Education does not equally influence all the Mini Mental State Examination subscales and items: inferences from a Brazilian community sample

Objective Mini Mental State Examination cutoffs have been presented for schooling levels to screen cognitive impairment However items may behave differently with regards to education The objective of this study was to examine the impact of education on MMSE subscales and items Method Community dwelling participants aged 65 years or more (n = 990 females = 637 age = 74 1 years range 65-108) were stratified as illiterate (n = 373) 1 8 (n = 540) 9-12 (n = 63), and more than 12 years of schooling (n = 14) and were screened with MMSE and Pfeffer Functional Activities Questionnaire To make the Mini Mental State Examination items comparable each item was transformed into z scores Multiple linear regression was used to estimate the effect of schooling on MMSE subscales and items controlling for age sex and activities of daily life Results Temporal and space orientation attention/calculation repetition reading writing and drawing scores improved as education increased, but not memory registration, three step command and naming Reading and writing displayed the largest coefficients whereas education exerted no influence on naming and three step command tasks Conclusion Education does not exert an important effect on naming three step command memory registration and delayed recall As memory is a key factor for diagnosing dementia these items could be considered despite education