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Folstein Mini-Mental Status Examination (MMSE)

Type: mental status examination Procedure: Number of items: 30 Maximum score: 30 (higher score better) Time: 5-10 minutes Advantages: - easy to administer Disadvantages: 1) language-dependent 2) many attention items Interpretation: Cutoffs for positive dementia screening: a) > 20/30 for patient with 6th grade education [9] b) > 21/30 for patient with 8th grade education c) > 23/30 for patient with high school education d) > 24/30 for college graduates e) test scores do not define dementia because they imply nothing about functional skills f) demented patients may score in the normal range ability to recall only 1 of 3 items suggests dementia only 50% of elderly can correctly perform serial 7s retired persons frequently error on the date by a day or 2 ................................................ Maximum Score Orientation: - Examiner asks the subject for the date, then specifically for parts omitted. - Examiner asks the subject 'What season is it?' year, season, date, day, month. 1 point each .......... 5 - Where are we?: state, county, town, hospital, floor .... 5 Registration: - Examiner names 3 objects (1 sec to say each), then asks the subject to repeat all 3. - 1 point for each correct object. ..... 3 - Repeated until patient able to recall all 3 objects (up to 6 trials). - The number of trials required is recorded. Attention & calculation: - Serial 7s. Examiner asks patient to begin at 100 & count backward by increments of 7, (93, 86, 79,72, 65). - Stop at 5 subtractions (i.e. 65). - Score isnumber of correct answers. ..... 5 - Alternatively, if patient cannot perform serial 7s, the examiner asks the subject to spell 'world' backwards. - The score is the number of letters in correct order (i.e. 'dlrow' = 5, 'dlorw' = 3). Recall: - Examiner asks subject to recall 3 objects repeated above in registration. - 1 point for each correct answer. ..... 3 Language: - Examiner shows subject a wristwatch & asks him/her what it is - This is repeated for a pencil or pen. - 1 point for each correct answer. ..... 2 - Examiner asks patient to repeat: 'No ifs ands or buts' ...... 1 - Follow a 3-stage command. - Examiner gives the subjecta blank piece of paper with the following instructions. - 'Take this piece of paper in your right hand, fold it in half & put it on the floor. - 1 point for each step executed correctly. ... 3 - Reading: - On a blank piece of paper, the examiner writes legibly the following: - 'Close your eyes.' - The examiner asks the subject to read it & do what it says. - 1 point for closing eyes. .. 1 - Writing: - Examiner gives the subject a blank piece of paper & asks subject to write a sentence. - The examiner does not dictate a sentence. - It is to be written spontaneously. - It must contain a subject & a verb & be sensible. - Correct grammar & punctuation are unnecessary. ... 1 - Copying: - On a clean piece of paper, the examiner draws intersecting pentagons, each side about 1 inch in length. - Examiner asks subject to copy the design exactly as it is. - All 10 angles must be present & the 2 must intersect - Rotation & tremor are ignored. ....... 1 Score total: ................................................. 30 Assess the patient's level of consciousness: - Alert, Drowsy, Stupor, Coma A score of 27/30 is considered normal A score of < 23 is suggestive of cognitive impairment. A score of < 22 indicates dementia [5] Notes: - absence of poor memory as rated by the patient's informant predicts misclassification [8] - years of education & heart problems also predict misclassification [8] - conversion between the Montreal Cognitive Assessment & the Mini-Mental Status Examination [10]

General

mental status examination (MSE)

References

  1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
  2. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 728-29
  3. Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw Hill, New York, 2000, pg 93
  4. Folstein MF, Folstein SE, McHugh PR. 'Mini-mental state'. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98. No abstract available. PMID: 1202204
  5. Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012
  6. Mini-Mental State Examination. Second Edition. http://www.minimental.com
  7. Tsoi KK et al Cognitive Tests to Detect Dementia. A Systematic Review and Meta-analysis. JAMA Intern Med. Published online June 08, 2015. PMID: 26052687 http://archinte.jamanetwork.com/article.aspx?articleID=2301149
  8. Ranson JM, Kuzma E, Hamilton W et al Predictors of dementia misclassification when using brief cognitive assessments. Neurology Clinical Practice. Nov 28, 2018 http://cp.neurology.org/content/early/2018/11/28/CPJ.0000000000000566
  9. Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA 1993 May 12;269(18):2386-91. PMID: 8479064
  10. Fasnacht JS et al. Conversion between the Montreal Cognitive Assessment and the Mini-Mental Status Examination. J Am Geriatr Soc 2023 Mar; 71:869 PMID: 36346002 Free article
  11. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022