Mini–mental state examination: Difference between revisions
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[[Image:InterlockingPentagons.svg|right|framed|Interlocking pentagons used for the last question]] |
[[Image:InterlockingPentagons.svg|right|framed|Interlocking pentagons used for the last question]] |
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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).<ref name=Folstein/> |
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).<ref name=Folstein/> |
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Although consistent application of identical questions increases the reliability of comparisons made using the scale, the test is sometimes customized (for example, for use on patients that are [[Intubation|intubated]], [[blind]], or partially immobilized. Also, some have questioned the use of the test on the [[deaf]].<ref name="pmid19861331">{{cite journal |author=Dean PM, Feldman DM, Morere D, Morton D |title=Clinical evaluation of the mini-mental state exam with culturally deaf senior citizens |journal=Arch Clin Neuropsychol |volume=24 |issue=8 |pages=753–60 |year=2009 |month=December |pmid=19861331 |doi=10.1093/arclin/acp077 |url=http://acn.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=19861331}}</ref>) However, the number of points assigned per category is usually consistent: |
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{| class="wikitable" |
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! Category |
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! Possible points |
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! Description |
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| Orientation to time |
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| 5 |
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| From broadest to most narrow. Orientation to time has been correlated with future decline.<ref name="pmid19382130">{{cite journal |author=Guerrero-Berroa E, Luo X, Schmeidler J, ''et al.'' |title=The MMSE orientation for time domain is a strong predictor of subsequent cognitive decline in the elderly |journal=Int J Geriatr Psychiatry |volume=24 |issue=12 |pages=1429–37 |year=2009 |month=December |pmid=19382130 |doi=10.1002/gps.2282 |url=http://dx.doi.org/10.1002/gps.2282}}</ref> |
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| Orientation to place |
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| 5 |
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| From broadest to most narrow. This is sometimes narrowed down to streets,<ref name="pmid17060821">{{cite journal |author=Morales LS, Flowers C, Gutierrez P, Kleinman M, Teresi JA |title=Item and scale differential functioning of the Mini-Mental State Exam assessed using the Differential Item and Test Functioning (DFIT) Framework |journal=Med Care |volume=44 |issue=11 Suppl 3 |pages=S143–51 |year=2006 |month=November |pmid=17060821 |pmc=1661831 |doi=10.1097/01.mlr.0000245141.70946.29 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0025-7079&volume=44&issue=11&spage=S143}}</ref> and sometimes to floor.<ref name="urlMMSE">{{cite web |url=http://www.utmb.edu/psychology/ClinPsych/MiniMental.htm |title=MMSE |format= |work= |accessdate=2009-12-10}}</ref> |
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| Registration |
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| 3 |
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| Repeating named prompts |
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| Attention and calculation |
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| 5 |
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| [[Serial sevens]], or spelling "world" backwards<ref name="pmid2073308">{{cite journal |author=Ganguli M, Ratcliff G, Huff FJ, ''et al.'' |title=Serial sevens versus world backwards: a comparison of the two measures of attention from the MMSE |journal=J Geriatr Psychiatry Neurol |volume=3 |issue=4 |pages=203–7 |year=1990 |pmid=2073308 |doi= |url=}}</ref> It has been suggested that serial sevens may be more appropriate in a population where English is not the first language.<ref name="pmid15086669">{{cite journal |author=Espino DV, Lichtenstein MJ, Palmer RF, Hazuda HP |title=Evaluation of the mini-mental state examination's internal consistency in a community-based sample of Mexican-American and European-American elders: results from the San Antonio Longitudinal Study of Aging |journal=J Am Geriatr Soc |volume=52 |issue=5 |pages=822–7 |year=2004 |month=May |pmid=15086669 |doi=10.1111/j.1532-5415.2004.52226.x |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2004&volume=52&issue=5&spage=822}}</ref> |
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| Recall |
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| 3 |
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| Registration recall |
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| Language |
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| 2 |
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| Name a pencil and a watch |
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| Repetition |
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| 1 |
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| Speaking back a phrase |
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| Complex commands |
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| 6 |
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| Varies. Can involve drawing figure shown. |
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==Interpretation== |
==Interpretation== |
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*[[Mental status examination]] |
*[[Mental status examination]] |
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*[[Informant Questionnaire on Cognitive Decline in the Elderly]] (IQCODE) |
*[[Informant Questionnaire on Cognitive Decline in the Elderly]] (IQCODE) |
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*[[NIH stroke scale]] |
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==References== |
==References== |
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Revision as of 05:42, 11 December 2009
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.
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]
Although consistent application of identical questions increases the reliability of comparisons made using the scale, the test is sometimes customized (for example, for use on patients that are intubated, blind, or partially immobilized. Also, some have questioned the use of the test on the deaf.[3]) However, the number of points assigned per category is usually consistent:
| Category | Possible points | Description |
|---|---|---|
| Orientation to time | 5 | From broadest to most narrow. Orientation to time has been correlated with future decline.[4] |
| Orientation to place | 5 | From broadest to most narrow. This is sometimes narrowed down to streets,[5] and sometimes to floor.[6] |
| Registration | 3 | Repeating named prompts |
| Attention and calculation | 5 | Serial sevens, or spelling "world" backwards[7] It has been suggested that serial sevens may be more appropriate in a population where English is not the first language.[8] |
| Recall | 3 | Registration recall |
| Language | 2 | Name a pencil and a watch |
| Repetition | 1 | Speaking back a phrase |
| Complex commands | 6 | Varies. Can involve drawing figure shown. |
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)[9]. The raw score may also need to be corrected for educational attainment and age.[10] 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.[11][12] 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).[11] The enforcement of the copyright has led to researchers looking for alternative strategies in assessing cognition.[13][14]
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)
- NIH stroke scale
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:10.1016/0022-3956(75)90026-6. PMID 1202204.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ 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:10.1093/ageing/1.4.233. PMID 4669880.
- ^ Dean PM, Feldman DM, Morere D, Morton D (2009). "Clinical evaluation of the mini-mental state exam with culturally deaf senior citizens". Arch Clin Neuropsychol. 24 (8): 753–60. doi:10.1093/arclin/acp077. PMID 19861331.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Guerrero-Berroa E, Luo X, Schmeidler J; et al. (2009). "The MMSE orientation for time domain is a strong predictor of subsequent cognitive decline in the elderly". Int J Geriatr Psychiatry. 24 (12): 1429–37. doi:10.1002/gps.2282. PMID 19382130.
{{cite journal}}: Explicit use of et al. in:|author=(help); Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Morales LS, Flowers C, Gutierrez P, Kleinman M, Teresi JA (2006). "Item and scale differential functioning of the Mini-Mental State Exam assessed using the Differential Item and Test Functioning (DFIT) Framework". Med Care. 44 (11 Suppl 3): S143–51. doi:10.1097/01.mlr.0000245141.70946.29. PMC 1661831. PMID 17060821.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ "MMSE". Retrieved 2009-12-10.
- ^ Ganguli M, Ratcliff G, Huff FJ; et al. (1990). "Serial sevens versus world backwards: a comparison of the two measures of attention from the MMSE". J Geriatr Psychiatry Neurol. 3 (4): 203–7. PMID 2073308.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) - ^ Espino DV, Lichtenstein MJ, Palmer RF, Hazuda HP (2004). "Evaluation of the mini-mental state examination's internal consistency in a community-based sample of Mexican-American and European-American elders: results from the San Antonio Longitudinal Study of Aging". J Am Geriatr Soc. 52 (5): 822–7. doi:10.1111/j.1532-5415.2004.52226.x. PMID 15086669.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Mungas, D (1991). "In-office mental status testing: a practical guide". Geriatrics. 46 (7): 54–56.
- ^ Crum RM, Anthony JC, Bassett SS, Folstein MF (1993). "Population-based norms for the Mini-Mental State Examination by age and educational level". JAMA. 269 (18): 2386–91. doi:10.1001/jama.269.18.2386. PMID 8479064.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ a b Powsner S, Powsner D (2005). "Cognition, copyright, and the classroom". The American journal of psychiatry. 162 (3): 627–8. doi:10.1176/appi.ajp.162.3.627-a. PMID 15741491.
- ^ "Mini-Mental State Examination. Psychological Assessment Resources, Inc". Retrieved 2006-06-22.
- ^ Holsinger T, Deveau J, Boustani M, Williams JW (2007). "Does this patient have dementia?". JAMA. 297 (21): 2391–404. doi:10.1001/jama.297.21.2391. PMID 17551132.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Mini-Mental State Exam (MMSE) Copyright, M. Smith, University of Iowa College of Nursing