Aging Division, Centro Médico Nacional XXI, Instituto Mexicano del Seguro Social, Mexico.
Int Psychogeriatr. 2010 Feb;22(1):72-81. doi: 10.1017/S1041610209990822. Epub 2009 Sep 7.
The Mini-mental State Examination (MMSE) is the most widely used cognitive test, both in clinical settings and in epidemiological studies. However, correcting its score for education may create ceiling effects when used for poorly educated people and floor effects for those with higher education.
MMSE and a recent cognitive test, the seven minute screen (7MS), were serially administered to a community sample of Mexican elderly. 7MS test scores were equated to MMSE scores. MMSE-equated 7MS differences indicated ceiling or floor effects. An ordinal logistic regression model was fitted to identify predictors of such effects.
Poorly educated persons were more prevalent on the side of MMSE ceiling effects. Concentration (serial-sevens), orientation and memory were the three MMSE subscales showing the strongest relationship to MMSE ceiling effects in the multivariate model.
Even when MMSE scores are corrected for educational level they still have ceiling and floor effects. These effects should be considered when interpreting data from longitudinal studies of cognitive decline. When an education-adjusted MMSE test is used to screen for cognitive impairment, additional testing may be required to rule out the possibility of mild cognitive impairment.
简易精神状态检查（MMSE）是最广泛使用的认知测试，无论是在临床环境还是在流行病学研究中。然而，对于受教育程度较低的人来说，对其分数进行教育修正可能会产生天花板效应，而对于受教育程度较高的人则会产生地板效应。
对墨西哥老年人群的社区样本进行了简易精神状态检查（MMSE）和最近的认知测试（7 分钟屏幕测试，7MS）的连续测试。将 7MS 测试分数与 MMSE 分数相匹配。MMSE 匹配的 7MS 差异表明存在天花板或地板效应。拟合了一个有序逻辑回归模型，以确定这些效应的预测因素。
受教育程度较低的人更有可能出现 MMSE 天花板效应。在多变量模型中，注意力（连续七位数）、定向和记忆是与 MMSE 天花板效应关系最强的三个 MMSE 子量表。
即使对 MMSE 分数进行了教育水平修正，它们仍然存在天花板和地板效应。在解释认知衰退的纵向研究数据时，应考虑这些效应。当使用教育调整后的 MMSE 测试来筛选认知障碍时，可能需要进行额外的测试以排除轻度认知障碍的可能性。
