MMSE—Popular Mental Status Exam
Mini-Mental State Exam (MMSE) Evaluates Possible Dementia.
Probably the world’s most widely used adult mental status exam, the MMSE has been around since 1975. It was designed to test different brain functions in a quick way in the general public. The person being tested answers questions and performs simple tasks, getting points for successes. A total of 30 points is possible. The MMSE is often used to evaluate possible Alzheimer's disease.
What Is Tested
Place Orientation. The subject is asked about the location (where the subject is at the time), including the city, county and state. A substitute for county is used in Washington, DC, where there is no county, in some Virginia cities that are not within counties, and in other countries where there is no county equivalent. This is an example of how the test is adapted to local populations.
Time orientation. Includes knowledge of month, date, weekday, year and season.
Registration. The subject must repeat a list of three words, and is asked to memorize them.
Calculation or Attention. The task is to do serial subtractions (five calculations); or, spell a five letter word backwards. Usually the word is “world.”
Recall. Repeat the three words in the Registration section.
Other challenges are to name common objects, follow simple commands, write a sentence, and copy a diagram.
Interpretation
While the test has wide acceptance, one weakness is that the examiner must interpret responses, a subjective process. Different examiners might score the same response differently, and local adaptations can affect comparisons. Internal consistency and test-retest validity have been reported from 0.68 to 0.95.
Generally, a score of less than 23 is considered suggestive of possible dementia.
Age and Education
A mistake is to ignore age and education in interpreting MMSE scores. There are useful statistical guidelines based on population studies. One way to consider these is to look at the median and 25 percentile scores. The median score is the score that half the population exceeds; the 25 percentile score is the score that 75% of the population exceeds. An MMSE score higher than the 25 percentile can be considered normal, at least in some terms.
Here are examples of age and education level effects on median and 25 percentile scores. Key: median/25 percentile
Age 60-64. Education 5-8 years: 27/24; 9-12 years: 28/27; Some college: 29/28
Age 80-84. Education 5-8 years: 25/22; 9-12 years: 26/23; Some college: 28/26
Thus, a score of 23 in a 64 year old with less than nine years education is “abnormal,” while the same score in an 80 year old with similar education is “normal.”
References
Tombaugh, TN, and McIntyre NJ: “The Mini-Mental State Examination.” Journal of the American Geriatrics Society 1992; 40: 922-935
Crum RM, Anthony JC, Bassett SS, et al.: “Population-based norms for the mini-mental state examination by age and educational level.” Journal of the American Medical Association 1993;269:2386-91.
What do you think about this article?
More in Health & Wellness
Latest Articles