Mini Mental State Examination (MMSE) Notes

Mini Mental State Examination (MMSE)

Overview

The Mini Mental State Examination (MMSE) is a brief cognitive assessment tool used to identify potential cognitive impairment. It was first published in 1975 by Folstein et al.

• The MMSE consists of 12 questions or tasks administered by an evaluator to a client.

Evaluated Areas of Mental Ability

The MMSE assesses six key areas of cognitive function:

1. Awareness of Time and Place
2. Attention and Concentration
3. Short-Term Memory
4. Language Skills
5. Visual-Spatial Relationship
6. Ability to Follow Directions

MMSE Questions and Tasks

The MMSE includes a variety of questions and tasks to assess cognitive function. Here's a breakdown of the tasks:

1. Orientation to Time (5 points total)

   • Time allowed: 10 seconds per reply.
   • a) What year is this? (Accept exact answer only) /1
   • b) What season is this? (Accept either the last week of the old season or the first week of a new season) /1
   • c) What month is this? (Accept either the first day of a new month or the last day of the previous month) /1
   • d) What is today's date? (Accept previous or next date) /1
   • e) What day of the week is this? (Accept exact answer only) /1

2. Orientation to Place (5 points total)

   • Time allowed: 10 seconds per reply.
   • a) What country are we in? (Accept exact answer only) /1
   • b) What province are we in? (Accept exact answer only) /1
   • c) What city/town are we in? (Accept exact answer only) /1
   • d) (In home) What is the street address of this house? (Accept street name and house number or equivalent in rural areas). (In facility) What is the name of this building? (Accept exact name of institution only) /1
   • e) (In home) What room are we in? (Accept exact answer only). (In facility) What floor of the building are we on? (Accept exact answer only) /1

3. Immediate Recall (3 points total)

   • Time allowed: 20 seconds.
   • The evaluator says: "I am going to name three objects. When I am finished, I want you to repeat them. Remember what they are because I am going to ask you to name them again in a few minutes."
   • Example objects: Ball/Car/Man (For repeated use: Bell, jar, fan; Bill, tar, can; Bull, bar, pan).
   • The subject repeats the three items. (Score one point for each correct reply on the first attempt.)
   • If the person did not repeat all three, repeat until they are learned or up to a maximum of five times (but only score first attempt).

4. Attention and Calculation (5 points total)

   • Time allowed: 30 seconds.
   • Spell the word WORLD. (You may help the person to spell the word correctly). Then Say: Now spell it backwards please.
   • If the subject cannot spell world even with assistance, score 0.

5. Delayed Recall (3 points total)

   • Time allowed: 10 seconds.
   • Say: "Now what were the three objects I asked you to remember?"
   • (Score one point for each correct answer regardless of order).

6. Naming (2 points total)

   • Time allowed: 10 seconds.
   • Show a wristwatch. Ask: "What is this called?"
     • Score one point for correct response: accept "wristwatch" or "watch"; do not accept "clock" or "time", etc.
   • Show a pencil. Ask: "What is this called?"
     • Score one point for correct response; accept "pencil" only; score 0 for pen

7. Repetition (1 point total)

   • Time allowed: 10 seconds.
   • Say: "I would like you to repeat a phrase after me: No ifs, ands or buts"
   • Score one point for a correct repetition. Must be exact, e.g. no ifs or buts, score 0.

8. Following a Written Command (1 point total)

   • Time allowed: 10 seconds.
   • Say: "Read the words on this page and then do what it says." Then, hand the person the sheet with CLOSE YOUR EYES on it.
   • If the subject just reads and does not close eyes, you may repeat: Read the words on this page and then do what it says, (a maximum of three times.
   • Score one point only if the subject closes eyes. The subject does not have to read aloud.

9. Writing a Sentence (1 point total)

   • Time allowed: 30 seconds.
   • Hand the person a pencil and paper. Say: "Write any complete sentence on that piece of paper."
   • Score one point. The sentence must make sense. Ignore spelling errors.

10. Copying a Design (1 point total)

    • Time allowed: 1 minute maximum.
    • Place design, eraser, and pencil in front of the person. Say: "Copy this design please." Allow multiple tries. Wait until the person is finished and hands it back.
    • Score one point for a correctly copied diagram. The person must have drawn a four-sided figure between two five-sided figures.

11. Three-Stage Command (3 points total)

    • Time allowed: 30 seconds.
    • Ask the person if he is right or left handed. Take a piece of paper, hold it up in front of the person and say: "Take this paper in your right/left hand (whichever is non-dominant), fold the paper in half once with both hands and put the paper down on the floor."
    • Score one point for each instruction executed correctly.

MMSE Scoring

The MMSE is scored out of 30 points. These points are categorized as follows:

• 30-26 points: Could be normal.
• 25-20 points: Mild Cognitive Impairment.
• 19-10 points: Moderate Cognitive Impairment.
• 9-0 points: Severe Cognitive Impairment.

Stages of Cognitive Impairment and Functional Impairment

Limitations of the MMSE

The MMSE has limitations that should be considered when interpreting the results:

• A low score does not definitively indicate dementia. Factors influencing the score include:
  1. Physical problems
  2. Intellectual disability
  3. Language or speech issues
  4. Education level
  5. Cultural differences
• A high score does not guarantee normal cognitive function, especially in highly educated individuals in the early stages of dementia.

A complete picture of cognitive health requires additional tests.

Other Cognitive Assessments

If the results of the MMSE are questionable, consider using secondary assessments such as:

1. Montreal Cognitive Assessment (MoCA)
2. Mini-Cog
3. Clock Drawing Test