Folstein Mini-Mental Status Examination (MMSE)

Introduction

Type: mental status examination

Advantages

• easy to administer

Disadvantages

• language-dependent
• many attention items

Procedure

Number of items: 30

Maximum score: 30 (higher score better)

Time: 5-10 minutes

Interpretation

Cutoffs for positive dementia screening:

• • > 20/30 for patient with 6th grade education
  • > 21/30 for patient with 8th grade education
  • > 23/30 for patient with high school education
  • > 24/30 for college graduates
  • test scores do not define dementia because they imply nothing about functional skills
  • 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 < 23 is suggestive of cognitive impairment.

A score of < 22 indicates dementia

Notes

• absence of poor memory as rated by the patient's informant predicts misclassification
• years of education & heart problems also predict misclassification
• conversion between the Montreal Cognitive Assessment & the Mini-Mental Status Examination

More general terms

• mental status examination (MSE)