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 impairment^[4] 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 (eg 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.