Mini-mental state examination

The mini-mental state examination (MMSE) or Folstein test is a brief 30-point questionnaire test that is used to assess cognition. It is commonly used in medicine to screen for dementia. 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,cite journal |author=Folstein MF, Folstein SE, McHugh PR |title="Mini-mental state". A practical method for grading the cognitive state of patients for the clinician |journal=Journal of psychiatric research |volume=12 |issue=3 |pages=189–98 |year=1975 |pmid=1202204 |doi=10.1016/0022-3956(75)90026-6] and is widely used with small modifications. This test is not the same thing as a mental status examination.

Various other tests are also used, such as the Hodkinson [cite journal |author=Hodkinson HM |title=Evaluation of a mental test score for assessment of mental impairment in the elderly |journal=Age and ageing |volume=1 |issue=4 |pages=233–8 |year=1972 |pmid=4669880 |doi=10.1093/ageing/1.4.233] abbreviated mental test score (1972, geriatrics) and 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, language use and comprehension, and basic motor skills. For example, one question asks to copy a drawing of two pentagons (shown on the right).

Interpretation

Any score over 27 (out of 30) is effectively normal. Below this, 20-26 indicates mild dementia; 10-19 moderate dementia, and below 10 severe dementia. The normal value is also corrected for degree of schooling and age. [cite journal |author=Crum RM, Anthony JC, Bassett SS, Folstein MF |title=Population-based norms for the Mini-Mental State Examination by age and educational level |journal=JAMA |volume=269 |issue=18 |pages=2386–91 |year=1993 |month=May |pmid=8479064 |doi= |url=] 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

With the significant popularity of the test, the current MMSE copyright owner Psychological Assessment Resources (PAR) decided, after many years, to start enforcing the copyright and set-up a website to sell official versions of the test.cite journal |author=Powsner S, Powsner D |title=Cognition, copyright, and the classroom |journal=The American journal of psychiatry |volume=162 |issue=3 |pages=627–8 |year=2005 |pmid=15741491 |doi=10.1176/appi.ajp.162.3.627-a | url=http://ajp.psychiatryonline.org/cgi/content/full/162/3/627-a] [cite web | title=Mini-Mental State Examination. Psychological Assessment Resources, Inc. | url=http://www.minimental.com/ | accessdate=2006-06-22]

The enforcement of the copyright on the MMSE has been compared to stealth patents, where a patent holder waits until an invention gains widespread popularity until commencing enforcement. The enforcement of the copyright has led to researchers looking for alternative strategies in assessing cognition. [cite journal |author=Holsinger T, Deveau J, Boustani M, Williams JW |title=Does this patient have dementia? |journal=JAMA |volume=297 |issue=21 |pages=2391–404 |year=2007 |month=June |pmid=17551132 |doi=10.1001/jama.297.21.2391 |url=http://jama.ama-assn.org/cgi/content/full/297/21/2391]

References

ee also

*Mental status examination
*Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)