Folstein Mini-Mental Status Examination (MMSE)

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Introduction

Type: mental status examination

Advantages

  • easy to administer

Disadvantages

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[9]
    • > 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 27/30 is considered normal

A score of < 23 is suggestive of cognitive impairment.

A score of < 22 indicates dementia[5]

Notes

More general terms

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: https://www.ncbi.nlm.nih.gov/pubmed/1202204
  5. 5.0 5.1 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. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26052687 <Internet> http://archinte.jamanetwork.com/article.aspx?articleID=2301149
  8. 8.0 8.1 8.2 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. 9.0 9.1 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: https://www.ncbi.nlm.nih.gov/pubmed/8479064
  10. 10.0 10.1 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: https://www.ncbi.nlm.nih.gov/pubmed/36346002 Free article
  11. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022