Ouvrier’s Modified Mini Mental State Examination as a screening test for cognitive impairment in school-aged children with epilepsy

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Hariadi Edi Saputra
Setyo Handryastuti
Irawan Mangunatmadja
Dwi Putro Widodo
Sudung O. Pardede


Background Epilepsy may affect children's development, including their cognitive function. The prevalence of cognitive impairment in epilepsy patients is quite high. Weschler Intelligence Scale for Children (WISC) takes a long time to administer and is expensive, so a simpler screening tool for cognitive evaluation is needed in pediatric epilepsy patients.

Objective To assess the diagnostic value of Ouvrier’s Modified Mini Mental State Examination (MMSE) for detecting cognitive impairment in children aged 8-11 years with epilepsy.

Methods This diagnostic study was conducted in December 2018 to February 2019 at Cipto Mangunkusumo and Fatmawati Hospitals in Jakarta. Data were collected with purposive sampling of children with epilepsy aged 8 to 11 years. Cognitive function was assessed by Ouvrier’s Modified MMSE and WISC. Ouvrier’s Modified MMSE was compared to WISC as and the gold standard. Results were analyzed using a 2x2 table.

Results The prevalence of cognitive impairment in 8-11-year-old epilepsy patients was 72.9%. Ouvrier’s Modified MMSE had 83% sensitivity, 85% specificity, 94% positive predictive value, 65% negative predictive value, and 83% accuracy.

Conclusions Ouvrier’s Modified MMSE has good diagnostic value, thus it may be useful for early detection of cognitive impairment in pediatric epilepsy.

Article Details

How to Cite
Saputra H, Handryastuti S, Mangunatmadja I, Widodo D, Pardede S. Ouvrier’s Modified Mini Mental State Examination as a screening test for cognitive impairment in school-aged children with epilepsy. PI [Internet]. 12Jun.2020 [cited 11Jul.2020];60(3). Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2225
Pediatric Neurology
Received 2019-07-06
Accepted 2020-06-12
Published 2020-06-12


1. UKK Neurologi IDAI. Epilepsi pada anak. Mangunatmadja I, Handryastuti S, Risan NA, editors. Jakarta: Ikatan Dokter Anak Indonesia; 2016. p.1-6.
2. Fiest KM, Birbeck GL, Jacoby A, Jette N. Stigma in epilepsy. Curr Neurol Neurosci Rep. 2014;14:444.
3. Lagunju IOA, Adeniyi YC, Olukolade G. Cognitive function in Nigerian children with newly diagnosed epilepsy: a preliminary report. Pan Afr Med J. 2016;24:113.
4. Besag FMC. Cognitive and behavioral outcomes of epileptic syndromes: implications for education and clinical practice. Epilepsia. 2006;47:119–25.
5. Ouvrier RA, Goldsmith RF, Ouvrier S, Williams IC. The value of the Mini-Mental State Examination in childhood: a preliminary study. J Child Neurol. 1993;8:145–8.
6. Jain M, Passi GR. Assessment of a modified Mini-Mental Scale for cognitive functions in children. Indian Pediatr. 2005;42:907–12.
7. Moura R, Andrade PMO, Fontes PLB, Ferreira FO, Salvador LS, Carvalho MRS, et al. Mini-mental state exam for children (MMC) in children with hemiplegic cerebral palsy. Dement Neuropsychol. 2017;11:287–96.
8. Inge SA. Validasi Mini Mental State Examination (MMSE) Modifikasi Ouvrier bahasa Indonesia sebagai alat penapisan fungsi kognisi pada anak usia 8-11 tahun di tiga sekolah dasar di kota Bandung [thesis]. [Bandung]: Universitas Padjajaran; 2015.
9. Heptayana P. Gambaran fungsi kognitif pasien epilepsi anak usia 8-11 tahun dengan menggunakan mini mental state examination (MMSE) modifikasi Ouvrier bahasa Indonesia [thesis]. [Jakarta]: Universitas Indonesia; 2018.
10. Schiller P. Early brain development research review and update. Brain Dev. 2010;5:26–30.
11. Thompson RA, Nelson C. Developmental science and the media: early brain development. Am Psychol. 2001;56:5–15.
12. Perry BD. Childhood experience and the expression of genetic potential: What childhood neglect tells us about nature and nurture. Brain and Mind. 2002;3:79–100.
13. Casey BJ, Tottenham N, Liston C, Durston S. Imaging the developing brain: what have we learned about cognitive development? Trends Cogn Sci. 2005;9:104–10.
14. Lenroot RK, Giedd JN. Brain development in children and adolescents: insights from anatomical magnetic resonance imaging. Neurosci Biobehav Rev. 2006;30:718–29.
15. Rapin I. Dyscalculia and the calculating brain. Pediatr Neurol. 2016;61:11-20
16. Kucian K, Aster MV. Developmental dyscalculia. Eur J Pediatr. 2015;174:1-13
17. Besson PS, Labbé EE. Use of the modified Mini-Mental State Examination with children. J Child Neurol. 1997;12:455–60.
18. Mitchell AJ. A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. J Psychiatr Res. 2009;43:411–31.
19. Villaseñor-Cabrera T, Guàrdia J, Jiménez-Maldonado M, Rizo-Curiel G, Cebollero M. Sensitivity and specificity of the Mini-Mental State Examination in the Mexican population. Appl Neuropsychol. 2010;44:1105–12.