Mini Mental State Examination (MMSE). The Mini-Mental State Examination (MMSE) is the most widely used screening tool for items such as orientation, registration, attention and calculation, recall, and language (Table). Maximum score is 30; scores between 21 to 24 indicate mild cognitive impairment, scores between 16 to 20 reflect moderate impairment, and a score of 15 and below indicates severe impairment.
The MMSE includes questions that assess orientation to time (“What is today's date?” “Month?” “Day of the week?” “Year?”) and orientation to place (“Where are you now?” “What state are you in?” “County?” “City?” “What is the name of this place?”). Each item is scored as pass or fail. Although the orientation section of the MMSE does not provide a separate score, a failure of two or more items is reflective of impaired performance.
TABLE: MINI MENTAL STATE EXAMINATION (mmse)
Data from Galea M, Woodward M. Mini-Mental State Examination (MMSE). AustJ Physiother. 2005;51:198; and Mossello E, Boncinelli M. Mini-Mental State Examination: a 30-year story. Aging Clin Exp Res. 2006;18:271-273.
METHOD OR QUERY
Is the patient responsive to you upon entering the exam room?
Does the patient looked depressed or despondent, admit to being depressed, and demonstrate psychomotor retardation?
Name of facility
Day of week (exact)
Date (plus or minus one day only)
Repeat three words: ball, tree, flag
Repeat "no ifs, ands, or buts"
Follow three-step command: "Take this paper in your (nondominant) hand, folded in half, and place it on your lap"
Ask patient to name: pencil, watch
Ask patient to write a sentence
Copy a figure (intersecting pentagons)
Spell "world" backward or count backward from 100 by 7s (take best score)
Read and execute "close your eyes"
Recall the three words (see Registration above)
Preliminary data derived from a random group of patients with initial MMSE scores between 17 and 22. A 3rd party formal study is being conducted to measure and compare the Ashby Method™ to a placebo group. *(2)Wolfson C, Oremus M, Shukla V et al.
Although the MMSE is the most commonly used mental status test, it has a number of problems. First, one must accept the basic limitation of any screening examination. Since the test has a limited number of questions, adequate testing of cognitive function is not possible. Practically, however, the MMSE score is used as an indicator of intact or impaired performance. The cut-off score of 24 is associated with relatively high false-negative rates (test indicates absence of impairment when impairment is present) and relatively high false-positive rates (test indicates impairment when no impairment is present). Additionally, MMSE score is affected by education, race, and gender. Despite these limitations, the MMSE provides a “quick-and-dirty” assessment of overall cognitive function, and in most contexts a score of 22 or lower is considered an accurate mark of clinically significant cognitive impairment.
Mossello E, Boncinelli M. Mini-Mental State Examination: a 30year story. Aging Clin Exp Res. 2006;18:271-273.
Folstein MF, Folstein SE, McHugh PR: Mini-mental state: a practical method for grading the cognitive state of outpatients for the clinician. J Psychiatr Res 1975; 12:189-198.