{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:28:29Z","timestamp":1785421709406,"version":"3.56.0"},"posted":{"date-parts":[[2026,7,16]]},"group-title":"Neurology","reference-count":38,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"award":["BX004192"],"award-info":[{"award-number":["BX004192"]}],"id":[{"id":"https:\/\/ror.org\/05rsv9s98","id-type":"ROR","asserted-by":"publisher"}]},{"award":["BX005749"],"award-info":[{"award-number":["BX005749"]}],"id":[{"id":"https:\/\/ror.org\/05rsv9s98","id-type":"ROR","asserted-by":"publisher"}]},{"award":["CX001952"],"award-info":[{"award-number":["CX001952"]}],"id":[{"id":"https:\/\/ror.org\/05rsv9s98","id-type":"ROR","asserted-by":"publisher"}]},{"award":["BX006350"],"award-info":[{"award-number":["BX006350"]}],"id":[{"id":"https:\/\/ror.org\/05rsv9s98","id-type":"ROR","asserted-by":"publisher"}]},{"award":["U24AG074855"],"award-info":[{"award-number":["U24AG074855"]}],"id":[{"id":"https:\/\/ror.org\/01cwqze88","id-type":"ROR","asserted-by":"publisher"}]},{"name":"VISN-22 VA Center of Excellence for Stress and Mental Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,7,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Electronic health record (EHR)-linked biorepositories provide opportunities to advance epidemiological research in Alzheimer\u2019s disease (AD) and related dementias.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Evaluate the extraction, curation, and associative validity of Mini Mental State Examination (MMSE) scores from the VA EHR for participants in the VA Million Veteran Program (MVP).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    The sample (N = 49,555; 7.4% women) included a multiethnic cohort (European [68.3%], African [20.4%], Hispanic [9.0%]) with EHR-extracted MMSE scores; 30.7% were apolipoprotein E (\n                    <jats:italic>APOE<\/jats:italic>\n                    ) \u03b54 carriers, and 25.8% had multiple scores. Linear regressions examined cross-sectional associations between \u03b54 dosage (0, 1, 2) and first and lowest MMSE scores. MMSE scores were also evaluated against MVP dementia diagnostic algorithms in participants aged \u226565 years.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    Among participants of European ancestry, there was a significant \u03b54 dose-response relationship (\n                    <jats:italic>p<\/jats:italic>\n                    s &lt; .001) with MMSE scores. Homozygote carriers scored lower than heterozygote carriers (M\n                    <jats:sub>diff<\/jats:sub>\n                    : first = -0.5; lowest = -0.9), who scored lower than non-carriers (M\n                    <jats:sub>diff<\/jats:sub>\n                    : first = -0.4; lowest = -0.6). Among Veterans of African and Hispanic ancestry, no dose-response relationship was observed, although \u03b54 carriers had lower scores than non-carriers (\n                    <jats:italic>p<\/jats:italic>\n                    s \u2264 .04). MMSE scores corresponded strongly with dementia case\/control status across phenotypes: mild impairment on the MMSE was strongly associated with AD (odds ratio [OR] = 11.48), with more severe MMSE impairment showing stronger associations (moderate OR = 17.95; severe OR = 27.83).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study demonstrated MMSE scores can be systematically extracted and curated from the VA EHR. Findings offer a scalable framework for future studies on risk stratification, highlighting the potential for harnessing MVP to explore genetic and clinical factors contributing to cognitive and dementia outcomes in diverse samples.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.07.14.26358064","type":"posted-content","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T19:55:20Z","timestamp":1784231720000},"source":"Crossref","is-referenced-by-count":0,"title":["Curation of Mini Mental State Examination (MMSE) Scores in the VA Million Veteran Program (MVP): Applications for Cognitive Aging Research"],"prefix":"10.64898","author":[{"given":"Francesca V.","family":"Lopez","sequence":"first","affiliation":[{"name":"Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA"},{"name":"Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA"},{"name":"Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Gillis","sequence":"additional","affiliation":[{"name":"National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Lee","sequence":"additional","affiliation":[{"name":"National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"McKenna S.","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"VA Million Veteran Program","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Sherva","sequence":"additional","affiliation":[{"name":"National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA"},{"name":"Department of Biomedical Genetics, Boston University Chobanian & Avedisian School of Medicine and School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W.","family":"Logue","sequence":"additional","affiliation":[{"name":"National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA"},{"name":"Department of Biomedical Genetics, Boston University Chobanian & Avedisian School of Medicine and School of Public Health, Boston, MA, USA"},{"name":"Department of Psychiatry and Biostatistics, Boston University Chobanian & Avedisian School of Medicine and School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria C.","family":"Merritt","sequence":"additional","affiliation":[{"name":"Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA"},{"name":"Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, USA"},{"name":"Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026071810051104000_2026.07.14.26358064v1.1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13016"},{"key":"2026071810051104000_2026.07.14.26358064v1.2","unstructured":"Bureau US . 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