Matthias Riepe

  • Designation: Head of the Ulm University Division of Old Age Psychiatry and the Department of Geriatrics and Old Age Psychiatry
  • Country: Germany
  • Title: 3-point decline in the MMSE: what does it mean in patients with verified Alzheimer’s Disease and verified Depressive Disorder


Matthias Riepe after graduating, Matthias served in several positions at the University of Münster and the Humboldt University Berlin (Charité) and Ulm University in Germany, the Center for Research on Occupational and Environmental Toxicology in Portland, Oregon, USA, and at the Wadsworth Center for Laboratories and Research in Albany, New York, USA. He is board-certified in Neurology, Psychiatry and Psychotherapy, and Geriatrics. Matthias held positions as Full Professor of Old Age Psychiatry at the Charité Medical Faculty in Berlin and is currently at Ulm University and Head of the University’s Division of Old Age Psychiatry and the Department of Geriatrics and Old Age Psychiatry at Bezirkskrankenhaus Günzburg. 


Composite cognitive scales are used ubiquitously in diagnostic algorithms, strategies to appraise the severity of cognitive impairment, and clinical trials. We analyzed the different meanings of the decline of three points in the MMSE. It is unclear whether the total MMSE score informs about the same deficits in different diseases, such as Alzheimer’s disease (AD) and Depressive Disorder (DD). At least partly, this results from studies that have not secured the diagnoses of AD and DD using biomarkers. In the present study, we only analyzed results from patients in whom the diagnosis of AD had been secured with Abeta1,42 and tau-protein. We only analyzed results from patients with DD in whom neurodegeneration was excluded (normal Abeta1,42 and normal tau-protein). We used data from a previously published cross-sectional retrospective observational clinical cohort study. The final analysis included only patients in whom AD biomarker analysis was characteristic for AD (n = 167) and patients with DD in whom AD was ruled out by analysis of biomarkers suggestive of AD (n = 69). The three-point difference between an MMSE score of 30 and 27 in patients with AD is a measure of memory decline, while it reflects a decline of diverse cognitive functions in patients with DD. We conclude that the different meaning of decline by any number of points from the total score of a composite scale needs to be considered. Solely memory reflects the impact of AD at the onset of clinical manifestation. Only memory should be used to assess the severity of the disease and the efficacy of therapeutic interventions in early AD. In early AD, decline in items beyond memory assessment reflect the impact of comorbidities rather than AD itself..

Don't miss our future updates!

Get in Touch