The Relation Between Mini Mental State Examination and Multiple Measures of Executive Functioning
Abstract
Given the necessity of executive functioning to perform day-to-day activities, the capacity of widely-used cognitive screening tools to detect potential executive dysfunctions could have important meanings for health care practices. Current research on this topic, however, is still scarce and controversial. The current study is the first of its kind to assess the association between a commonly used cognitive screening tool with multiple executive measures from two wildly used batteries of executive functioning tests. The Mini Mental State Examination (MMSE) along with the Delis Kaplan Executive Function System (D-KEFS) and the Behavioural Assessment of the Dysexecutive Syndrome (BADS) were administered to 73 healthy adults aged 16-40 years (M=24.34, SD=6.53). Most of the relations between the MMSE total score and the executive measures were significant and in the moderate-to-strong range. The highest correlation of MMSE was with the BADS total profile score (r= .62, P< .01). In a secondary analysis, among the MMSE domains, the Attention and Calculation domain had the highest relations with the executive measures. As a measure of general cognitive ability, the MMSE taps on various basic- and higher-level cognitive processes interconnected with the multi-dimensional and multi-level executive processing. Thus, empirical separation of executive measures and general cognitive indices is difficult. Using multiple measures of the executive functioning could be an effective strategy to better understanding the interconnections.
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13. Chan RCK. Dysexecutive symptoms among a non-clinical sample: A study with the use of the Dysexecutive Questionnaire. Br J Psychol 2001; 92(3): 551-565. doi: 10.1348/000712601162338.
14. Folstein MF, Folstein, SE, McHugh PR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-198. doi: 10.1016/0022-3956(75)90026-6.
15. Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992; 40(9): 922-35. doi: 10.1111/j.1532-5415.1992.tb01992.x.
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19. Axelrod BN, Goldman RS, Henry RR. Sensitivity of the Mini-Mental State Examination to frontal lobe dysfunction in normal aging. J Clin Psychol 1992; 48(1): 68-71. doi: 10.1002/1097-4679(199201)48:1<68::AID JCLP2270480110>3.0.CO;2-N.
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22. Delis DC, Kaplan E, Kramer JH. Delis-Kaplan Executive Function System (DKEFS). San Antonio, TX: The Psychological Corporation; 2001.
23. Wilson BA, Alderman N, Burgess PW, Emslie H, Evans JJ. Behavioural Assessment of the Dysexecutive Syndrome (BADS). London: Thames Valley Test Company; 1996.
24. Ghawami H, Raghibi M, Tamini BK, Dolatshahi B, Rahimi-Movaghar V. Cross-Cultural Adaptation of Executive Function Tests for Assessments of Traumatic Brain Injury Patients in Southeast Iran. Psicol Conductual 2017; 24(3): 531-554. doi: 10.1080/23279095.2016.1157078.
25. Seyedian M, Falah M, Noroozyan M, Nejat S, Delavar A, Ghasemzadeh H. Tahie va taiine etebere noskheye farsiye azmoone kutahe vazeiate zehni [Development and validation of Persian version of Mini-Mental State Examination]. J Med Counc Islam Repub Iran 2007; 25: 408-414.
26. Crawford JR, Henry JD. (2005). Assessment of executive dysfunction. In Halligan PW, Wade DT, eds. The effectiveness of rehabilitation for cognitive deficits. 1st ed. London: Oxford University Press; 2005; 233-245.
27. Kreutzer J, DeLuca J, Caplan B. (2011). Encyclopaedia of Clinical Neuropsychology. New York: Springer; 2011.
28. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Erlbaum; 1988.
29. Diamond A. Executive Functions. Annu Rev Psychol 2013; 64: 135–168. doi: 10.1146/annurev-psych-113011-143750.
30. Blair C. Toward a revised theory of general intelligence: Further examination of fluid cognitive abilities as unique aspects of human cognition. Behav Brain Sci 2006; 29(2): 145-160. doi: 10.1017/S0140525X06419038.
31. Shallice T, Burgess P. Supervisory control of action and thought selection. In: Baddeley AD, Weiskrantz L, eds. Attention: Selection, awareness, and control. 1st ed. Oxford: Oxford University Press; 1993: 171-187.
32. McCabe DP, Roediger HL, McDaniel MA, Balota DA, Hambrick DZ. The relationship between working memory capacity and executive functioning: evidence for a common executive attention construct. Neuropsychology 2010; 24(2): 222-43. doi: 10.1037/a0017619.
33. Lan X, Legare CH, Ponitz CC, Li S, Morrison FJ. Investigating the links between the subcomponents of executive function and academic achievement: a cross-cultural analysis of Chinese and American preschoolers. J Exp Child Psychol 2011; 108(3): 677-92. doi: 10.1016/j.jecp.2010.11.001.
34. Royall DR, Mahurin RK, Gray K. Bedside assessment of executive dyscontrol: the executive interview (EXIT25). J Am Geriatr Soc 1992; 40(12): 1221–1226. doi: 10.1111/j.1532-5415.1992.tb03646.x.
35. Marshall GA, Rentz D. M, Frey MT, Locascio JJ, Johnson KA, Sperling RA. Executive function and instrumental activities of daily living in mild cognitive impairment and Alzheimer's disease. Alzheimers Dement 2010; 7(3): 300-8. doi: 10.1016/j.jalz.2010.04.005.
36. Royall DR, Lauterbach EC, Kaufer D, Malloy P, Coburn KL, Black KJ. The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci 2007; 19(3): 2492-65. doi: 10.1176/jnp.2007.19.3.249.
2. Serpell ZN, Esposito AG. Development of Executive Functions: Implications for Educational Policy and Practice. Policy Insights Behav Brain Sci 2016; 3(2): 203–210. doi: 10.1177/2372732216654718.
3. Collins A, Koechlin E. Reasoning, Learning, and Creativity: Frontal Lobe Function and Human Decision-Making. PLoS Biol 2012, 10(3): e1001293. doi: 10.1371/journal.pbio.1001293.
4. Fuster JM. The Prefrontal Cortex. 5th ed. London, UK: Elsevier; 2015.
5. Grafman J, Litvan I. Importance of deficits in executive functions. Lancet 1999; 354(9194): 1921–1923. doi: 10.1016/S0140-6736(99)90438-5
6. Lezak MD, Howieson DB, Bigler ED, Tranel D. Neuropsychological Assessment. 8th ed. New York: Oxford University Press; 2012.
7. Juby A, Tench S, Baker V. The value of clock drawing in identifying executive cognitive dysfunction in people with a normal Mini-Mental State Examination score. Can Med Assoc J 2002; 167(8): 859-864.
8. Vaughan L, Giovanello K. Executive Function in Daily Life: Age-Related Influences of Executive Processes on Instrumental Activities of Daily Living. Psychol Aging 2010; 25(2): 343–355. doi: 10.1037/a0017729.
9. Baudic S, Barba GD, Thibaudet MC, Smagghe A, Remy P, Traykov L. Executive function deficits in early Alzheimer's disease and their relations with episodic memory. Arch Clin Neuropsychol 2006; 21(1): 15-21. doi: 10.1016/j.acn.2005.07.002.
10. Kirova A, Bays RB, Lagalwar S. Working Memory and Executive Function Decline across Normal Aging, Mild Cognitive Impairment, and Alzheimer’s disease. Biomed Res Int 2015; Article ID 748212. doi: 10.1155/2015/748212.
11. McGuinness B, Barrett SL, Craig D, Lawson J, Passmore AP. Executive functioning in Alzheimer’s disease and vascular dementia. Int J Geriatr Psychiatry 2010; 25(6): 562-8. doi: 10.1002/gps.2375.
12. Razani J, Casas R, Wong JT, Lu P, Alessi C, Josephson K. Relationship between executive functioning and activities of daily living in patients with relatively mild dementia. Appl Neuropsychol 2007; 14(3): 208-14. doi: 10.1080/09084280701509125.
13. Chan RCK. Dysexecutive symptoms among a non-clinical sample: A study with the use of the Dysexecutive Questionnaire. Br J Psychol 2001; 92(3): 551-565. doi: 10.1348/000712601162338.
14. Folstein MF, Folstein, SE, McHugh PR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-198. doi: 10.1016/0022-3956(75)90026-6.
15. Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992; 40(9): 922-35. doi: 10.1111/j.1532-5415.1992.tb01992.x.
16. Lam B, Middleton LE, Masellis M, Stuss DT, Harry RD, Kiss A, Black SE. Criterion and convergent validity of the Montreal cognitive assessment with screening and standardized neuropsychological testing. J Am Geriatr Soc 2013; 61(12): 2181-5. doi: 10.1111/jgs.12541.
17. Nys GM, van Zandvoort MJ, de Kort PL, Jansen BP, Kappelle LJ, de Haan EH. Restrictions of the Mini-Mental State Examination in acute stroke. Arch Clin Neuropsychol 2005; 20(5): 623-629. doi: 10.1016/j.acn.2005.04.001.
18. Oliver J. Evaluating the Efficacy of the Mini-Mental State Examination (MMSE). 2007. Retrieved from University of Cape Town, Department of Psychology website: http://www.psychology.uct.ac.za/psy/graduateprogrammes/honours/projects
19. Axelrod BN, Goldman RS, Henry RR. Sensitivity of the Mini-Mental State Examination to frontal lobe dysfunction in normal aging. J Clin Psychol 1992; 48(1): 68-71. doi: 10.1002/1097-4679(199201)48:1<68::AID JCLP2270480110>3.0.CO;2-N.
20. Jefferson AL, Cosentino SA, Ball SK, Bogdanoff B, Leopold N, Kaplan E, Libon DJ. Errors produced on the mini-mental state examination and neuropsychological test performance in Alzheimer's disease, ischemic vascular dementia, and Parkinson's disease. J Neuropsychiatry Clin Neurosci 2002; 14(3): 311-320. doi: 10.1176/jnp.14.3.311.
21. Votruba KL, Persad C, Giordani B. Cognitive Deficits in Healthy Elderly Population with "Normal" Scores on the Mini-Mental State Examination. J Geriatr Psychiatry Neurol 2016; 29(3): 126-132. doi: 10.1177/0891988716629858.
22. Delis DC, Kaplan E, Kramer JH. Delis-Kaplan Executive Function System (DKEFS). San Antonio, TX: The Psychological Corporation; 2001.
23. Wilson BA, Alderman N, Burgess PW, Emslie H, Evans JJ. Behavioural Assessment of the Dysexecutive Syndrome (BADS). London: Thames Valley Test Company; 1996.
24. Ghawami H, Raghibi M, Tamini BK, Dolatshahi B, Rahimi-Movaghar V. Cross-Cultural Adaptation of Executive Function Tests for Assessments of Traumatic Brain Injury Patients in Southeast Iran. Psicol Conductual 2017; 24(3): 531-554. doi: 10.1080/23279095.2016.1157078.
25. Seyedian M, Falah M, Noroozyan M, Nejat S, Delavar A, Ghasemzadeh H. Tahie va taiine etebere noskheye farsiye azmoone kutahe vazeiate zehni [Development and validation of Persian version of Mini-Mental State Examination]. J Med Counc Islam Repub Iran 2007; 25: 408-414.
26. Crawford JR, Henry JD. (2005). Assessment of executive dysfunction. In Halligan PW, Wade DT, eds. The effectiveness of rehabilitation for cognitive deficits. 1st ed. London: Oxford University Press; 2005; 233-245.
27. Kreutzer J, DeLuca J, Caplan B. (2011). Encyclopaedia of Clinical Neuropsychology. New York: Springer; 2011.
28. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Erlbaum; 1988.
29. Diamond A. Executive Functions. Annu Rev Psychol 2013; 64: 135–168. doi: 10.1146/annurev-psych-113011-143750.
30. Blair C. Toward a revised theory of general intelligence: Further examination of fluid cognitive abilities as unique aspects of human cognition. Behav Brain Sci 2006; 29(2): 145-160. doi: 10.1017/S0140525X06419038.
31. Shallice T, Burgess P. Supervisory control of action and thought selection. In: Baddeley AD, Weiskrantz L, eds. Attention: Selection, awareness, and control. 1st ed. Oxford: Oxford University Press; 1993: 171-187.
32. McCabe DP, Roediger HL, McDaniel MA, Balota DA, Hambrick DZ. The relationship between working memory capacity and executive functioning: evidence for a common executive attention construct. Neuropsychology 2010; 24(2): 222-43. doi: 10.1037/a0017619.
33. Lan X, Legare CH, Ponitz CC, Li S, Morrison FJ. Investigating the links between the subcomponents of executive function and academic achievement: a cross-cultural analysis of Chinese and American preschoolers. J Exp Child Psychol 2011; 108(3): 677-92. doi: 10.1016/j.jecp.2010.11.001.
34. Royall DR, Mahurin RK, Gray K. Bedside assessment of executive dyscontrol: the executive interview (EXIT25). J Am Geriatr Soc 1992; 40(12): 1221–1226. doi: 10.1111/j.1532-5415.1992.tb03646.x.
35. Marshall GA, Rentz D. M, Frey MT, Locascio JJ, Johnson KA, Sperling RA. Executive function and instrumental activities of daily living in mild cognitive impairment and Alzheimer's disease. Alzheimers Dement 2010; 7(3): 300-8. doi: 10.1016/j.jalz.2010.04.005.
36. Royall DR, Lauterbach EC, Kaufer D, Malloy P, Coburn KL, Black KJ. The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci 2007; 19(3): 2492-65. doi: 10.1176/jnp.2007.19.3.249.
| Files | ||
| Issue | Vol 57, No 9 (2019) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v57i9.2637 | |
| Keywords | ||
| Cognitive screening Cognitive functions Executive functions Attention Delis kaplan executive function system (D-KEFS) Behavioural assessment of the dysexecutive syndrome (BADS) | ||
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How to Cite
1.
Ghawami H, Sabeti A, Vaccaro AR, Rahimi-Movaghar V. The Relation Between Mini Mental State Examination and Multiple Measures of Executive Functioning. Acta Med Iran. 2020;57(9).
