The mini mental state examination (MMSE)¹ is the most commonly used instrument for screening cognitive function. This examination is not suitable for making a diagnosis but can be used to indicate the presence of cognitive impairment, such as in a person with suspected dementia or following a head injury.² The MMSE is far more sensitive in detecting cognitive impairment than the use of informal questioning or overall impression of a patient's orientation.

• The test takes only about 10 minutes, but is limited because it will not detect subtle memory losses, particularly in well-educated patients.³
• People from different cultural groups, or of low intelligence or education, may score poorly on this examination in the absence of cognitive impairment⁴ and well-educated people may score well despite having cognitive impairment.⁵
• The MMSE provides measures of orientation, registration (immediate memory), short-term memory (but not long-term memory) as well as language functioning.
• The examination has been validated in a number of populations. Scores of 25-30 out of 30 are considered normal; NICE classify 21-24 as mild, 10-20 as moderate and <10 as severe impairment. The MMSE may not be an appropriate assessment if the patient has learning, linguistic/communication or other disabilities (e.g. sensory impairments).⁶

Before administering the MMSE it is important to make the patient comfortable and to establish a rapport with the patient. Praising success may help to maintain the rapport and is acceptable, but persisting on items the patient finds difficult should be avoided.

Copyright

The mini-mental state examination was originally distributed free, but the current copyright holders are Psychological Assessment Resources (PAR) who "will not grant permission to include or reproduce an entire test or scale in any publication (including dissertations and theses) or on any website ".⁷ All users will need to purchase the tests from PAR.

We regret therefore that we have removed further details of the test from this site. GPs may prefer to use the General Practitioner's Assessment of Cognition (GPCOG) Score test.

Document references

1. Folstein MF, Folstein SE, McHugh PR; "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98.
2. Crum RM, Anthony JC, Bassett SS, et al; Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993 May 12;269(18):2386-91. [abstract]
3. Small GW; What we need to know about age related memory loss. BMJ. 2002 Jun 22;324(7352):1502-5.
4. Tombaugh TN, McIntyre NJ; The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992 Sep;40(9):922-35. [abstract]
5. Brayne C, Calloway P; The association of education and socioeconomic status with the Mini Mental State Examination and the clinical diagnosis of dementia in elderly people. Age Ageing. 1990 Mar;19(2):91-6. [abstract]
6. Dementia: Supporting people with dementia and their carers in health and social care, NICE Clinical Guideline (2006)
7. Mini-Mental® State Examination (MMSE®), Psychological Assessment Resources (PAR).

Internet and further reading

• Mini-Mental® State Examination (MMSE®), Psychological Assessment Resources (PAR).

Acknowledgements