Lessons learned in clinical research: Using the MMSE with older Mexican American nursing home residents

This authors examined the utility of the Mini-Mental State Examination (MMSE) in a pilot study to measure cognitive function in older Mexican American nursing home residents. Many of the lessons learned are transferable to the community: Cognitive screening instruments must be carefully examined for validity and utility, they may need to be administered in Spanish, certain items may need alteration in the questions or expected responses, phrases to be repeated must be culturally appropriate, cutoff scores may need adjustment, "serial sevens" must be used, and education and socioeconomic status must be considered in interpretation of results. Consequently, the MMSE may not be an appropriate measure to use to assess cognitive functioning in older Hispanic populations whose educational levels or literacy is low or unknown. Instead, clinicians should seek other ways to assess mental status, such as other instruments normed for those populations or measures that do not require literacy.