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Mini-Mental State Examination (MMSE)

Authors: Dr. D. William Molloy and Dr. Roger Clarnette

1.0 Introduction

The population is a ging. Elderly frail adults are the most rapidly growing group in developed countries. More and more physicians are coming to recognize the importance of cognitive testing in the assessment of older adults. About 10% of people aged 70 or more and a third of those aged 85 and over have dementia. Yet this is often missed, particularly in the early stages.

The Mini-Mental State Examination (MMSE) is the most widely used screening test of mental function in this age group. This manual describes a standardized version of this test and shows how physicians and other health care professionals can use and interpret it. This manual describes some uses that they may not be aware of previously.

Since Dr. Marshall Folstein first developed the Mini-Mental State Examination (MMSE) in 1975, it has become widely used as a screening test for cognitive impairment and it is routinely used as an inclusion/exclusion criterion and outcome measure in clinical trials. The test covers a variety of cognitive domains, including orientation to time and place, short and long term memory, registration, recall, constructional ability, language and the ability to understand and follow commands. This test should never be used alone. It is used in conjunction with a corroborative history.

The test usually takes about ten minutes to complete and can be used reliably after a short training period by physicians, nurses and other health-care professionals. The original MMSE had few instructions for administration and scoring. These were left to the discretion of each rater. Different raters developed their own unique styles and techniques of administration and scoring. This led to wide differences and lowered the reliability of the test.

The Standardized Mini-Mental State Examination (SMMSE) was developed to provide clear unequivocal guidelines for administration and scoring. The SMMSE takes less time to administer and has significantly reduced the variability of the MMSE.

The intrarater variability is significantly lower with the SMMSE (86%, P<0.003) and the interrater variance was reduced by 76%, compared to the MMSE. Intraclass correlation for the MMSE was 0.69 compared to 0.90 for the SMMSE. The mean duration of assessments was 13.4 minutes for the MMSE, compared to 10.5 minutes for the SMMSE (p <0.004).

The instructions for administration and scoring the SMMSE are short and cryptic. Some further background, discussion and explanation of these rules and guidelines may be useful.

1.0 Introduction

2.0 General Guidelines

3.0 Specific Scoring Guidelines

4.0 Total Scores

5.0 Diagnostic Algorithm

6.0 The Alzheimer’s Journey

7.0 Using the Pattern of Deficits to Distinguish between the Different Dementias

8.0 Care plan for Alzheimer’s disease (and other dementias)

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