Mini-Mental State Examination


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)
    Intersecting Pentagons

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



Content by Dr Íomhar O' Sullivan 10/02/2007. Last review Dr ÍOS 10/06/21.