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October 22, 1982

Screening for Cognitive Impairment-Reply

JAMA. 1982;248(16):1975. doi:10.1001/jama.1982.03330160027018

In Reply.—  Dr Hershey and associates are to be applauded for their comparison of two widely used cognitive screening examinations. They have used a cutoff score for MMSE that is three points lower than the cutoff score recommended by Folstein and associates1 and DePaulo and associates.2 Had they used the 23/24 cutoff, it seems there would have been only one false-negative result rather than four. Thus, the MMSE and the CCSE have comparable sensitivity and specificity in this study. Although there is more published verification of the reliability and validity of the MMSE, both tests have been verified to have reasonable sensitivity in detecting cognitive defects among the hospitalized medical and neurological patients.2-4 Anthony et al4 recently reported variation in the sensitivity and specificity of the MMSE in relation to age, education, and cutoff score. Finally, in a community-based sample, the MMSE and two other brief tests