Is the Mini-Mental State Examination the best cognitive screening test for less educated people?

Objective: Mini-Mental State Examination (MMSE) results are strongly influenced by educational level. The Brief Cognitive Screening Battery (BCSB) is an alternative assessment tool that provides more accurate results in individuals with less education. Our aim was to compare the MMSE and BCSB as screening tests.
Methods: The MMSE and BCSB were assessed in 112 participants by two evaluators blind to the other test's result. Participants were classified according to their level of education. The influence of education level was analyzed using the Kruskal-Wallis and multiple comparison tests.
Results: Scores of the MMSE (p < 0.0001) and the clock-drawing test (p < 0.0001) were influenced by education level but the delayed recall test score was not (p = 0.0804). The verbal fluency test (p = 0.00035) was influenced only by higher educational levels. It took three minutes less to apply the MMSE than to apply the BCSB (p < 0.0001).
Conclusions: These findings suggest that the delayed recall test and the verbal fluency test of the BCSB are better than the MMSE and clock-drawing test as tools for evaluating cognition in people with limited education.