Do elderly people score better on cognitive tests at home?

OBJECTIVE

To determine whether Mini-Mental State Examination (MMSE) scores of elderly family medicine patients are different when the test is administered at home rather than at the clinic.

DESIGN

Cross-sectional comparison study.

SETTING

University family practice unit in an urban area.

PARTICIPANTS

A convenience sample of family practice clinic patients 70 years or older were referred to the study in the sequence seen at the clinic. Of 171 patients approached in person or by telephone, 77 agreed to participate.

METHOD: The MMSE was administered at home and at the clinic on the same day for all subjects. Testing site order was randomized across patients.

MAIN FINDINGS: Of the 77 patients who agreed to be subjects, only 13 (16.9%) had low MMSE scores (< or = 24). Five (41.7%) of these had normal scores (> 24) at home, but low scores in the clinic. Subjects had significantly higher scores on MMSEs administered at home (P < .01) on the same day.

CONCLUSIONS

Previous research has shown patients achieve higher MMSE scores at home; this study demonstrated it in a representative family medicine population. Primary care physicians should be cautious about classifying elderly patients as possibly cognitively impaired based on clinic testing alone. Testing at home could avoid many unnecessary referrals to specialist services for further assessment and diagnostic tests that use up precious health care resources.