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what is the maximum score given to a patient in the mini-mental state examination (mmse)?

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Test to measure out cognitive damage

Mini–Mental State Test
Synonyms Folstein test
Purpose measure cognitive harm

The Mini–Mental Country Test (MMSE) or Folstein test is a xxx-point questionnaire that is used extensively in clinical and enquiry settings to measure cognitive impairment.[1] Information technology is commonly used in medicine and allied health to screen for dementia. It is besides used to gauge the severity and progression of cerebral impairment and to follow the grade of cognitive changes in an private over time; thus making information technology an effective style to document an individual's response to treatment. The MMSE's purpose has been not, on its own, to provide a diagnosis for whatsoever item nosological entity.[2]

Assistants of the test takes betwixt 5 and 10 minutes and examines functions including registration (repeating named prompts), attention and calculation, think, language, ability to follow elementary commands and orientation.[3] It was originally introduced by Folstein et al. in 1975, in order to differentiate organic from functional psychiatric patients[4] [5] but is very similar to, or even directly incorporates, tests which were in use previous to its publication.[6] [7] [viii] This test is not a mental condition examination. The standard MMSE grade which is currently published by Psychological Assessment Resources is based on its original 1975 conceptualization, with pocket-size subsequent modifications by the authors.

Advantages to the MMSE include requiring no specialized equipment or training for administration, and has both validity and reliability for the diagnosis and longitudinal assessment of Alzheimer'due south disease. Due to its short administration menstruation and ease of apply, it is useful for cognitive assessment in the clinician'south office space or at the bedside.[ix] Disadvantages to the utilization of the MMSE is that it is affected by demographic factors; age and pedagogy exert the greatest effect. The most frequently noted disadvantage of the MMSE relates to its lack of sensitivity to mild cognitive impairment and its failure to fairly discriminate patients with mild Alzheimer'due south affliction from normal patients. The MMSE has also received criticism regarding its insensitivity to progressive changes occurring with severe Alzheimer's disease. The content of the MMSE is highly exact, lacking sufficient items to adequately measure visuospatial and/or constructional praxis. Hence, its utility in detecting impairment caused past focal lesions is uncertain.[10]

Other tests are also used, such as the Hodkinson[11] Abbreviated Mental Test score (1972), Geriatric Mental State Examination (GMS),[12] or the General Practitioner Cess of Cognition, bedside tests such equally the 4AT (which also assesses for delirium), and computerised tests such as CoPs[13] and Mental Attributes Profiling System,[xiv] likewise as longer formal tests for deeper analysis of specific deficits.

Test features [edit]

Interlocking pentagons used for the last question

The MMSE test includes uncomplicated questions and problems in a number of areas: the time and place of the exam, repeating lists of words, arithmetic such as the serial sevens, language use and comprehension, and basic motor skills. For instance, one question, derived from the older Bough-Gestalt Exam, asks to re-create a drawing of two pentagons (shown on the right or in a higher place).[4]

A version of the MMSE questionnaire can be found on the British Columbia Ministry of Wellness website.[fifteen]

Although consequent application of identical questions increases the reliability of comparisons made using the scale, the test tin can be customized (for instance, for apply on patients that are blind or partially immobilized.) Also, some have questioned the use of the test on the deaf.[16] Notwithstanding, the number of points assigned per category is usually consequent:

Category Possible points Description
Orientation to time five From broadest to most narrow. Orientation to time has been correlated with future turn down.[17]
Orientation to place 5 From broadest to most narrow. This is sometimes narrowed down to streets,[xviii] and sometimes to floor.[19]
Registration 3 Repeating named prompts
Attending and calculation 5 Serial sevens, or spelling "world" backwards.[20] It has been suggested that serial sevens may be more appropriate in a population where English is not the first language.[21]
Remember three Registration think
Linguistic communication 2 Naming a pencil and a lookout man
Repetition i Speaking back a phrase
Complex commands 6 Varies. Can involve drawing effigy shown.

Interpretations [edit]

Whatever score of 24 or more than (out of thirty) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (ten–18 points) or mild (19–23 points) cognitive impairment. The raw score may besides need to be corrected for educational attainment and age.[22] Even a maximum score of 30 points tin never rule out dementia and at that place is no strong evidence to support this exam as a stand-alone ane-fourth dimension test for identifying high gamble individuals who are probable to develop Alzheimer's.[23] Low to very low scores may correlate closely with the presence of dementia, although other mental disorders can also lead to abnormal findings on MMSE testing. The presence of purely physical problems tin also interfere with interpretation if not properly noted; for example, a patient may exist physically unable to hear or read instructions properly or may have a motor deficit that affects writing and drawing skills.

In order to maximize the benefits of the MMSE the post-obit recommendations from Tombaugh and McIntyre (1992) should be employed:

  1. The MMSE should exist used as a screening device for cognitive impairment or a diagnostic adjunct in which a depression score indicates the need for further evaluation. It should non serve as the sole benchmark for diagnosing dementia or to differentiate betwixt various forms of dementia.[23] However, the MMSE scores may be used to classify the severity of cognitive impairment or to certificate serial change in dementia patients.
  2. The following four cut-off levels should be employed to classify the severity of cognitive damage: no cerebral harm 24-30; mild cognitive impairment 19-23; moderate cognitive impairment x-eighteen; and severe cognitive impairment ≤nine.
  3. The MMSE should not be used clinically unless the person has at to the lowest degree a course viii education[ description needed ] and is fluent in English. While this recommendation does not discount the possibility that future inquiry may show that number of years of educational activity constitutes a risk factor for dementia, it does acknowledge the weight of evidence showing that low educational levels substantially increase the likelihood of misclassifying normal subjects as cognitively impaired.
  4. Serial 7'due south and Earth should not be considered equivalent items. Both items should exist administered and the college of the two should be used. In scoring serial 7's each number must be independently compared to the prior number to ensure that a single mistake is non unduly penalized. WORLD should exist spelled frontward (and corrected) prior to spelling it backward.
  5. The words apple, penny and tabular array should be used for registration and recall. If necessary, the words may exist administered up to three times in gild to obtain perfect registration, but the score is based on the first trial.
  6. The 'canton' and 'where are yous' orientation to identify questions should be modified: the proper name of the county where a person lives should be asked rather than the county of the testing site, and the name of the street where the individual lives should be asked rather than the proper noun of the flooring where the testing is taking place.

The MMSE may aid differentiate different types of dementias. People with Alzheimer'due south disease may score significantly lower on orientation to time and place, and retrieve compared to who have dementia with Lewy bodies, vascular dementia and Parkinson's disease dementia.[24] [25] [26]

Copyright issues [edit]

The MMSE was commencement published in 1975 as an appendix to an article written by Align F. Folstein, Susan Folstein, and Paul R. McHugh.[4] It was published in Book 12 of the Journal of Psychiatric Enquiry, published by Pergamon Press. While the MMSE was fastened every bit an appendix to the article, the copyright ownership of the MMSE (to the extent that it contains copyrightable content[27]) remained with the three authors. Pergamon Press was later on taken over by Elsevier, who also took over copyright of the Periodical of Psychiatric Research.[28]

The authors later transferred all their intellectual holding rights, including the copyright of the MMSE, to MiniMental registering the transfer with the U.S. Copyright Office on June eight, 2000.[29] In March 2001, MiniMental entered into an sectional understanding with Psychological Assessment Resources granting PAR the exclusive rights to publish, license, and manage all intellectual property rights to the MMSE in all media and languages in the world.[xxx] Despite the many free versions of the test that are bachelor on the internet, PAR claims that the official version is copyrighted and must be ordered only through information technology.[31] [32] At least one legal expert has claimed that PAR's copyright claims are weak.[27] The enforcement of copyright on the MMSE has been compared to the phenomenon of "stealth" or "submarine" patents, in which a patent applicant waited until an invention gained widespread popularity earlier allowing the patent to issue, and only so commenced enforcement. Such applications are no longer possible, given changes in patent law.[31] The enforcement of the copyright has led to researchers looking for culling strategies in assessing knowledge.[33]

PAR have as well asserted their copyright against an alternative diagnostic test, "Sweet xvi", which was designed to avoid the copyright bug surrounding the MMSE. Sweet sixteen was a 16-detail assessment adult and validated by Tamara Fong and published in March 2011; like the MMSE it included orientation and three-object retrieve. Assertion of copyright forced the removal of this exam from the Internet.[34]

Editions [edit]

In February 2010, PAR released a 2nd edition of the MMSE; ten foreign linguistic communication translations (French, German language, Dutch, Castilian for the Usa, Spanish for Latin America, European Spanish, Hindi, Russian, Italian, and Simplified Chinese) were also created.[35]

See as well [edit]

  • Abbreviated mental exam score (AMTS)
  • Addenbrooke's Cognitive Examination (ACE)
  • Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
  • Mental status exam (MSE)
  • Montreal Cognitive Assessment (MoCA)
  • NIH stroke calibration (NIHSS)
  • Saint Louis University Mental Condition Exam (SLUMS)
  • Self-administered Gerocognitive Test (SAGE)

References [edit]

  1. ^ Pangman, VC; Sloan, J; Guse, 50. (2000). "An Examination of Psychometric Backdrop of the Mini-Mental Status Examination and the Standardized Mini-Mental Status Examination: Implications for Clinical Practice". Applied Nursing Research. 13 (iv): 209–213. doi:10.1053/apnr.2000.9231. PMID 11078787.
  2. ^ Tombaugh, TN; McIntyre, NJ (1992). "The mini-mental Condition Examination: A comprehensive Review". Journal of the American Elderliness Guild. 40 (9): 922–935. doi:ten.1111/j.1532-5415.1992.tb01992.x. PMID 1512391. S2CID 25169596.
  3. ^ Tuijl, JP; Scholte, EM; de Craen, AJM; van der Mast, RC (2012). "Screening for cognitive impairment in older general hospital patients: comparison of the six-particular cognitive test with the Mini-Mental Status Examination". International Journal of Geriatric Psychiatry. 27 (seven): 755–762. doi:10.1002/gps.2776. PMID 21919059. S2CID 24638804.
  4. ^ a b c Folstein, MF; Folstein, SE; McHugh, PR (1975). ""Mini-mental status". A practical method for grading the cognitive state of patients for the clinician". Journal of Psychiatric Research. 12 (3): 189–98. doi:x.1016/0022-3956(75)90026-6. PMID 1202204.
  5. ^ Tombaugh, Tom North.; McIntyre, Nancy J. (1992). "The Mini Mental Condition Examination: A comprehensive review". Journal of the American Geriatrics Order. 40 (ix): 922–935. doi:10.1111/j.1532-5415.1992.tb01992.x. PMID 1512391. S2CID 25169596.
  6. ^ Eileen Withers; John Hinton (1971). "The Usefulness of the Clinical Tests of the Sensorium". The British Journal of Psychiatry. 119 (548): nine–18. doi:10.1192/bjp.119.548.9. PMID 5556665.
  7. ^ Jurgen Ruesch (1944). "Intellectual Harm in Head Injuries". The American Periodical of Psychiatry. 100 (4): 480–496. doi:x.1176/ajp.100.4.480.
  8. ^ David Wechsler (1945). "A Standardized Memory Scale for Clinical Use". The Journal of Psychology: Interdisciplinary and Applied. xix (ane): 87–95. doi:10.1080/00223980.1945.9917223.
  9. ^ Harrell, LE; Marson, D; Chatterjee, A; Parrish, JA (2000). "The Severe Mini-Mental Status Examination: A New Neuropsychologic Instrument for the Bedside Assessment of Severely Impaired with Alzheimer's Disease". Alzheimer Disease and Associated Disorders. xiv (3): 168–175. doi:10.1097/00002093-200007000-00008. PMID 10994658. S2CID 10506318.
  10. ^ Tomburgh; McIntyre (1992). "The Mini-Mental Condition Examination: A comprehensive Review". Periodical of the American Geriatrics Guild. twoscore (9): 922–935. doi:x.1111/j.1532-5415.1992.tb01992.x. PMID 1512391. S2CID 25169596.
  11. ^ Hodkinson, HM (1972). "Evaluation of a mental exam score for assessment of mental harm in the elderly". Age and Ageing. 1 (4): 233–8. doi:10.1093/ageing/1.four.233. PMID 4669880.
  12. ^ McWilliam, Christopher; Copeland, John R. M.; Dewey, Michael Eastward.; Wood, Neil (Feb 2018). "The Geriatric Mental Country (GMS) used in the customs: replication studies of the computerized diagnosis AGECAT". Br. J. Psychiatry. 152 (2): 205–208. doi:10.1192/bjp.152.2.205. PMID 3048522.
  13. ^ CoPs
  14. ^ Mental Attributes Profiling System
  15. ^ "British Columbia Ministry of Health Standard MMSE (PDF)" (PDF). Archived from the original (PDF) on 29 October 2013.
  16. ^ Dean, PM; Feldman, DM; Morere, D; Morton, D (December 2009). "Clinical evaluation of the mini-mental status exam with culturally Deaf senior citizens". Arch Clin Neuropsychol. 24 (8): 753–60. doi:ten.1093/arclin/acp077. PMID 19861331.
  17. ^ Guerrero-Berroa E, Luo 10, Schmeidler J, et al. (Dec 2009). "The MMSE orientation for fourth dimension domain is a strong predictor of subsequent cognitive turn down in the elderly". Int J Geriatr Psychiatry. 24 (12): 1429–37. doi:10.1002/gps.2282. PMC2919210. PMID 19382130.
  18. ^ Morales LS, Flowers C, Gutierrez P, Kleinman Chiliad, Teresi JA; Flowers; Gutierrez; Kleinman; Teresi (November 2006). "Item and calibration differential functioning of the Mini-Mental Status Test assessed using the Differential Detail and Test Functioning (DFIT) Framework". Medical Care. 44 (11 Suppl three): S143–51. doi:10.1097/01.mlr.0000245141.70946.29. PMC1661831. PMID 17060821. {{cite periodical}}: CS1 maint: multiple names: authors listing (link)
  19. ^ "MMSE". Archived from the original on 2010-02-25. Retrieved 2009-12-10 .
  20. ^ Ganguli M, Ratcliff M, Huff FJ, et al. (1990). "Serial sevens versus world backwards: a comparison of the ii measures of attention from the MMSE". J Geriatr Psychiatry Neurol. iii (4): 203–vii. doi:10.1177/089198879000300405. PMID 2073308. S2CID 23054498.
  21. ^ Espino DV, Lichtenstein MJ, Palmer RF, Hazuda HP; Lichtenstein; Palmer; Hazuda (May 2004). "Evaluation of the mini-mental status test's internal consistency in a community-based sample of Mexican-American and European-American elders: results from the San Antonio Longitudinal Study of Aging". Journal of the American Geriatrics Society. 52 (five): 822–7. doi:x.1111/j.1532-5415.2004.52226.x. PMID 15086669. S2CID 21220067. {{cite journal}}: CS1 maint: multiple names: authors list (link)
  22. ^ Crum RM, Anthony JC, Bassett SS, Folstein MF; Anthony; Bassett; Folstein (May 1993). "Population-based norms for the Mini-Mental Status Examination by historic period and educational level". JAMA. 269 (xviii): 2386–91. doi:10.1001/jama.1993.03500180078038. PMID 8479064. {{cite periodical}}: CS1 maint: multiple names: authors list (link)
  23. ^ a b Arevalo-Rodriguez, Ingrid; Smailagic, Nadja; Roqué-Figuls, Marta; Ciapponi, Agustín; Sanchez-Perez, Erick; Giannakou, Antri; Pedraza, Olga L.; Bonfill Cosp, Xavier; Cullum, Sarah (2021-07-27). "Mini-Mental State Examination (MMSE) for the early on detection of dementia in people with mild cognitive damage (MCI)". The Cochrane Database of Systematic Reviews. 2021 (vii): CD010783. doi:10.1002/14651858.CD010783.pub3. ISSN 1469-493X. PMC 8406467. PMID 34313331.
  24. ^ Palmqvist, S; Hansson, O; Minthon, L; Londos, E (December 2009). "Applied suggestions on how to differentiate dementia with Lewy bodies from Alzheimer'due south disease with mutual cognitive tests". International Journal of Geriatric Psychiatry. 24 (12): 1405–12. doi:10.1002/gps.2277. PMID 19347836. S2CID 30099877.
  25. ^ Jefferson, AL; Cosentino, SA; Brawl, SK; Bogdanoff, B; Leopold, N; Kaplan, East; Libon, DJ (Summer 2002). "Errors produced on the mini-mental status examination and neuropsychological test performance in Alzheimer'south illness, ischemic vascular dementia, and Parkinson's disease". The Periodical of Neuropsychiatry and Clinical Neurosciences. 14 (iii): 311–xx. doi:x.1176/appi.neuropsych.fourteen.three.311. PMID 12154156.
  26. ^ Ala, TA; Hughes, LF; Kyrouac, GA; Ghobrial, MW; Elble, RJ (June 2002). "The Mini-Mental Status exam may help in the differentiation of dementia with Lewy bodies and Alzheimer's disease". International Journal of Geriatric Psychiatry. 17 (6): 503–ix. doi:10.1002/gps.550. PMID 12112173. S2CID 19992084.
  27. ^ a b James Grimmelmann. "How Copyright Is Like Cognitive Impairment".
  28. ^ "History of Elsevier" (PDF). Elsevier. Archived from the original (PDF) on 2009-01-17. Retrieved 2010-ten-29 .
  29. ^ Folstein MF, Folstein SE; McHugh, PR (2000-06-08). Mini-mental status : a practical method for grading the cognitive state of patients for the clinician. Patent number TX0005228282
  30. ^ U.Southward. Copyright Office record #ii
  31. ^ a b Powsner Due south, Powsner D; Powsner (2005). "Cognition, copyright, and the classroom". The American Journal of Psychiatry. 162 (iii): 627–8. doi:10.1176/appi.ajp.162.3.627-a. PMID 15741491.
  32. ^ "Mini-Mental Status Examination. Psychological Assessment Resource, Inc". Archived from the original on 2006-06-27. Retrieved 2006-06-22 .
  33. ^ Holsinger T, Deveau J, Boustani Thou, Williams JW; Deveau; Boustani; Williams Jr (June 2007). "Does this patient have dementia?". JAMA. 297 (21): 2391–404. doi:10.1001/jama.297.21.2391. PMID 17551132. {{cite journal}}: CS1 maint: multiple names: authors list (link)
  34. ^ John C. Newman, Chiliad.D.; Robin Feldman, J.D. (December 2011). "Copyright and Open Access at the Bedside". NEJM. 365 (26): 2447–2449. doi:ten.1056/NEJMp1110652. PMID 22204721.
  35. ^ PAR. "MMSE-2 home page". Retrieved 2010-10-29 .

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Source: https://en.wikipedia.org/wiki/Mini%E2%80%93Mental_State_Examination

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