The three paired items stress the memory system more than do the three single items of the Mini-Mental State Examination (MMSE). Additionally, the time from encoding to recall is longer in the Q&E than in the MMSE. Thus, the Q&E is a more specific test of recall than the MMSE, stated Dr. Dash.
In the Q&E, subjects repeat the items twice to ensure coding and are allowed to hear the items repeated once, to compensate for hearing impairment. The verbal fluency task is allotted a standard time of 1 minute, whereas in
the MMSE, time to recall may change according to the task requested. Furthermore, the distractor items in the MMSE are educationally sensitive, but the “animals-in-a-minute” task is not. Unlike in the MMSE, subjects cannot fail the memory task of the Q&E and still pass the entire test.
Both the Q&E and the MMSE detected dementia in patients with a previous diagnosis of dementia. Among patients referred for evaluation of cognitive impairment, the Q&E detected a few more subjects with cognitive impairment. The Q&E also detected more cases of mild Alzheimer’s disease (AD) than the MMSE among patients referred for evaluation of another problem but who had some noticeable difficulty with memory. In 66 patients referred for another problem but who denied any memory problems (“control” group), the MMSE (using a cut score of 26 as abnormal) misidentified 24 normal subjects, whereas the Q&E misidentified only 3 as abnormal. Thus, the Q&E has a higher specificity than the MMSE. A lower cut score of the MMSE enhanced its specificity, but at the cost of sensitivity. With all subjects, the Q&E was quicker to administer than the MMSE.