during “on” phases.

Results: Of the 198 participants, 89 (44.9%) were women with a mean age of 65 years. Also, 130 patients (65.6%) had 8 years of education or less. Most of the patients (151; 76.2%) were staged as HY 2 to 3. There was a statistically significant difference in bivariate analysis between educational level and cutoff classification (p=0.002), where illiterate patients had a lower prevalence of people below the cutoff (35%), diverging from the other categories. Therefore, having more years of education was associated with below cutoff scoring. Among those with more than 11, with 9 to 11, with 4 to 8 years of education, 75%, 68.8%, and 79.7% were respectively below the suggested Brazilian cutoff. These results suggest that education-adjusted Brucki’s cutoffs are high for this sample.

Conclusion: The MMSE may have limitations when targeting a low-education population with PD. Further studies in the northeast of Brazil are needed to review MMSE cutoff values based on schooling levels. The development of cognition screening instruments less influenced by education is encouraged.

References: 1. Yarnall AJ, Breen DP, Duncan GW, Khoo TK, Coleman SY, Firbank MJ, et al. Characterizing mild cognitive impairment in incident Parkinson disease: The ICICLE-PD Study. Neurology. 2014;82(4):308–16. 2. Drumond Andrade FC, Deepak Mehta J. Increasing educational inequalities in self-rated health in Brazil, 1998-2013. PLoS One. 2018;13(4):1–13. 3. Brucki SMD, Nitrin R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr. 2003;61(3 B):777–81.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cognitive-assessment-of-parkinsons-disease-patients-in-a-northeast-brazilian-population-current-challenges/