P1‐468: Severe Mini‐Mental State Examination: a brief cognitive assessment for patients with moderate and severe dementia

About two thirds of demented patients are in moderate to severe stages and live in developing countries. The most used screening tool available, the Mini-mental State Evaluation (MMSE), has limited applicability in these patients due to floor effects. The Severe Mini-Mental State Examination (SMMES) is an instrument based on the original MMSE developed with the objective of evaluating cognition in patients with more advanced Alzheimer's Disease. This study analyzed the correlation between the MMSE and the SMMSE in the cognitive assessment of a sample with moderate and severe dementia and the factors that interfered in this correlation. Transversal study of patients 60 years or older from an out-patient geriatric clinic at University of Sao Paulo. Both MMSE and SMMSE were administered followed by patient's charts search for health and demographics data. Possible interference variables were gender, age, morbidity using the Charlson index, dementia etiology, schooling, functionality, depression and other behavioral symptoms, evaluated by Cornell depression scale and Neuropsychiatric Inventory (NPI). 75 patients with mean age of 81 (SD = 5.9) years, 65% female and mean schooling of 4 (SD 3.6) years. Mean scores on MMSE and SMMSE were 7.8 (SD = 7.0) and 17.8 (SD = 9.4), respectively. Performances on both scales were found to correlate significantly only for scores on MMSE < 9 (r = 0.87; p < 0.001). A strong correlation was also found between the SMMSE and functional scales like de Clinical Dementia Rating (p < 0.001), Functional Assessment Staging (< 0.001) and Activities of Daily Living (p < 0.001). Educational level did not interfere with SMMSE scores. In a linear regression model, correlation between MMSE and SMMSE suffered little influence of FAST, ADL and NPI. Performances on MMSE and SMMSE were found to correlate significantly only for scores on MMSE < 9. Educational level did not interfere with scores on SMMSE. Some factors like behavior and functionality seen to interfere with performance on this scale. The SMMSE is a useful instrument to be used for brief cognitive assessment in patients with moderate to severe dementia, even in samples from developing countries, where low educational level prevails.