Formal MMSE
- Orientation for time- year, season, date, day, month (5 points)
- Orientation in place- country, county, town, hospital, ward (5 points)
- Registration of new information- repeat carrot, purple, library (3 points)
- Attention/Concentration- spell WORLD backwards (5 points)
- Short term memory- recall the above three words (3 points)
- Language- (9 points)
- Name 2 objects (2)
- Repeat “no ifs, ands or buts” (1)
- Three stage command “take this piece of paper with your right hand, fold it in half and put it on the floor (3)
- Read and obey (Close your eyes) (1)
- Write a sentence (subject/verb/makes sense) (1)
- Copy this diagram: (1)
Total Score out of 30. 23 is taken as cut off for significant mental impairment in most elderly
Suggested Mini-mental status exam
- Age
- Time (to 1 hour)
- Address for recall at end of test (patient should repeat to ensure heard correctly)
- Year
- Name of institution
- Recognition 2 persons (e.g. doctor, nurse)
- Date of birth
- Date St. Patrick's day
- Present Taoiseach
- Count backwards 20 - 1
Dementia
Is an acquired syndrome of decline in memory and at least one other cognitive domain such as language, visuo-spatial, or executive function sufficient to interfere with social or occupational functioning in an alert person.
- Commonest causes are Alzheimer's disease (70%) and cerebrovascular ischaemia (vascular dementia) (20-30%)
- Dementia causes a high burden of suffering for patients and their families
- Age is the strongest risk factor for dementia:
- 3% - 11% >65yo have dementia, (rising to 25% - 47 % in those >85yo)
- 1st degree relatives have x2 the risk of developing dementia compared with general population
- CVS risk factors (e.g. ↑BP) risk of both Alzheimer's disease and vascular dementia
Mini-Mental Statue Examination (MMSE)
- The Mini-Mental Status Exam (MMSE) is the best-studied instrument for screening for cognitive impairment
- Similar sensitivity and specificity as using a more detailed Functional Activities Questionnaire (FAQ)
- The accuracy of the MMSE depends upon a person's age and educational level
- Early detection of dementia is important for both the patient and care givers
Potential treatment options
Cholinesterase inhibitors: moderate supporting RCT evidence (they slow progression of symptoms if used early)
Ginkgo biloba, selegeline, vitamin E, and oestrogen: No real evidence in favour of their use.
Management of ↑BP in vascular dementia: No strong evidence supporting pharmacotherapy
Non-pharmacological Interventions: (e.g. behaviour training) Some weak supporting evidence for caregiver burden
Links
- U.S. Preventive Services Task Force - Screening For Dementia
- Print version MMSE (Oxford Medical, Cork)