Mini mental state examination

What is the mini mental state examination (MMSE)?

The mini mental state examination (MMSE) is a commonly used set of questions for screening cognitive function.¹ This examination is not suitable for making a diagnosis but can be used to indicate the presence of cognitive impairment, such as in a person with suspected dementia or following a head injury.²

The mini mental state examination is far more sensitive in detecting cognitive impairment than the use of informal questioning or overall impression of a patient's orientation. The benefits of the MMSE include:

• The test takes only about 10 minutes but is limited because it will not detect subtle memory losses, particularly in well-educated patients.³

• In interpreting test scores, allowance may have to be made for education and ethnicity.⁴

• The mini mental state examination provides measures of orientation, registration (immediate memory), short-term memory (but not long-term memory) as well as language functioning.

• The examination has been validated in a number of populations. Scores of 25-30 out of 30 are considered normal, 21-24 as mild, 10-20 as moderate and below 10 as severe impairment.

Before administering the Mini Mental State Examination it is important to make the patient comfortable and to establish a rapport. Praising success may help to maintain the rapport and is acceptable. However, persisting on items the patient finds difficult should be avoided.

However, a Cochrane review did not find evidence supporting a substantial role of MMSE as a stand-alone single-administration test in the identification of mild cognitive impairment for patients who could develop dementia.⁵

A further Cochrane review concluded that MMSE contributes to a diagnosis of dementia in low prevalence settings, but should not be used in isolation to confirm or exclude disease.⁶

The findings of one review suggested that the delayed recall test and the verbal fluency test of the Brief Cognitive Screening Battery (BCSB) are better than the MMSE and clock-drawing test as tools for evaluating cognition in people with limited education.⁷ Therefore the MMSE may also not be an appropriate assessment for someone who has learning, linguistic/communication or other disabilities (eg, sensory impairments).

The National Institute for Health and Care Excellence (NICE) guideline for the assessment and management of people with dementia does not refer to the MMSE. Instead the guideline states for the initial assessment in non-specialist settings:⁸

• At the initial assessment take a history (including cognitive, behavioural and psychological symptoms, and the impact symptoms have on their daily life) from the person with suspected dementia, and if possible from someone who knows the person well (such as a family member).

• If dementia is still suspected after initial assessment, conduct a physical examination, undertake appropriate blood and urine tests to exclude reversible causes of cognitive decline, and use cognitive testing.

• When using cognitive testing, use a validated brief, structured cognitive instrument such as:

• • The 10-point cognitive screener (10-CS).

  • The 6-item cognitive impairment test (6CIT).

  • The 6-item screener.

  • The Memory Impairment Screen (MIS).

  • The Mini-Cog.

  • Test Your Memory (TYM).

• Do not rule out dementia solely because the person has a normal score on a cognitive instrument.

Copyright

The mini mental state examination was originally distributed without cost but the current copyright holders are Psychological Assessment Resources (PAR) who "will not grant permission to include or reproduce an entire test or scale in any publication (including dissertations and theses) or on any website". All users will need to purchase the tests from PAR.⁹

We regret, therefore, that we have removed further details of the test from this site. GPs may alternatively use the General Practitioner Assessment of Cognition (GPCOG) test.