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Reliability and Validity of the
“Middlesex Elderly Assessment
of Mental State” (MEAMS)
Among Hospitalized Elderly
in Israel as a Predictor of
Functional Potential
A. Yaretzky MD , O. Lif-Kimchi BOT , B. Finkeltov
MD , H. Karpin BOT , T. Turani-Feldman BOT , Y.
Shaked-Bregman BOT , L. Peleg BOT , J. Feldman
MD , D. Spiegel MD & N. Weinblatt PhD, OT
Published online: 11 Oct 2008.
To cite this article: A. Yaretzky MD , O. Lif-Kimchi BOT , B. Finkeltov MD , H. Karpin
BOT , T. Turani-Feldman BOT , Y. Shaked-Bregman BOT , L. Peleg BOT , J. Feldman
MD , D. Spiegel MD & N. Weinblatt PhD, OT (2000) Reliability and Validity of the
“Middlesex Elderly Assessment of Mental State” (MEAMS) Among Hospitalized Elderly
in Israel as a Predictor of Functional Potential, Clinical Gerontologist, 21:4, 91-98,
DOI: 10.1300/J018v21n04_07
To link to this article: http://dx.doi.org/10.1300/J018v21n04_07
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Reliability and Validity
of the ‘‘Middlesex Elderly Assessment
of Mental State’’ (MEAMS)
Among Hospitalized Elderly in Israel
as a Predictor of Functional Potential
A. Yaretzky, MD
O. Lif-Kimchi, BOT
B. Finkeltov, MD
H. Karpin, BOT
T. Turani-Feldman, BOT
Y. Shaked-Bregman, BOT
L. Peleg, BOT
J. Feldman, MD
D. Spiegel, MD
N. Weinblatt, PhD, OT
ABSTRACT. This study of Hebrew speaking Israelis (n = 77) found that
the MEAMS had internal reliability (Cronbach alpha = .75) and parallel
form reliability (r = .71). Validity was examined by correlaing the
MEAMS to established tests such as the MMSE (r = .64) and Clock
Completion Test (r = ꢀ.53) and Functional Independent Measure (r =
.35). The MEAMS correlated with demographic variables (age r = ꢀ.38,
education r = .24). [Article copies available for a fee from The Haworth
Document Delivery Service: 1-800-342-9678. E-mail address: <getinfo@
haworthpressinc.com> Website: <http://www.HaworthPress.com>]
Address correspondence to: A. Yaretzky, MD, Professor of Internal and Geriatric
Medicine, Head, Education Program in The Occupational Therapy Department,
Sackler Faculty of Medicine, Tel Aviv University Campus, 39040, Ramat Aviv, Tel
Aviv 69978 Israel (E-mail: nurw@post.tau.ac.il).
Clinical Gerontologist, Vol. 21(4) 2000
E 2000 by The Haworth Press, Inc. All rights reserved.
91

CLINICAL GERONTOLOGIST
92
KEYWORDS. MEAMS, elderly rehabilitation, cognitive assessment,
cognition
INTRODUCTION
The Middlesex Elderly Assessment of Mental State (MEAMS) is a
neuro-psychological screening test. It was created in England by
Golding (1989),1 published by the Thames Valley Test Company and
is intended for the use of the medical professions. The test examines
cognitive functions necessary for daily functioning and helps in diag-
nosing either organic or mental disabilities among the hospitalized
elderly.1
The MEAMS is characterized by its evaluation contexts that are not
tested by other short assessment tools, such as the Mini Mental State
Examination (MMSE)2 and the Clock Completion Test (CCT).3,4
Each of the two versions comprises 12 sub-tests: name learning, nam-
ing, comprehension, remembering pictures, arithmetic, spatial construc-
tion, fragmental letters, perception, unusual views, usual views, verbal
fluency, motor perseveration. The final score is reached by the sum of
the sub-tests answered correctly (pass: 1 point, fail: 0 points). Perfor-
mance norms are as follows: 10-12: good performance, 9-8:borderline
range, 7 or below: comprehensive evaluation is required.
Golding (1989)1 Examined the validity, reliability and the deter-
mination of norms for the MEAMS among 120 elderly patients and
Husband and Tarbuck (1994)5 expanded the use of the test to a psy-
cho-geriatric population. Powell, Brokers and Papadopolous (1994)6
found problems in the reliability of some of the MEAMS’ sub tests:
visual perception, naming, comprehension, calculation and verbal
fluency. The researchers have limited their conclusions in light of their
small sample.
The purpose of the present study is to examine the test’s reliability
and validity among elderly population in an acute geriatric and reha-
bilitative unit in Israel in order to use it for both clinical and research
purposes.
METHODS
Population
The sample comprised 77 elderly people, (mean age 79.4 years,
median 81.5), hospitalized in the geriatric ward (rehabilitative and

Yaretzky et al.
93
acute patients) at the Meir Hospital, Kfar Sava, Israel (see Table 1).
Forty-nine percent of the patients had undergone orthopedic surgery,
15.6% suffered from neurological diseases or stroke, 35% suffered
from internal diseases and/or functional decline. Average hospitaliza-
tion was 54.4 days (median 65.5).
All the subjects were Hebrew-speakers and had an average of 9
years education. Sixty-two percent of the subjects were independent in
the activities of daily living (ADL) prior to their hospitalization. Ex-
clusion criteria were patients with aphasia, visual or auditory impair-
ment.
PROCEDURE
The study’s battery was administered to all subjects on admission
and discharge and comprised the following research tools:
S A demographic and medical questionnaire was completed by a
geriatrician exclusively on admission.
S The CCT,3,4 MMSE2 MEAMS (two versions)1 were adminis-
trated by occupational therapists.
S The Functional Independent Measure (FIM)7 was assessed by a
multi-disciplinary team.
STATISTICAL ANALYSIS
Statistical analysis was carried out using SPSS software. The level
of significance was B < 0.05. The MEAMS test was given to an
academic expert in order to determine content validity of the Hebrew
version.
Internal reliability was tested by the Cronbach Test and parallel
version reliability by the Pearson Correlation Coefficient. Examina-
tion of parallel validity was performed by comparing the MEAMS
with the MMSE and the CCT tests, and predictive validity by compar-
ing it with the FIM test. These tests were examined using the Pearson
Correlation Coefficient. Examination of the discriminating validity of
the test was conducted by the Analysis of Variance (Anova) Model
and Scheffe test.
RESULTS
Reliability. The study’s results show high internal reliability be-
tween the sub-tests of both versions: MEAMS A: B = .7456, MEAMS

CLINICAL GERONTOLOGIST
94
TABLE 1. Characteristic of the Study Subjects
Sample
77
Sex
Age
Male: 28
Female: 49
Mean = 79.4
S.D. = á 7.94
Median = 81.5
Range: 67-95
Diagnosis
Orthopedic
33.8%--hip fracture
15.6%--joint replacement
15.6%
Neurological
Functional Decline/lnternal Disease
Ethnic Origin
35%
71% Eastern Europe
13% Asia, Africa
2% Israeli born
Mean = 54.5
Duration of Hospitalization
Range 11-114
Median = 65.5
B: B = .7561, and a significant positive correlation between versions A
and B: (r = .7155, p = .005).
Validity. The test was translated by the researchers and contextually
validated by an expert--the head of the occupational therapy depart-
ment at Tel Aviv University and a geriatric specialist.
Parallel validity. A significant positive correlation was found be-
tween MEAMS A and MMSE relating to admission: (r = .6422, p =
.000) and between MEAMS B and MMSE relating to discharge (r =
.4828, p = .000).
Comparison of the MEAMS with the CCT indicates a significant
negative correlation between MEAMS A and CCT on admission (r =
ꢀ.5285, p = .000) and on discharge (r = ꢀ.4980, p = .000). Correla-
tion was found negative due to the scoring method of the CCT, which
gives points for mistakes. A normal clock drawing of the CCT ranges
between 0 and 3.
Predictive validity. Comparison of the MEAMS A with the FIM
indicates a weak but significant positive correlation relating to admis-

Yaretzky et al.
95
sion (r = .349, p = .000) and discharge (r = .349, p = .000). No
significant correlation was found between the MMSE and the FIM
relating to admission (r = .166, p = .955) or discharge (r = .093, p =
.423).
Discriminating validity. In accordance with the MEAMS norms (A:
12-10, B:9-8, C: 7 or below) the subjects were divided into 3 groups
according to their performance level on the MMSE and FIM tests, and
significant differences were found between the groups (see Tables 2
and 3).
Effect of demographic data on MEAMS performance. A significant
negative correlation was found between age and score on the MEAMS
A on admission (r = ꢀ.3785, p = .000) and a significant positive
TABLE 2. Differences in FIM Score on Admission and Discharge Between
Subjects in Group A and C
Measuring
Tool
Mean Group Score (S.D.)
Df
p-value
.0042
.002
A
B
C
F
FIM
96.21
86.333
(16.334)
105.272
(14.781)
82.81
5.923
(2.72)
(2.70)
Admission
FIM
(15.238)*
114.09
(26.09)*
(14.798)*
91.97
9.447
Discharge
(13.795)
Norms A: 12-10, B: 9-8, C: 7 or below.
*Significant differences
TABLE 3. Differences in MMSE Scores on Admission and Discharge Between
Subjects in Group A and B and Group A and C
Measuring
Tool
Mean Group Score (S.D.)
F
Df
P-value
A
B
C
MMSE
90.44
88.22
71.50
22.916
12.609
(2.74)
(2.71)
.0001
Admission
MMSE
(7.948)*
90.05
(6. 530)*
62.27
(15.466)*
60.63
.0001
Discharge
(19.544)*
(30.522)*
(24.921)*
Norms A: 12-10, B: 9-8, C: 7 or below
*All differences are significant.

CLINICAL GERONTOLOGIST
96
correlation between the number of years of education on admission (r =
.3499, p = .002) and discharge (r = .232, p = .005). A significant
positive correlation was also found between the number of years of
education and the MMSE on admission: (r = .236, p = .043)
DISCUSSION
The MEAMS test was found to have high parallel version reliability
and high internal reliability. Parallel version reliability indicates that
both versions examine an identical world of contents. Internal reliabil-
ity permits separate use of some of the sub-tests without compromis-
ing the reliability of the tool.
This finding contradicts the results of the study conducted by
Powell Brookers and Papadopolos (1994)6 that indicated problems of
reliability in several of the sub-tests. Comparison of the results of
scores on the MEAMS (both versions) and the MMSE on admission
and discharge showed an average-level of positive correlation, a
finding which gives the tool parallel validity and underscoring its
uniqueness in comparison with the MMSE. The significant correla-
tion found also with the CCT supports and strengthens its parallel
validity.
These results points to the sensitivity of the MEAMS in locating
difficulties in the components of cognitive functions among hospital-
ized elderly and during their rehabilitation.
The significant parallel correlation found between the two ver-
sions of the MEAMS and the FIM gives the tool predictive validity.
Due to the fact that each tool contains a different world of content the
validity was found weak. In light of these results, only the MEAMS,
and not the MMSE or CCT, is an important predictor of the level of
occupational performance during hospitalization and rehabilitation
of the elderly. The norms of the MEAMS also give it the ability to
differentiate between different performance levels on the FIM and
the MMSE.
These findings strengthen the importance of cognitive status as an
important rehabilitative criterion that affects occupational perfor-
mance, rehabilitative potential, duration of hospitalization and dis-
charge disposition.3,8,9
The significant negative relationship that was found between age
and success on the MEAMS and the significant positive relationship

Yaretzky et al.
97
with years of education is appropriate to that known in the literature.
As age increases the frequency of cognitive impairment rises, and the
number of years of education affect performance ability on the neuro-
psychological tests.10
In conclusion, the MEAMS is a short, easy-to-administer cognitive
screening test, which examines a variety of cognitive components
necessary for daily functioning. The tool was found to have internal
reliability and parallel version reliability, contents validity, parallel
validity, discriminating validity, predictive validity and norms. This
implies that MEAMS provides a sensitive assessment of neurocogni-
tive status and functional potential among the hospitalized geriatric
and rehabilitative population in Israel. The tool is affected, like most
neuro-psychological tests, by age and years of education and therefore
is unsuitable for uneducated population. The MEAMS is also not
recommended for patients suffering from aphasia or severe visual and
auditory disorders.
In order to extend the clinical and research uses of the tool among a
variety of populations, it is recommended to conduct further research
while comparing it with both cognitive and functional assessment
tools as well.
REFERENCES
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of Psychiatric Research, 1975, 12; pp. 189-198.
3. Watson, JI, Arfen, CL, Briggs, SJ. Clock Completion: An objective screening
test for dementia. The American Geriatric Society, 1993, 41; pp. 1235-1240.
4. Heinik, J. Clock Drawing Test in Dementia in Alzheimer’s disease. Herefuah,
1998, 134; pp. 143-148 (Hebrew).
5. Husband, HJ, Tarbuck, AF. Cognitive Rating Scale: A comparison of the Mini
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7. Granger,CV, Hamilton, BB, Sherwin, FS. Guide for Use of the Uniform Data
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RECEIVED: 09/21/99
REVISED: 10/21/99
ACCEPTED: 01/26/00