Authors: Dr. D. William Molloy and Dr. Roger Clarnette
The MMSE provides a short, reliable measure of cognition. The level of cognitive impairment helps to quantify the severity of impairment and stage dementia. Serial scores provide useful information about function over time and can be used to measure disease progression and treatment effects.
If a person presents with memory loss and cognitive impairment, analysis of the pattern of scores also helps to pinpoint the specific deficits and provides important clues to the cause of the problem.
Scores of 30 usually indicate no impairment. People who have received a good deal of education, with no obvious sensory, language or communication problems, usually score 30.
MMSE scores are related to age and education level. There is an inverse relationship between MMSE scores and age. People aged 18 to 50 score a median of 29 and those aged 51 to 64 have a median of 28. After 65, there is a steady, gradual decline, so at age 75, the median is about 27 and it falls to 26 by age 80 and beyond.
MMSE scores are directly related to the level of education and formal schooling. The median is 29 for individuals with at least 9 years of schooling, 26 for those with 5-8 years and 22 for those with 0-4 years of schooling.
In general, scores of 26 to 30 are considered "normal." Scores between 20 and 25 are consistent with mild cognitive impairment. Scores between 10 and 19 are consistent with moderate cognitive impairment. Scores between 0 and 9 are considered severe cognitive impairment.
These are very general rules. The test scores have to be taken in context with the history and other findings. It is unreasonable to expect that this short test is valid and/or reliable in everyone. Consider a fit and healthy 75-year old retired school teacher. Family complain that she is forgetting names, repeating questions and stories, and that this is progressive. She scores 27 on the MMSE which is in the "normal" range. However the three points are lost because she could not remember any of the three words in the recall section, which represents new learning ability. This is a highly significant finding in this woman. Take a careful history from the family and inquire about function in instrumental activities of daily living (IADL) such as managing finances, driving, taking medications, shopping, and cooking. If there is impairment in IADL and the person is repeating questions and stories - this should be investigated further because it is suggestive of early Alzheimer’s Disease.