Dr KK Answers: What is Mini-Mental State Examination?

Is the most widely used cognitive test for dementia. The examination takes approximately seven minutes to complete. It tests a broad range of cognitive functions including orientation, recall, attention, calculation, language manipulation, and constructional praxis.

The MMSE includes the following tasks:

• What is the date: (year)(season)(date)(day)(month) - 5 points
• Where are we: (state)(county)(town)(hospital)(floor) - 5 points
• Name three objects: Ask the patient all three after you have said them. Give one point for each correct answer. Then repeat them until he/she learns all three. Count trials and record. The first repetition determines the score, but if the patient cannot learn the words after six trials then recall cannot be meaningfully tested. Maximum score - 3 points.
• Serial 7s, beginning with 100 and counting backward: one point for each correct; stop after five answers. Alternatively, spell WORLD backwards: one point for each letter in correct order. Maximum score - 5 points.
• Ask for the three objects repeated above: one point for each correct. Maximum score - 3 points.
• Show and ask patient to name a pencil and wrist watch - 2 points.
• Repeat the following, "No ifs, ands, or buts." Allow only one trial - 1 point.
• Follow a three stage command, "Take a paper in your right hand, fold it in half, and put it on the floor." Score one point for each task executed. Maximum score - 3 points.
• On a blank piece of paper write "close your eyes;" ask the patient to read and do what it says - 1 point.
• Give the patient a blank piece of paper and ask him/her to write a sentence. The sentence must contain a noun and verb and be sensible - 1 point.
• Ask the patient to copy a design (eg, intersecting pentagons). All 10 angles must be present and two must intersect - 1 point.

 A total maximal score on the MMSE is 30 points. A score of less than 24 points is suggestive of dementia or delirium. Using a cutoff of 24 points, the MMSE had a sensitivity of 87 percent and a specificity of 82 percent.

The test is not sensitive for mild dementia, and scores may be influenced by age and education, as well as language, motor, and visual impairments.

For research purposes, some investigators use a cutoff score of 26 or 27 in symptomatic populations in order to not miss few true cases.