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Last edited on April 30, 2020

This shows you the differences between two versions of the page.

--- cognitive-testing:mmse [on March 23, 2020]
+++ cognitive-testing:mmse [on June 5, 2021] (current)
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+~~META:
+description abstract = The MMSE is the most commonly used cognitive test. It is more geared towards detecting memory, attention, construction, orientation, and language deficits, and is less sensitive to executive dysfunction.
+~~
 ====== Mini-Mental Status Exam (MMSE) ======
+{{INLINETOC}}
 ===== Primer =====
-<WRAP right 400px>
+<WRAP group>
-<panel type="info" title="Download" no-body="true">
+<WRAP twothirds column>
-| <button type="info" icon="fa fa-file" size="sm">{{ :detailed_guide_to_the_mini-mental_.pdf |MMSE Instructions}}</button>  | <button type="success" icon="fa fa-download" size="sm">{{ :mmse.pdf |MMSE Download}}</button>            |
+The **Mini-Mental Status Exam (MMSE)** is a cognitive screening tool that provides a brief, objective measure of cognitive function. It can be used to screen for cognitive impairment, to estimate the severity of the impairment, and to document cognitive change over time. The MMSE is the most widely used brief test of cognition in clinical and research settings. The MMSE tests multiple cognitive domains: orientation, repetition, verbal recall, attention and calculation, language and visual construction.
-| <button type="info" icon="fa fa-file" size="sm">{{ ::smmse_instructions.pdf |SMMSE Instructions}}</button>                | <button type="success" icon="fa fa-download" size="sm">{{ :cognitive-testing:smmse.pdf |SMMSE Download}}</button>  |
+</WRAP>
+<WRAP third column>
+<panel type="default" title="Download MMSE" icon="fa fa-download" no-body="true">
+| <button type="primary" icon="fa fa-file" block="true" size="sm">{{ :detailed_guide_to_the_mini-mental_.pdf |Instructions}}</button>  |
+| <button type="success" icon="fa fa-download" block="true" size="sm">{{ :mmse.pdf |MMSE}}</button>                                    |
 </panel>
 </WRAP>
-The **Mini-Mental Status Exam (MMSE)** is a cognitive screening tool that provides a brief, objective measure of cognitive function. It can be used to screen for cognitive impairment, to estimate the severity of the impairment, and to document cognitive change over time. The MMSE is the most widely used brief test of cognition in clinical and research settings. The MMSE tests multiple cognitive domains: orientation, repetition, verbal recall, attention and calculation, language and visual construction.
+</WRAP>
 ==== Standardized MMSE (SMMSE) ====
+<WRAP group>
+<WRAP twothirds column>
 The original MMSE (created in 1975!) can be vulnerable to poor inter-rater reliability. The **Standardized MMSE (SMMSE)** was developed in 1997 to provide exact scoring instructions with clear and unambiguous guidelines to administer the test, in order to increase reliability and reduce variability.[([[https://www.ncbi.nlm.nih.gov/pubmed/9447431|Molloy, D. William, and Timothy IM Standish. "A guide to the standardized Mini-Mental State Examination." International Psychogeriatrics 9.S1 (1997): 87-94.]])] Of note, scoring of WORLD is different in the MMSE compared to the SMMSE ([[cognitive-testing:mmse#attention-world|see below]]).
+</WRAP>
+<WRAP third column>
+<panel type="default" title="Download SMMSE" icon="fa fa-download" no-body="true">
+| <button type="primary" block="true" icon="fa fa-file" size="sm">{{ ::smmse_instructions.pdf |Instructions}}</button>   |
+| <button type="success" block="true" icon="fa fa-download" size="sm">{{ :cognitive-testing:smmse.pdf |SMMSE}}</button>  |
+</panel>
+</WRAP>
+</WRAP>
 <HTML>
@@ Line 54: / Line 75: @@
 ==== Attention (WORLD)  ====
-<imgcaption image1|>{{ :cognitive-testing:world_scoring_1_.png?nolink&500|Scoring WORLD using the line method}}
+<WRAP group>
-</imgcaption>
+<WRAP half column>
 Spelling WORLD backwards is straightforward, but the scoring of it is often incorrect, even by experienced clinicians.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1738900/|Davey, R. J., & Jamieson, S. (2004). The validity of using the mini mental state examination in NICE dementia guidelines. Journal of Neurology, Neurosurgery & Psychiatry, 75(2), 343-344.]])][([[https://pn.bmj.com/content/practneurol/5/5/298.full.pdf|Ridha, Basil, and Martin Rossor. "The mini mental state examination." Practical Neurology 5.5 (2005): 298-303.]])]  Originally, the creator of the MMSE, psychiatrist Dr. Marshal Folstein advised that the score is "the number of letters in the correct order," however, this often led to incorrect scoring due to the numerous possible permutations. With the creation of the Standardized MMSE (SMMSE), the proposed and easiest way to score WORLD is using the "line method" (see <imgref image1>). The line method involves drawing lines to match the letters from the correct response (DLROW) and the response given by the patient.
 The total score is the //maximum// number of lines that can be drawn without crossing __any__ lines.
 WORLD should first be spelled forwards to allow the correction of any mistakes and then backwards. One point is given for //each letter// spelled in the //correct order backwards// to a maximum score of five. If more or less then 5 letters are given, then one point is deducted for each extra or missing letter. Only use the best score of either the serial 7 s or spelling WORLD backwards in the total MMSE score.
+</WRAP>
+<WRAP half column>
+<imgcaption image1|>{{ :cognitive-testing:world_scoring_1_.png?nolink&500|Scoring WORLD using the line method}}
+</imgcaption>
+</WRAP>
+</WRAP>
 ==== Writing and Drawing ====
@@ Line 71: / Line 97: @@
 <panel type="info" title="Average MMSE Scores: Age and Education Norms" no-body="true" subtitle="Crum, Rosa M., et al. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA 269.18 (1993): 2386-2391.">
-!^!                           ^ 18-24  ^ 25-29  ^ 30-34  ^ 35-39  ^ 40-44  ^ 45-49  ^ 50-54  ^ 55-59  ^ 60-64  ^ 65-69  ^ 70-74  ^ 75-79  ^ 80-84  ^ 85  ^
+<mobiletable 1>
+^                           ^ 18-24  ^ 25-29  ^ 30-34  ^ 35-39  ^ 40-44  ^ 45-49  ^ 50-54  ^ 55-59  ^ 60-64  ^ 65-69  ^ 70-74  ^ 75-79  ^ 80-84  ^ 85  ^
 ^ 0-4 years education                | 22     | 25     | 25     | 23     | 23     | 23     | 23     | 22     | 23     | 22     | 22     | 21     | 20     | 19  |
 ^ 5-8 years education                | 27     | 27     | 26     | 26     | 27     | 26     | 27     | 26     | 26     | 26     | 26     | 25     | 25     | 23  |
 ^ 9-12 years (high school)  | 29     | 29     | 29     | 28     | 28     | 28     | 28     | 28     | 28     | 28     | 27     | 27     | 25     | 26  |
 ^ College or higher         | 29     | 29     | 29     | 29     | 29     | 29     | 29     | 29     | 29     | 29     | 28     | 28     | 27     | 27  |
+</mobiletable>
 </panel>
@@ Line 86: / Line 114: @@
 <WRAP half column>
 <panel type="info" title="MMSE Findings and Dementia Subtypes" no-body="true">
+<mobiletable 1>
 ^ Dementia                                                        ^ MMSE Findings                                                                                                                                                                                       ^ Impairment                                                                                                                                                                      ^
 ^ [[geri:dementia:alzheimers|Alzheimer’s disease]]                                             | Worse performance on recall of three words and orientation to time/place          | Memory |
 ^ [[geri:dementia:vascular|Vascular dementia]], [[geri:parkinsons|Parkinson’s disease]], and [[geri:dementia:lewy-body|Lewy body dementia]]  | Worse on attention, obeying a three step command, writing a sentence and copying intersecting pentagons,                                                                                            | Impairment of working memory and motor, constructional and visuo- perceptual skills                                                                                             |
 ^ [[geri:dementia:frontotemporal|Frontotemporal dementia]]                                         | Tend to have higher MMSE scores in comparison to Alzheimer's at initial presentation, and slower annual rates of decline, because MMSE is geared more towards detecting impairments of orientation  | The MMSE is less able to detect the executive dysfunction typical of fronto-temporal dementia, and other screening tests like the [[cognitive-testing:fab|FAB]] should be used  |
+</mobiletable>
 </panel>
@@ Line 95: / Line 125: @@
 <WRAP half column>
 <panel type="success" title="Diagnoses and Average MMSE Scores" no-body="true">
+<mobiletable 1>
 ^          ^ Score              ^
 | Normal Subjects  | > 27  |
@@ Line 102: / Line 132: @@
 | Moderate Dementia        | 10-18           |
 | Severe Dementia        | 10[([[https://www.ncbi.nlm.nih.gov/pubmed/18362376|Feldman, H. H., Jacova, C., Robillard, A., Garcia, A., Chow, T., Borrie, M., ... & Chertkow, H. (2008). Diagnosis and treatment of dementia: 2. Diagnosis. Canadian Medical Association Journal, 178(7), 825-836.]])]           |
+</mobiletable>
 </panel>
 </WRAP>
@@ Line 117: / Line 147: @@
 Practice effects are improvements in cognitive testing performance due to repeated exposure to the test material. To reduce the bias of practice effects, different words can be used for the recall task, and different common objects can be used for naming.
+===== Other Languages =====
+==== Chinese ====
+  * [[https://pubmed.ncbi.nlm.nih.gov/3193141/|Katzman, R. et al. (1988). A Chinese version of the Mini-Mental State Examination; impact of illiteracy in a Shanghai dementia survey. Journal of clinical epidemiology, 41(10), 971-978.]]
+  * [[https://www.easap.asia/index.php/find-issues/past-issue/item/504-v4n2-9402-p25-28|Chiu, H. F. et al. (1994). Reliability and validity of the Cantonese version of mini-mental state examination-a preliminary study. Hong Kong Journal of Psychiatry, 4(2), 25.]]
 ===== Resources =====
 == For Providers ==
   * [[http://quoco.org/index_en.html|QuoCo]] - Validated MMSE score tracking tool used differentiate expected cognitive decline from aging versus neurological disease.
   * [[https://pn.bmj.com/content/5/5/298|Ridha, B., & Rossor, M. (2005). The mini mental state examination. Practical Neurology, 5(5), 298-303.]]
+{{tag>cognitive-testing-common}}