Validity and reliability of Mini-Mental State Examination in Older Adults in China: Inline Mini-Mental State Examination with cognitive functions

Abstract

The main aim of the study is to validate the factor structure of the Mini-Mental State Examination (MMSE) of China’s older population using the Chinese Longitudinal Healthy Longevity Survey. The validation process used the exploratory factor analysis (EFA) to determine the number of dimensions of MMSE, the confirmatory factor analysis (CFA) to confirm the factorial structure of MMSE, and the factorial invariance to conclude the factor structure does not differ between the young-old (aged 65 – 79) and old-old (aged 80 or older). The results of the EFAs suggested two possible factor structures: A six-factor and a seven-factor solution. The seven-factor confirmatory factor model turned out as the best fit by comparison to the four competing confirmatory models. Strict factorial invariance was attained for the two age groups, indicating a high level of measurement equality, a property of invariance was seldom achieved in the literature of factorial invariance studies. In comparison to the MMSE literature that focused solely on EFA that aims to establish a single summated score, the present study suggests using EFA, CFA, and factorial invariance that takes into consideration of measurement errors as the preferred procedure since it establishes the appropriate MMSE dimensionality that is in line with their respective cognitive functions.