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Comparing the latent structure of the Mini-Mental State Examination among young children and older adults: A preliminary study

Eugenia Savvidou1*, Georgia Papantoniou1, Despoina Moraitou2, Magda Dinou1, Effie Katsadima1, Evangelia Foutsitzi1 and Glykeria Tsentidou2
  • 1 University of Ioannina, Greece
  • 2 University of Thessaloniki, Greece

Aim: The aim of the study was the comparison of the cognitive functioning between young children and older adults through the investigation of the latent structure qualitative changes in Mini-Mental State Examination (MMSE) from age to age, using Confirmatory Factor Analyses (CFA) and testing a conventional two-factor model and/or a unidimensional model of MMSE. Method: The sample consisted of 42 kindergarten and 56 elementary school students (age range: 5-8 years) and 118 new-old adults and 27 old-old adults (age range: 61-88 years) whose cognitive functioning was examined in MMSE. Results: Regarding the new-old adults group, CFA indicated that individual variability across MMSE measured variables (total scores for each of the five subsets) can be modeled by a two-factor model. The patterns of two-factor and one-factor MMSE structure were not verified for the groups of kindergarten students, elementary school students, and old-old adults. Conclusion: The results support the hypothesis of “retrogenesis”. Retrogenesis has been defined as the process by which degenerative mechanisms reverse the order of acquisition in normal development (Borza, 2012; Da Silva, Bueno, & Bertolucci, 2011; Reinsberg, Franssen, Souren, Auer, Akram et al., 2002). Since the retrogenic models suggest that comparisons of cognitive ability should be made between the developing children and the cognitively normal older adults or preclinical AD patients, the administration of the same screening instruments to the two groups should be available (Papantoniou, Moraitou, Dinou, Katsadima, Savvidou et al., 2015; Rubial-Alvarez, Machado, Sintas, de Sola, Böhm, & Peña-Casanova, 2007; Shoji, Fukushima, Wakayana, Shizuka-Ikeda, Ikeda et al., 2002). Based on the hypothesis of “retrogenesis”, the aim of the present study was the comparison of the cognitive functioning between the developing children and the retrograding older adults through the investigation of the latent structure qualitative changes in Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975), from age to age, using Confirmatory Factor Analyses (CFA) and testing a conventional two-factor model and/or a unidimensional model of MMSE (Kahle-Wrobleski, Corrada, & Kawas, 2007; Lancu & Olmer, 2006). The total sample consisted of four groups. The first group comprised 42 (16 boys and 26 girls) kindergarten students (mean age = 68.1 months). The second group included 56 (22 boys and 34 girls) first- to second- grade elementary school students (mean age = 85.45 months). All children were attending regular classrooms, without a history of learning difficulties. The third group comprised 118 (45 men and 73 women) new-old adults (mean age = 71.33 years). The fourth group included 27 (10 men and 17 women) old-old adults (mean age = 83.04 years). Exclusion criteria for the older adults were history of neurological conditions or psychiatric diseases, alcohol or drug abuse, severe head trauma, profound visual impairments, and verbal incomprehension. All participants completed the Greek version of the MMSE (Fountoulakis, Tsolaki, Chantzi, & Kazis, 2000; see Jain & Passi, 2005; Ouvrier, Goldsmith, Ouvrier, & Williams, 1993). For the comparison of the MMSE structure between the aforementioned groups, we tested, at first, in the group of new-old adults, a two-factor Model A1 (MA.1) which proposed a factor consisted of Time Orientation, Place Orientation and Constructional Ability subtests, and a second factor consisted of Language and Recall - Attention subtests, with interrelations between the two factors. CFA verified the MA.1 [χ2 (4, Ν = 118) = 4.51, p = .34, χ2/df = 1.13, CFI = .99, SRMR = .03, RMSEA = .03 (CI90% .00 - .15)]. All the parameters’ loadings were statistically significant. Then, we tested the two-factor model in the groups of elementary school (Model B1) and kindergarten students (Model C1). Due to the statistically significant excess kurtosis of the group, MB.1 was computed using the Maximum Likelihood (ML ROBUST) estimation method. For MB.1 and MC.1, the Goodness-of-Fit Indexes were accepted: Satorra-Bentler χ2 (4, Ν=56) = 4.10, p = .39, χ2/df = 1.02, CFI = .99, RMSEA = .02 (CI90% .00 - .20), and χ2 (4, Ν=42) = 1.88, p = .76, χ2/df = 0.47, CFI = 1.00, SRMR = .05, RMSEA = .00 (CI90% .00 - .16), respectively (Brown, 2006). However, according to the suggestions of the Wald test, the two-factor structure of the MMSE was not confirmed: In MB.1 the variance of the second factor was not statistically significant (p = .48). In MC.1 the loadings of three observed variables [Place Orientation (p = .73), Constructional Ability (p = .73), and Language (p = .64)] were not statistically significant. Consequently, we tested, in both groups, a unidimensional model [Models B2 and C2 in which all five measured variables loaded on a single factor]. For MB.2 and MC.2, the Goodness-of-Fit Indexes were accepted: Satorra-Bentler χ2 (5, Ν=56) = 5.09, p = .40, χ2/df = 1.02, CFI = .99, RMSEA = .02 (CI90% .00 - .19), and χ2 (5, Ν=42) = 1.92, p = .86, χ2/df = 0.38, CFI = 1.00, SRMR = .05, RMSEA = .00 (CI90% .00 - .11), respectively (Brown, 2006). However, according to the suggestions of the Wald test, the one-factor structure of the MMSE was not confirmed: In MB.2 the loadings of four observed variables [Place Orientation (p = .35), Constructional Ability (p = .23), Language (p = .28), and Recall - Attention (p = .30)] were not statistically significant. Similarly, in MC.2 the loadings of four observed variables [Time Orientation (p = .68), Place Orientation (p = .81), Constructional Ability (p = .60), and Language (p = .76)] were not statistically significant. Finally, we tested both a two-factor (Model D1) and a unidimensional (Model D2) model in the group of old-old adults. However, CFA did verify none of the aforementioned models, since in both outputs (EQS 6.1. Bentler, 2005) there was a warning that “test results may not be appropriate due to condition code”. Generally speaking, the different pattern in the MMSE latent factor structure, that was found between the groups of kindergarten and elementary school students and old-old adults, on the one hand, and the group of new-old adults, on the other, supports the hypothesis of “retrogenesis” (Rubial-Álvarez, de Sola, Machado, Sintas, Böhm et al., 2013).

References

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Keywords: degenerative mechanisms, cognitive aging, cognitive development, cognitive functioning, Retrogenesis

Conference: SAN2016 Meeting, Corfu, Greece, 6 Oct - 9 Oct, 2016.

Presentation Type: Poster Presentation in SAN2016 Conference

Topic: Posters

Citation: Savvidou E, Papantoniou G, Moraitou D, Dinou M, Katsadima E, Foutsitzi E and Tsentidou G (2016). Comparing the latent structure of the Mini-Mental State Examination among young children and older adults: A preliminary study. Conference Abstract: SAN2016 Meeting. doi: 10.3389/conf.fnhum.2016.220.00077

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Received: 29 Jul 2016; Published Online: 01 Aug 2016.

* Correspondence: Ms. Eugenia Savvidou, University of Ioannina, Ioannina, Greece, eugenia.savvidou6@gmail.com