Mini Mental State Examination (MMSE)

The mini mental state examination¹ 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 when dementia or head injury are suspected.²

• 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 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, 18-24 indicate mild to moderate impairment, and scores of 17 or less indicate severe impairment.

Orientation

• What is the year, season, date, day and month (1 point for each; maximum total 5 points).
• Where are we: town, county, country, which hospital, surgery or house, and which floor (1 point for each; maximum total 5 points).

Registration

• Name 3 objects (e.g., apple, table, penny) taking 1 second to say each one.
• Then ask the individual to repeat the names of all 3 objects.
• Give 1 point for each correct answer.
• Repeat the object names until all 3 are learned (up to 6 trials).
• Record number of trials needed (maximum total 3 points).

Attention and Calculation

• Spell "world" backwards. Give 1 point for each letter that is in the right place (e.g., DLROW = 5 points, DLORW = 3 points).
• Alternatively, do serial 7s:
  • Ask the person to count backwards from 100 in blocks of 7 (i.e., 93, 86, 79, 72, 65).
  • Stop after 5 subtractions.
  • Give one point for each correct answer. If one answer is incorrect (e.g. 92) but the following answer is 7 less than the previous answer (i.e., 85), count the second answer as being correct. 1 point for each subtraction (maximum total 5 points).

Recall

• Ask for the 3 objects repeated above (e.g., apple, table, penny). Give 1 point for each correct object (maximum total 3 points).

Language

• Point to a pencil and ask the person to name this object (1 point). Do the same thing with a wrist-watch (1 point). (maximum total 2 points)
• Ask the person to repeat the following: "No ifs, ands or buts" (1 point). Allow only one trial (1 point).
• Give the person a piece of blank white paper and ask them to follow a 3-stage command: "Take a paper in your right hand, fold it in half and put it on the floor" (1 point for each part that is correctly followed). (maximum total 3 points)
• Write "CLOSE YOUR EYES" in large letters and show it to the patient. Ask him or her to read the message and do what it says (give 1 point if they actually close their eyes).
• Ask the individual to write a sentence of their choice on a blank piece of paper. The sentence must contain a subject and a verb, and must make sense. Spelling, punctuation and grammar are not important (1 point).
• Show the person a drawing of 2 pentagons which intersect to form a quadrangle. Each side should be about 1.5 cm. Ask them to copy the design exactly as it is (1 point). All 10 angles need to be present and the two shapes must intersect to score 1 point. Tremor and rotation are ignored.