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The mini mental state examination (MMSE) is a commonly used set of questions for screening cognitive function. 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. The MMSE is far more sensitive in detecting cognitive impairment than the use of informal questioning or overall impression of a patient's orientation.
- The test takes only about 10 minutes but is limited because it will not detect subtle memory losses, particularly in well-educated patients.
- In interpreting test scores, allowance may have to be made for education and ethnicity.
- The MMSE 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; the National Institute for Health and Care Excellence (NICE) classifies 21-24 as mild, 10-20 as moderate and <10 as severe impairment. The MMSE may not be an appropriate assessment if the patient has learning, linguistic/communication or other disabilities (eg, sensory impairments).
Before administering the MMSE 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.
The MMSE 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.
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.
Further reading and references
Mitolo M, Salmon DP, Gardini S, et al; The New Qualitative Scoring MMSE Pentagon Test (QSPT) as a Valid Screening Tool between Autopsy-Confirmed Dementia with Lewy Bodies and Alzheimer's Disease. J Alzheimers Dis. 2013 Nov 27.
de Boer C, Mattace-Raso F, van der Steen J, et al; Mini-Mental State Examination subscores indicate visuomotor deficits in Alzheimer's disease patients: A cross-sectional study in a Dutch population. Geriatr Gerontol Int. 2013 Nov 15. doi: 10.1111/ggi.12183.
Sallam K, Amr M; The use of the mini-mental state examination and the clock-drawing test for dementia in a tertiary hospital. J Clin Diagn Res. 2013 Mar7(3):484-8. doi: 10.7860/JCDR/2013/4203.2803. Epub 2013 Mar 1.
Costa PS, Santos NC, Cunha P, et al; The use of bayesian latent class cluster models to classify patterns of cognitive performance in healthy ageing. PLoS One. 2013 Aug 208(8):e71940. doi: 10.1371/journal.pone.0071940.
Spering CC, Hobson V, Lucas JA, et al; Diagnostic accuracy of the MMSE in detecting probable and possible Alzheimer's disease in ethnically diverse highly educated individuals: an analysis of the NACC database. J Gerontol A Biol Sci Med Sci. 2012 Aug67(8):890-6. doi: 10.1093/gerona/gls006. Epub 2012 Mar 6.
Dementia: Supporting people with dementia and their carers in health and social care; NICE Clinical Guideline (November 2006, last updated September 2016)
Mini-Mental® State Examination (MMSE®); Psychological Assessment Resources (PAR)
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