• Vol. 42 No. 7, 315–319
  • 15 July 2013

Diagnostic Performance of Short Portable Mental Status Questionnaire for Screening Dementia among Patients Attending Cognitive Assessment Clinics in Singapore

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ABSTRACT

Introduction: The Short Portable Mental Status Questionnaire (SPMSQ) is a brief cognitive screening instrument, which is easy to use by a healthcare worker with little training. However, the validity of this instrument has not been established in Singapore. Thus, the primary aim of this study was to determine the diagnostic performance of SPMSQ for screening dementia among patients attending outpatient cognitive assessment clinics and to assess whether the appropriate cut-off score varies by patient’s age and education. A secondary aim of the study was to map the SPMSQ scores with Mini-Mental State Examination (MMSE) scores.

Materials and Methods: SPMSQ and MMSE were administered by a trained interviewer to 127 patients visiting outpatient cognitive assessment clinics at the Singapore General Hospital, Changi General Hospital and Tan Tock Seng Hospital. The geriatricians at these clinics then diagnosed these patients with dementia or no dementia (reference standard). Sensitivity and specificity of SPMSQ with different cut-off points (number of errors) were calculated and compared to the reference standard using the Receiver Operator Characteristic (ROC) analysis. Correlation coefficient was also calculated between MMSE and SPMSQ scores.

Results: Based on the ROC analysis and a balance of sensitivity and specificity, the appropriate cut-off for SPMSQ was found to be 5 or more errors (sensitivity 78%, specificity 75%). The cut-off varied by education, but not by patient’s age. There was a high correlation between SPMSQ and MMSE scores (r = 0.814, P <0.0001).

Conclusion: Despite the advantage of being a brief screening instrument for dementia, the use of SPMSQ is limited by its low sensitivity and specificity, especially among patients with less than 6 years of education.


Healthcare workers and researchers have widely acknowledged the need for a brief cognitive screening instrument for the diagnosis of dementia. While many physicians use the Mini-Mental State Examination (MMSE), it is considered too long and too difficult to
interpret, especially by junior healthcare workers. The Short Portable Mental Status Questionnaire (SPMSQ) is a widely used 10-item cognitive screening instrument, whose items test orientation to time and place, memory, current event information (date, day of the week, name of this place, telephone number, date of birth, age, name of current prime minister and previous prime minister, mother’s maiden name), and calculation (subtract 3s starting with number 20). The total number of errors is computed and it
ranges from 0 to 10.

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