The mini-mental state examination (MMSE) or Folstein test is a brief 30-point questionnaire test that is used to screen for cognitive impairment. It is commonly used in medicine to screen for dementia. It is also used to estimate the severity of cognitive impairment at a given point in time and to follow the course of cognitive changes in an individual over time, thus making it an effective way to document an individual's response to treatment.
In the time span of about 10 minutes it samples various functions including arithmetic, memory and orientation. It was introduced by Folstein et al. in 1975,[1]. This test is not the same thing as a mental status examination. The standard MMSE form which is currently published by Psychological Assessment Resources is based on its original 1975 conceptualization, with minor subsequent modifications by the authors.
Various other tests are also used, such as the Hodkinson[2] abbreviated mental test score (1972, geriatrics) or the General Practitioner Assessment Of Cognition as well as longer formal tests for deeper analysis of specific deficits.
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The test
The MMSE test includes simple questions and problems in a number of areas: the time and place of the test, repeating lists of words, arithmetic such as the serial sevens, language use and comprehension, and basic motor skills. For example, one question asks to copy a drawing of two pentagons (shown on the right).[1]
Interpretation
Any score greater than or equal to 25 points (out of 30) is effectively normal (intact). Below this, scores can indicate severe (≤9 points), moderate (10-20 points) or mild (21-24 points)[3]. The raw score may also need to be corrected for educational attainment and age.[4] Low to very low scores correlate closely with the presence of dementia, although other mental disorders can also lead to abnormal findings on MMSE testing. The presence of purely physical problems can also interfere with interpretation if not properly noted; for example, a patient may be physically unable to hear or read instructions properly, or may have a motor deficit that affects writing and drawing skills.
Copyright issues
Originally, the MMSE was distributed widely for free. However, the current version of the MMSE is owned by copyright owner Psychological Assessment Resources (PAR). Despite the many free versions of the test that are available on the internet, the official version is copyrighted and must be ordered through PAR.[5][6] The enforcement of the copyright on the MMSE has been compared to "stealth", or "submarine" patents, where a patent applicant would wait until an invention gains widespread popularity until allowing the patent to issue and only then commencing enforcement (such patent applications are no longer possible with changes made to the patent term).[5] The enforcement of the copyright has led to researchers looking for alternative strategies in assessing cognition.[7][8]
See also
- Abbreviated mental test score A shorter, 10 question screen for impaired cognition.
- General Practitioner Assessment Of Cognition A brief screening tool designed for General Practitioners and Primary Care Physicians
- Mental status examination
- Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
References
- ^ a b Folstein MF, Folstein SE, McHugh PR (1975). ""Mini-mental state". A practical method for grading the cognitive state of patients for the clinician". Journal of psychiatric research 12 (3): 189–98. doi:. PMID 1202204.
- ^ Hodkinson HM (1972). "Evaluation of a mental test score for assessment of mental impairment in the elderly". Age and ageing 1 (4): 233–8. doi:. PMID 4669880.
- ^ Mungas, D (1991). "In-office mental status testing: a practical guide". Geriatrics 46 (7): 54-56.
- ^ Crum RM, Anthony JC, Bassett SS, Folstein MF (May 1993). "Population-based norms for the Mini-Mental State Examination by age and educational level". JAMA 269 (18): 2386–91. doi:. PMID 8479064.
- ^ a b Powsner S, Powsner D (2005). "Cognition, copyright, and the classroom". The American journal of psychiatry 162 (3): 627–8. doi:. PMID 15741491. http://ajp.psychiatryonline.org/cgi/content/full/162/3/627-a.
- ^ "Mini-Mental State Examination. Psychological Assessment Resources, Inc.". http://www.minimental.com/. Retrieved 2006-06-22.
- ^ Holsinger T, Deveau J, Boustani M, Williams JW (June 2007). "Does this patient have dementia?". JAMA 297 (21): 2391–404. doi:. PMID 17551132. http://jama.ama-assn.org/cgi/content/full/297/21/2391.
- ^ Mini-Mental State Exam (MMSE) Copyright, M. Smith, University of Iowa College of Nursing
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