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Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.
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 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.
- In interpreting test scores, allowance may have to be made for education and ethnicity.
- 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.
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.
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. 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:
- 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.
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.
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
Dementia; NICE CKS, May 2021 (UK access only)
Norris D, Clark MS, Shipley S; The Mental Status Examination. Am Fam Physician. 2016 Oct 1594(8):635-641.
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.
Arevalo-Rodriguez I, Smailagic N, Roque-Figuls M, et al; Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev. 2021 Jul 277:CD010783. doi: 10.1002/14651858.CD010783.pub3.
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 Jan 13(1):CD011145. doi: 10.1002/14651858.CD011145.pub2.
Scarabelot LF, Monteiro MM, Rubert MCDS, et al; Is the Mini-Mental State Examination the best cognitive screening test for less educated people? Arq Neuropsiquiatr. 2019 May 177(5):330-334. doi: 10.1590/0004-282X20190043.
Dementia: assessment, management and support for people living with dementia and their carers; NICE Guideline (June 2018)
Mini-Mental® State Examination (MMSE®); Psychological Assessment Resources (PAR)