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IIR 96-079 – HSR&D Study

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IIR 96-079
Validation of Spanish Translation of Folstein Mini Mental State Exam
Carolee A. DeVito PhD MPH
Miami VA Healthcare System, Miami, FL
Miami, FL
Funding Period: October 1998 - March 2001

BACKGROUND/RATIONALE:
The Mini-Mental State Exam (MMSE) is a short measure of cognitive function that is widely used in clinical settings. Despite its wide use and clinical value there are no published Spanish translations of the MMSE that have been validated for use in the United States. As a result of the lack of a validated Spanish translation, many users of the MMSE use 'ad hoc' Spanish translations. Anecdotal reports suggest that mistranslation is not uncommon and does affect final scores, often resulting in lower scores than would probably be obtained with an appropriate translation.

OBJECTIVE(S):
The Mini-Mental State Exam (MMSE) is a short measure of cognitive function that is widely used in clinical settings. In this study, we will first translate the MMSE into Spanish and assess whether the translation appears to be equally effective in two centers with populations of Hispanic veterans reflecting different national origins (Miami-primarily Puerto Rican Hispanic; Tuscon-primarily Mexican Hispanic).

METHODS:
Translating the MMSE into Spanish will involve three steps: translation from English to Spanish; back translation from Spanish to English; and committee approval of the translations. Once a final instrument is developed, 240 Spanish-speaking veterans from the Miami and Tucson VAMCs will participate in the validation component of this study. They will complete the instrument twice, two hours apart. They will also complete the Spanish version of the Fuld Object Memory Evaluation, to compare how two comparable measures work as screening tools for cognitive impairment. Statistical analysis will examine: test-retest reliability (kappa), internal consistency (Cronbach’s alpha), sensitivity and specificity. The final instrument will be distributed to researchers and clinicians at Veterans Affairs medical center (VAMC) sites that serve Spanish speaking veterans. The translation also will be published in the medical literature to ensure that other researchers and clinicains who treat Spanish speaking patients will have access to a validated Spanish translation of this important, widely used screening tool.

FINDINGS/RESULTS:
We have reconciled several variations of the English version of the MMSE in order to produce a single version with a fixed format for administration. This version served as the basis for the Spanish translation. The translation procedures have been completed.

IMPACT:
This study is expected to be a major contribution to the care of elderly Spanish-speaking individuals in both veteran and non-veteran populations. The MMSE is commonly used for screening in both clinical practice and in research. In both cases, many questions of competency for consent and control over medical care are initially identified via MMSE results. The possibility that the translation of a screening tool impacts treatment choice participation in research underscores the importance of careful attention to issues of translation. From practical, clinical and ethical perspectives, it is important that research and clinical decisions for Spanish speaking individuals be based on results from appropriate screening tools.

PUBLICATIONS:
None at this time.


DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Diagnosis, Technology Development and Assessment
Keywords: Cognitive impairment, Research measure
MeSH Terms: none

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