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1.  Do positive children become positive adults? Evidence from a longitudinal birth cohort study 
Background
Little is known about the long-term consequences of positive wellbeing in childhood in the general population. We used the MRC National Survey of Health and Development (the British 1946 birth cohort) to test associations between adolescent positive wellbeing and social functioning in midlife.
Method
Temperament and behaviour at ages 13 and 15 years were rated by school teachers on a range of criteria. These mostly referred to absence or presence of conduct and emotional problems, but four items allowed positive ratings: ‘very popular with other children’, ‘unusually happy and contented’, ‘makes friends extremely easily’ and ‘extremely energetic, never tired’. In addition, at age 16 years survey members self-completed the Maudsley Personality Inventory, from which a summary measure of extraversion was derived, as this was previously found to be associated with midlife positive wellbeing in this cohort.
Results
Being a happy child, defined as receiving at least two of the above teacher ratings, was positively associated with midlife functioning and wellbeing, specifically a low probability of lifetime emotional problems, a high frequency of contact with friends or relatives, engagement in social activities, and to a lesser extent feeling satisfied with accomplishments in working life. These associations were independent of father’s social class, childhood cognition, educational attainment, and midlife occupational social class. There were no independent associations between being a happy child and educational or occupational attainment, being married, engagement in prosocial activities, taking leadership in community activities, and with life satisfaction in general or with family life. Extraversion was associated with a low probability of lifetime emotional problems, high engagement in social activities, being married, general midlife life satisfaction, and satisfaction with family life, but not with social contact, prosocial activity, leadership activity, or work satisfaction. While childhood conduct and emotional problems were associated with few of the social and life satisfaction outcomes, the former were negatively associated with educational and occupational attainment, and positively with divorce, whereas the latter were negatively associated with being married.
Conclusions
Prospectively rated childhood wellbeing has long-term beneficial links to adult functioning; our results also support the view that positive wellbeing has a unique impact on these outcomes, and does not merely represent the absence of mental ill-health.
doi:10.1080/17439760.2011.536655
PMCID: PMC3378184  PMID: 22723805
2.  Flourishing Across Europe: Application of a New Conceptual Framework for Defining Well-Being 
Social Indicators Research  2011;110(3):837-861.
Governments around the world are recognising the importance of measuring subjective well-being as an indicator of progress. But how should well-being be measured? A conceptual framework is offered which equates high well-being with positive mental health. Well-being is seen as lying at the opposite end of a spectrum to the common mental disorders (depression, anxiety). By examining internationally agreed criteria for depression and anxiety (DSM and ICD classifications), and defining the opposite of each symptom, we identify ten features of positive well-being. These combine feeling and functioning, i.e. hedonic and eudaimonic aspects of well-being: competence, emotional stability, engagement, meaning, optimism, positive emotion, positive relationships, resilience, self esteem, and vitality. An operational definition of flourishing is developed, based on psychometric analysis of indicators of these ten features, using data from a representative sample of 43,000 Europeans. Application of this definition to respondents from the 23 countries which participated in the European Social Survey (Round 3) reveals a four-fold difference in flourishing rate, from 41% in Denmark to less than 10% in Slovakia, Russia and Portugal. There are also striking differences in country profiles across the 10 features. These profiles offer fresh insight into cultural differences in well-being, and indicate which features may provide the most promising targets for policies to improve well-being. Comparison with a life satisfaction measure shows that valuable information would be lost if well-being was measured by life satisfaction. Taken together, our findings reinforce the need to measure subjective well-being as a multi-dimensional construct in future surveys.
doi:10.1007/s11205-011-9966-7
PMCID: PMC3545194  PMID: 23329863
Well-being; Flourishing; Population sample; Europe; Measurement; Survey
3.  The relationship between early personality and midlife psychological well-being: evidence from a UK birth cohort study 
Background
Individual differences in personality influence the occurrence, reporting and outcome of mental health problems across the life course, but little is known about the effects on adult psychological well-being. The aim of this study was to examine long range associations between Eysenck’s personality dimensions and psychological well-being in midlife.
Methods
The study sample comprised 1,134 women from the 1946 British birth cohort. Extraversion and neuroticism were assessed using the Maudsley Personality Inventory in adolescence (age 16 years) and early adulthood (age 26). Psychological well-being was assessed at age 52 with a 42-item version of Ryff’s psychological well-being scale. Analyses were undertaken within a structural equation modelling framework that allowed for an ordinal treatment of well-being and personality items, and latent variable modelling of longitudinal data on emotional adjustment. The contribution of mental health problems in linking personality variations to later well-being was assessed using a summary measure of mental health (emotional adjustment) created from multiple time-point assessments.
Results
Women who were more socially outgoing (extravert) reported higher well-being on all dimensions. Neuroticism was associated with lower well-being on all dimensions. The effect of early neuroticism on midlife well-being was almost entirely mediated through emotional adjustment defined in terms of continuities in psychological/ psychiatric distress. The effect of extraversion was not mediated by emotional adjustment, nor attenuated after adjustment for neuroticism.
Conclusions
Individual differences in extraversion and neuroticism in early adult life influence levels of well-being reported in midlife.
doi:10.1007/s00127-008-0355-8
PMCID: PMC3188366  PMID: 18443733
Personality; psychological well-being; emotional adjustment; mental health; birth cohort; structural equation modelling
4.  Polymorphisms in LMNA and near a SERPINA gene cluster are associated with cognitive function in older people 
Neurobiology of aging  2008;31(9):1563-1568.
A recent genome-wide association (GWA) study of late-onset Alzheimer's disease (LOAD) identified 15 novel single nucleotide polymorphisms (SNPs) independent of ApoE. We hypothesized that variants associated with LOAD are also associated with poor cognitive function in elderly populations. We measured additive associations between the five most strongly associated LOAD SNPs and grouped Mini Mental State Examination (MMSE) scores. Variants were genotyped in respondents (mean age 79yrs) from the Oxford Healthy Aging project (OHAP) and other sites of the MRC Cognitive Function and Aging Study (MRC-CFAS). In adjusted ordinal logistic models, two variants were associated with poorer cognitive function: rs11622883 (OR=1.14, 95%CI: 1.01 to 1.28, p=0.040) and rs505058 (OR=1.29, 95% CI: 1.02 to 1.64, p=0.036). These SNPs are close to a SERPINA gene cluster and within LMNA respectively. The mechanisms underlying the associations with cognitive impairment and LOAD require further elucidation, but both genes are interesting candidates for involvement in age-related cognitive impairment.
doi:10.1016/j.neurobiolaging.2008.08.020
PMCID: PMC2975102  PMID: 18848371
Late-onset Alzheimer's disease; dementia; cognitive function; cognitive impairment; gene; single nucleotide polymorphism; ApoE; LMNA
5.  Cognitive function and psychological well-being: findings from a population-based cohort 
Age and Ageing  2008;37(6):685-689.
Background: depression is associated with poor cognitive function, though little is known about the relationship between psychological well-being and cognitive function.
Objective: to investigate whether psychological well-being is associated with levels of cognitive function.
Design: nationally representative population-based cohort study.
Setting and participants: 11,234 non-institutionalised adults aged 50 years and over of the English Longitudinal Study of Ageing in 2002.
Methods: psychological well-being was measured using the CASP-19, and cognitive function was assessed using neuropsychological tests of time orientation, immediate and delayed verbal memory, prospective memory, verbal fluency, numerical ability, cognitive speed and attention. The relation of psychological well-being to cognitive function was modelled using linear regression.
Results: on a global cognitive score combining all cognitive tests, those in the fifth quintile of psychological well-being scored an average of 0.30 SD units higher than those in the lowest quintile (95% CI 0.24–0.35) after adjustment for depressive symptoms and sociodemographics. This association remained after additional adjustment for physical health and health behaviours. The same pattern of association was observed for men and women, and across all cognitive domains.
Conclusions: in a large population of community living adults, higher levels of psychological well-being were associated with better cognitive function.
doi:10.1093/ageing/afn194
PMCID: PMC2720691  PMID: 18852289
cognition; cognitive function; psychological well-being; risk factors; elderly
6.  An Evaluation of the Precision of Measurement of Ryff’s Psychological Well-Being Scales in a Population Sample 
Social Indicators Research  2009;97(3):357-373.
The aim of this study is to assess the effective measurement range of Ryff’s Psychological Well-being scales (PWB). It applies normal ogive item response theory (IRT) methodology using factor analysis procedures for ordinal data based on a limited information estimation approach. The data come from a sample of 1,179 women participating in a midlife follow-up of a national birth cohort study in the UK. The PWB scales incorporate six dimensions: autonomy, positive relations with others, environmental mastery, personal growth, purpose in life and self-acceptance. Scale information functions were calculated to derive standard errors of measurement for estimated scores on each dimension. Construct variance was distinguished from method variance by inclusion of method factors from item wording (positive versus negative). Our IRT analysis revealed that the PWB measures well-being most accurately in the middle range of the score distribution, i.e. for women with average well-being. Score precision diminished at higher levels of well-being, and low well-being was measured more reliably than high well-being. A second-order well-being factor loaded by four of the dimensions achieved higher measurement precision and greater score accuracy across a wider range than any individual dimension. Future development of well-being scales should be designed to include items that are able to discriminate at high levels of well-being.
doi:10.1007/s11205-009-9506-x
PMCID: PMC2879484  PMID: 20543875
Psychological well-being; Item response theory; Psychometric modelling; Measurement
7.  Memory Encoding and Dopamine in the Aging Brain: A Psychopharmacological Neuroimaging Study 
Cerebral Cortex (New York, NY)  2009;20(3):743-757.
Normal aging brings with it changes in dopaminergic and memory functions. However, little is known about how these 2 changes are related. In this study, we identify a link between dopamine, episodic memory networks, and aging, using pharmacological functional magnetic resonance imaging. Young and older adults received a D2-like agonist (Bromocriptine, 1.25 mg), a D2-like antagonist (Sulpiride, 400 mg), and Placebo, in a double-blind crossover procedure. We observed group differences, during memory encoding, in medial temporal, frontal, and striatal regions and moreover, these regions were differentially sensitive across groups to dopaminergic perturbation. These findings suggest that brain systems underlying memory show age-related changes and that dopaminergic function may be key in understanding these changes. That these changes have behavioral consequences was suggested by the observation that drug modulations were most pronounced in older subjects with poorer recognition memory. Our findings provide direct evidence linking ageing, memory, and dopaminergic change.
doi:10.1093/cercor/bhp139
PMCID: PMC2820708  PMID: 19625385
aging; dopamine; encoding; fMRI; memory
8.  Cognitive health among older adults in the United States and in England 
BMC Geriatrics  2009;9:23.
Background
Cognitive function is a key determinant of independence and quality of life among older adults. Compared to adults in England, US adults have a greater prevalence of cardiovascular risk factors and disease that may lead to poorer cognitive function. We compared cognitive performance of older adults in the US and England, and sought to identify sociodemographic and medical factors associated with differences in cognitive function between the two countries.
Methods
Data were from the 2002 waves of the US Health and Retirement Study (HRS) (n = 8,299) and the English Longitudinal Study of Ageing (ELSA) (n = 5,276), nationally representative population-based studies designed to facilitate direct comparisons of health, wealth, and well-being. There were differences in the administration of the HRS and ELSA surveys, including use of both telephone and in-person administration of the HRS compared to only in-person administration of the ELSA, and a significantly higher response rate for the HRS (87% for the HRS vs. 67% for the ELSA). In each country, we assessed cognitive performance in non-hispanic whites aged 65 and over using the same tests of memory and orientation (0 to 24 point scale).
Results
US adults scored significantly better than English adults on the 24-point cognitive scale (unadjusted mean: 12.8 vs. 11.4, P < .001; age- and sex-adjusted: 13.2 vs. 11.7, P < .001). The US cognitive advantage was apparent even though US adults had a significantly higher prevalence of cardiovascular risk factors and disease. In a series of OLS regression analyses that controlled for a range of sociodemographic and medical factors, higher levels of education and wealth, and lower levels of depressive symptoms, accounted for some of the US cognitive advantage. US adults were also more likely to be taking medications for hypertension, and hypertension treatment was associated with significantly better cognitive function in the US, but not in England (P = .014 for treatment × country interaction).
Conclusion
Despite methodological differences in the administration of the surveys in the two countries, US adults aged ≥ 65 appeared to be cognitively healthier than English adults, even though they had a higher burden of cardiovascular risk factors and disease. Given the growing number of older adults worldwide, future cross-national studies aimed at identifying the medical and social factors that might prevent or delay cognitive decline in older adults would make important and valuable contributions to public health.
doi:10.1186/1471-2318-9-23
PMCID: PMC2709651  PMID: 19555494
9.  Neighborhood Deprivation, Individual Socioeconomic Status, and Cognitive Function in Older People: Analyses from the English Longitudinal Study of Ageing 
OBJECTIVES
To assess the relationship between cognitive function, socioeconomic status, and neighborhood deprivation (lack of local resources of all types, financial and otherwise).
DESIGN
Nationally representative cross-section.
SETTING
The English Longitudinal Study of Ageing (ELSA).
PARTICIPANTS
Seven thousand one hundred twenty-six community-dwelling individuals aged 52 and older and resident in urban areas.
MEASUREMENTS
Individual cognitive function score and index of multiple deprivation (IMD) at the Super Output Area level, adjusting for health, lifestyle, and sociode-mographic confounders. Analyses were conducted separately according to sex and age group (52–69 and ≥70).
RESULTS
IMD affected cognitive function independent of the effects of education and socioeconomic status. For example, in fully adjusted models, women aged 70 and older had a standardized cognitive function score (z-score) that was 0.20 points (95% confidence interval (CI) = 0.01–0.39) lower in the bottom 20% of wealth than the top 20%, 0.44 points (95% CI = 0.20–0.69) lower in the least-educated group than in the most educated, and 0.31 points (95% CI 0.15–0.48) lower if resident lived in an area in the bottom 20% of IMD than in the top 20%.
CONCLUSION
In community-based older people in urban neighborhoods, neighborhood deprivation—living in a neighborhood with high levels of deprivation, compared with national levels—is associated with cognitive function independent of individual socioeconomic circumstances. The mechanisms underlying this relationship are unclear and warrant further investigation.
doi:10.1111/j.1532-5415.2007.01557.x
PMCID: PMC2671806  PMID: 18179489
deprivation; education; socioeconomic status; cognitive function; cognition
10.  Framingham Stroke Risk Profile and poor cognitive function: a population-based study 
BMC Neurology  2008;8:12.
Background
The relationship between stroke risk and cognitive function has not previously been examined in a large community living sample other than the Framingham cohort. The objective of this study was to examine the relationship between 10-year risk for incident stroke and cognitive function in a large population-based sample.
Methods
Participants were 7377 adults aged 50 years and over of the 2002 wave of the English Longitudinal Study of Ageing, a prospective cohort study. A modified version of the Framingham Stroke Risk Profile (incorporating age, sex, systolic blood pressure, antihypertensive medication, diabetes, smoking status, cardiovascular disease, and atrial fibrillation) was used to assess 10-year risk of stroke. Linear regression models were used to determine the cross-sectional relationship of stroke risk to global cognitive function and performance in multiple cognitive domains.
Results
In unadjusted models 10 percentage point increments of 10-year stroke risk were associated with poor global cognitive function (-0.40 SD units, 95% CI -0.43 – -0.38), and lowered performance in all cognitive domains. After statistical adjustment for age, sex, testing interval and other correlates of cognitive function the association with stroke risk was attenuated though remained significant for global cognitive function (-0.06 SD units, 95% CI -0.09 – -0.03), immediate and delayed verbal memory, semantic verbal fluency and processing speed.
Conclusion
In individuals free from a history of stroke or dementia, high subclinical cerebrovascular disease burden was associated with worse cognitive function in multiple domains.
doi:10.1186/1471-2377-8-12
PMCID: PMC2386808  PMID: 18430227
11.  Middle-Aged and Mobility-Limited: Prevalence of Disability and Symptom Attributions in a National Survey 
Journal of General Internal Medicine  2006;21(10):1091-1096.
BACKGROUND
Lower limb mobility disabilities are well understood in older people, but the causes in middle age have attracted little attention.
OBJECTIVES
To estimate the prevalence of mobility disabilities among noninstitutionalized adults in England and to compare the disabling symptoms reported by middle-aged and older people.
DESIGN
Cross-sectional data from the 2002 English Longitudinal Study of Ageing (ELSA). Mobility disability was identified by level of reported difficulty walking a quarter mile.
PARTICIPANTS
Eleven thousand two hundred sixteen respondents aged 50 years and older living in private households in 2002.
RESULTS
The prevalence of difficulty walking a quarter mile increases sharply with age, but even in the middle-aged (50 to 64 years age-group) 18% (95% confidence interval [CI]: 16% to 19%) of men and 19% (95% CI: 17% to 20%) of women reported some degree of difficulty. Of the 16 main symptoms reported as causing mobility disability in middle age, 2 dominated: pain in the leg or the foot (43%; 95% CI: 40% to 46%) and shortness of breath/dyspnea (21%; 95% CI: 18% to 23%). Fatigue or tiredness, and stability problems were cited by only 5% and 6%, respectively. These proportions were slightly different from those in the 65 to 79-year age group: 40%, 23%, 6%, and 8%, respectively.
CONCLUSIONS
Mobility (walking) disabilities in the middle-aged are relatively common. The symptoms reported as causes in this age group differ little from those reported by older groups, and are dominated by lower limb pain and shortness of breath. More clinical attention paid to disabling symptoms may lead to disability reductions in later life.
doi:10.1111/j.1525-1497.2006.00564.x
PMCID: PMC1831629  PMID: 16970558
mobility-limited; middle-aged; symptoms
12.  Cohort differences in disease and disability in the young-old: findings from the MRC Cognitive Function and Ageing Study (MRC-CFAS) 
BMC Public Health  2007;7:156.
Background
Projections of health and social care need are highly sensitive to assumptions about cohort trends in health and disability. We use a repeated population-based cross-sectional study from the Cambridgeshire centre of the UK Medical Research Council Cognitive Function and Ageing Study to investigate trends in the health of the young-old UK population
Methods
Non-overlapping cohorts of men and women aged 65–69 years in 1991/2 (n = 689) and 1996/7 (n = 687) were compared on: self-reported diseases and conditions; self-rated health; mobility limitation; disability by logistic regression and four-year survival by Cox Proportional Hazards Regression models, with adjustments for differences in socio-economic and lifestyle factors.
Results
Survival was similar between cohorts (HR: 0.91, 95% CI: 0.62 to 1.32). There was a significant increase in the number of conditions reported between cohorts, with more participants reporting 3 or more conditions in the new cohort (14.2% vs. 10.1%). When individual conditions were considered, there was a 10% increase in the reporting of arthritis and a significant increase in the reporting of chronic airways obstruction (OR: 1.36, 95% CI: 1.04 to 1.78).
Conclusion
This study provides evidence of rising levels of ill-health, as measured by the prevalence of self-reported chronic conditions, in the newer cohorts of the young-old. Though changes in diagnosis or reporting of disease cannot, as yet, be excluded, to better understand whether our findings reflect real increases in ill-health, investment should be made into improved population-based databases, linking self-report and objective measures of health and function, and including those in long-term care.
doi:10.1186/1471-2458-7-156
PMCID: PMC1947964  PMID: 17629910
13.  Improvements in social functioning reported by a birth cohort in mid-adult life: A person-centred analysis of GHQ-28 social dysfunction items using latent class analysis 
The General Health Questionnaire is widely used to measure the health status of individuals. Most studies have focused on traditional score values for one or more dimensions of psychopathology. We introduce a new analysis model that is person-centred and uses a latent structure approach to group individuals by a discrete latent variable. Data were drawn from a midlife (age 53) follow up of a national birth cohort study (n = 3035). For both men and women, three groups (latent classes) were sufficient to summarise individuals’ reports of recent changes in social functioning. The groups differed in the number and nature of the reported changes. Furthermore, they were shown to differ in terms of: (1) reported general health, (2) in mean scores on the conventional GHQ factors and (3) in several other variables external to the GHQ (happiness in job, ability to express feelings and self-confidence). Latent Class Analysis of positively worded GHQ items defined groups who differ in perceptions of recent positive changes in social functioning. These groups extend the value of individual health profiles afforded by the GHQ by using distinctions between categories in the first and second responses that are usually combined.
doi:10.1016/j.paid.2006.07.010
PMCID: PMC3504660  PMID: 23275680
Latent structure analysis; General health questionnaire; Positive outcomes; Social dysfunction; Positive functioning; Latent class analysis
14.  Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women 
Background
Investigations of the structure of psychological well-being items are useful for advancing knowledge of what dimensions define psychological well-being in practice. Ryff has proposed a multidimensional model of psychological well-being and her questionnaire items are widely used but their latent structure and factorial validity remains contentious.
Methods
We applied latent variable models for factor analysis of ordinal/categorical data to a 42-item version of Ryff's psychological well-being scales administered to women aged 52 in a UK birth cohort study (n = 1,179). Construct (predictive) validity was examined against a measure of mental health recorded one year later.
Results
Inter-factor correlations among four of the first-order psychological well-being constructs were sufficiently high (> 0.80) to warrant a parsimonious representation as a second-order general well-being dimension. Method factors for questions reflecting positive and negative item content, orthogonal to the construct factors and assumed independent of each other, improved model fit by removing nuisance variance. Predictive validity correlations between psychological well-being and a multidimensional measure of psychological distress were dominated by the contribution of environmental mastery, in keeping with earlier findings from cross-sectional studies that have correlated well-being and severity of depression.
Conclusion
Our preferred model included a single second-order factor, loaded by four of the six first-order factors, two method factors, and two more distinct first-order factors. Psychological well-being is negatively associated with dimensions of mental health. Further investigation of precision of measurement across the health continuum is required.
doi:10.1186/1477-7525-4-76
PMCID: PMC1634744  PMID: 17020614
15.  Introduction: why do we need a science of well-being? 
Introduction: why do we need a science of well-being?
doi:10.1098/rstb.2004.1519
PMCID: PMC1693426  PMID: 15347524
16.  Well-being: towards an integration of psychology, neurobiology and social science. 
Well-being: towards an integration of psychology, neurobiology and social science
doi:10.1098/rstb.2004.1520
PMCID: PMC1693424  PMID: 15347535
17.  A randomised controlled trial investigating the effect of n-3 long-chain polyunsaturated fatty acid supplementation on cognitive and retinal function in cognitively healthy older people: the Older People And n-3 Long-chain polyunsaturated fatty acids (OPAL) study protocol [ISRCTN72331636] 
Nutrition Journal  2006;5:20.
The number of individuals with age-related cognitive impairment is rising dramatically in the UK and globally. There is considerable interest in the general hypothesis that improving the diet of older people may slow the progression of cognitive decline. To date, there has been little attention given to the possible protective role of n-3 long-chain polyunsaturated fatty acids (n-3 LCPs) most commonly found in oily fish, in age-related loss of cognitive function. The main research hypothesis of this study is that an increased dietary intake of n-3 LCPs will have a positive effect on cognitive performance in older people in the UK.
To test this hypothesis, a double-blind randomised placebo-controlled trial will be carried out among adults aged 70–79 years in which the intervention arm will receive daily capsules containing n-3 LCP (0.5 g/day docosahexaenoic acid and 0.2 g/day eicosapentaenoic acid) while the placebo arm will receive daily capsules containing olive oil. The main outcome variable assessed at 24 months will be cognitive performance and a second major outcome variable will be retinal function. Retinal function tests are included as the retina is a specifically differentiated neural tissue and therefore represents an accessible window into the functioning of the brain.
The overall purpose of this public-health research is to help define a simple and effective dietary intervention aimed at maintaining cognitive and retinal function in later life. This will be the first trial of its kind aiming to slow the decline of cognitive and retinal function in older people by increasing daily dietary intake of n-3 LCPs. The link between cognitive ability, visual function and quality of life among older people suggests that this novel line of research may have considerable public health importance.
doi:10.1186/1475-2891-5-20
PMCID: PMC1564406  PMID: 16945130
18.  Brief cognitive assessment in a UK population sample – distributional properties and the relationship between the MMSE and an extended mental state examination 
BMC Geriatrics  2005;5:7.
Background
Despite the MMSE's known flaws, it is still used extensively as both a screening instrument for dementia and a population measure of cognitive ability. The aim of this paper is to provide data on the distribution of MMSE scores in a representative sample from the UK population and to compare it with an extended cognitive assessment (EMSE) which covers a wider range of cognitive domains and provides a wider range of difficulty levels.
Methods
The MMSE and the EMSE were administered to over 12,000 participants at the screening stage of the MRC Cognitive Function and Ageing Study (MRC CFAS). MRC CFAS is a multi-centre population-based study in England and Wales with respondents aged 65 years and older.
Results
Normative values on the MMSE and EMSE are presented by age group, sex and level of education. There are very large differences between age groups, with smaller differences seen between the sexes and by level of education. The EMSE extends the scores at the high end of the ability range, but is no better than the MMSE at differentiating between dementia and non-dementia.
Conclusion
Population-derived norms are valuable for comparing an individual's score to the score that would be expected among the general population, given the individual's specific demographic characteristics.
doi:10.1186/1471-2318-5-7
PMCID: PMC1134657  PMID: 15869717

Results 1-18 (18)