Mini-Mental State Examination

Original Editor - Simisola Ajeyalemi

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Top Contributors - Simisola Ajeyalemi and Kim Jackson  

Description

The Mini-mental state examination is used to measure cognitive impairment in older adults. According to Folstein et al, it can be used to screen for cognitive impairment, to estimate the severity of cognitive impairment at a given point in time, to follow the course of cognitive changes in an individual over time, and to document an individual’s response to treatment.[1] It assesses different subset of cognitive status including attention, language, memory, orientation, visuospatial proficiency. It has also been recommended for the screening of cognition in depressed patients[2] The mini-mental state examination is proprietary and takes about 10-15 minutes to administer.

According to some studies, patients with Alzheimer's disease score significantly lower on orientation to time and place, and recall compared to patients with dementia with Lewy bodies, vascular dementia and Parkinson's dementia.[3][4][5] However, it should not be used to exclusively diagnose or differentiate the different types of dementia.[6][7]

The Mini-Cog and revised Addenbrooke's Cognitive Examination are preferred alternatives to the Mini-Mental State Examination for dementia screening, and the Montreal Cognitive Assessment is a preferred alternative to detect mild cognitive impairment.[8]


Scoring and Interpretation of Scores

The Mini-mental state examination is scored on a scale of 0-30 with scores > 25 interpreted as normal cognitive status.

  • Severe cognitive impairment: 0-17
  • Mild cognitive impairment: 18-23
  • No cognitive impairment: 24-30

Interpretation of the mental status examination must take into account the patient's native language, education level, and culture as these factors can affect perfromance.[9]

Validity

In 14 studies, the MMSE had a sensitivity of 88.3% (95% confidence interval [CI], 81.3% to 92.9%) and a specificity of 86.2% (95% CI, 81.8% to 89.7%) for dementia, with a score cutoff of 23 to 25 indicating significant impairment.[8] A more recent meta-analysis of 108 cohort studies found a sensitivity of 81% (95% CI, 78% to 84%) and specificity of 89% (95% CI, 87% to 91%)[10]

References

  1. 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.
  2. Special Report, Expert Consensus Guideline Series, Postgraduate Medicine, October 2001.
  3. Ala, TA; Hughes, LF; Kyrouac, GA; Ghobrial, MW; Elble, RJ. "The Mini-Mental Status exam may help in the differentiation of dementia with Lewy bodies and Alzheimer's disease". International Journal of Geriatric Psychiatry.  June 2002;17 (6): 503–9. 
  4. Jefferson, AL; Cosentino, SA; Ball, SK; Bogdanoff, B; Leopold, N; Kaplan, E; Libon, DJ. "Errors produced on the mini-mental status examination and neuropsychological test performance in Alzheimer's disease, ischemic vascular dementia, and Parkinson's". The Journal of Neuropsychiatry and Clinical Neurosciences. 2002;14 (3): 311–20. 
  5. Palmqvist, S; Hansson, O; Minthon, L; Londos, E. "Practical suggestions on how to differentiate dementia with Lewy bodies from Alzheimer's disease with common cognitive tests". International Journal of Geriatric Psychiatry. December 2009;24 (12): 1405–12. 
  6. Arevalo-Rodriguez I.; Smailagic N.; Ciapponi A.; Sanchez-Perez E.; Giannakou A.; Figuls M.; Cullum S. "Mini-Mental Status Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI)". 2015. 
  7. Creavin ST, Wisniewski S, Noel-Storr AH, et al. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016;(1):CD011145.
  8. 8.0 8.1 Tsoi KK, Chan JY, Hirai HW, Wong SY, Kwok TC. Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Intern Med. 2015;175(9):1450–1458.
  9. Faber RA. The neuropsychiatric mental status examination. Semin Neurol. 2009;29(3):185–193. Level of evidence C
  10. Lin JS, O'Connor E, Rossom RC, Perdue LA, Eckstrom E. Screening for cognitive impairment in older adults: a systematic review for the U.S. Preventive Services Task Force [published correction appears in Ann Intern Med. 2014;160(1):72]. Ann Intern Med. 2013;159(9):601–612.