Acta neurol. belg., 2006, 106, 132-136 Abstract The biggest challenge regarding cognitive prospec- tive evaluations in the elderly is the identification of sub- jects that go on to develop cognitive impairment. In this study, we compared the Italian telephone version of the MMSE (Itel-MMSE) with both the MMSE and a battery of neuropsychological tests in a group of 107 healthy elderly subjects. The aim of the study was to identify a subset of subjects who, despite having an overall score within the normal range, performed poorly in the cogni- tive neuropsychological evaluation. The Itel-MMSE score showed a good internal consistency as well as a significant correlation with the MMSE score, age and education. A score of  21 on the Itel-MMSE was the score which reflected the highest degree of sensitivity in the neuropsychological tests. There was a statistically significant difference between subjects with an Itel- MMSE score of  21 and those with a score of 22 in age, education, Attentional Matrices and Copying Drawings. Despite some potential limitations, our results strongly suggest that the Itel-MMSE may be used as a screening test to identify healthy elderly subjects whose cognitive performance is poor. Key words : MMSE ; telephone MMSE ; neuropsycho- logical evaluation, aging ; cognitive impairment ; mild cognitive impairment. Introduction The biggest challenge regarding cognitive prospective evaluation in the elderly is the identifi- cation of subjects that subsequently develop mild cognitive impairment (MCI) or dementia (Xu G. et al. 2002 ; Busse A. et al. 2003 ; Lipton R. B. et al. 2003). Approximately 20% of elderly subjects “cognitively normal” at the common screening instruments such as Mini Mental State Examination (MMSE) and Cambridge Cognitive Examination show a neuropsychological perfor- mance below the normal range (4). Such instru- ments have a number of limitations in wide popu- lation-base studies because of difficulties encoun- tered in administering them to the whole popula- tion. In this regard, numerous telephone screening tests have been proposed to evaluate pathological cognitive status, and in particular Alzheimer’s dis- ease (AD), MCI and post-stroke dementia (5, 6, 7, 8). The most widely used telephone screening tests (TICS and TELE) have many elements in common with the MMSE, and they have high sensitivity and specificity in the differentiation of AD patients from healthy controls (9, 10). No data are, howev- er, available regarding healthy elderly subjects. An Italian telephone version of the MMSE (Itel- MMSE) has recently been validated in a group of patients affected by dementia with varying degrees of the cognitive impairment (11). However, the Itel-MMSE was not validated to identify subjects with a poor cognitive performance in neuropsycho- logical tests, although within normal range score. In this study, we compared the Itel-MMSE with both the MMSE and a battery of neuropsychologi- cal tests in a group of healthy elderly subjects. The aim of our study was to identify a subset of subjects who, despite having an overall score within the normal range score, performed poorly in the cogni- tive neuropsychological evaluation. These subjects should be included in a prospective evaluation of cognitive status because they could have a high risk of developing MCI or dementia. Methods and materials A project is currently being conducted to identi- fy, using the National Twin Registry, any cases of twins affected by cognitive deficit who are resi- dents in the Rome area (12). A random sample of 321 (126 male and 195 female ; age 63.7 ± 1.1 years ; education 10.5 ± 4.4 years ; Itel-MMSE score 21.3 ± 1.3) healthy twins were identified in this project and the Itel-MMSE administered. One hundred and fifteen of these 321 twins agreed to undergo a neuropsychological evaluation in our hospital outpatient memory clinic from January 2002 to May 2003. Eight twins (2 male and 6 female ; age 63.7 ± 1.6 years, education 9.5 Original articles Validity of the italian telephone version of the mini-mental state examination in the elderly healthy population Nicola V ANACORE*, Antonella DE CAROLIS**, Micaela SEPE-MONTI**, Giuseppe BOMBOI**, Antonia STAZI*, Angelo BIANCHETTI*** and Franco GIUBILEI** *National Centre of Epidemiology, National Institute of Health, Rome, Italy ; **Department of Neurological Sciences, “La Sapienza” University, Rome, Italy ; ***Department of Medicine and Rehabilitation “S. Anna” Hospital, Brescia and Geriatric Group, Brescia, Italy ————