1. MINI MENTAL STATUS EXAMINATION (MMSE) PREPARED BY DR. IRENE ROCO ASST. PROFESSOR

2. OUTLINE MMSE DEFINITION COGNITIVE DOMAINS IN MMSE CONTENTS OF MMSE HOW TO ADMINISTER MMSE CATEGORIES IN MMSE POINTS TO CONSIDER IN INTERPRETATION REFERENCES

3. DEVELOPED BY DR. MARSHALL FOLSTEIN IN 1975, HAS BECOME WIDELY USED AS A SCREENING TEST FOR COGNITIVE IMPAIRMENT THIS TEST SHOULD NEVER BE USED ALONE. IT IS USED IN CONJUNCTION WITH A CORROBORATIVE HISTORY. THE TEST USUALLY TAKES ABOUT TEN MINUTES TO COMPLETE AND CAN BE USED RELIABLY AFTER A SHORT TRAINING PERIOD BY PHYSICIANS, NURSES AND OTHER HEALTH CARE PROFESSIONALS. MINI MENTAL STATUS EXAMINATION (MMSE)

4. THE TEST COVERS A VARIETY OF COGNITIVE DOMAINS, INCLUDING 1.ORIENTATION TO TIME AND PLACE 2.SHORT AND LONG TERM MEMORY 3.REGISTRATION 4.RECALL 5.CONSTRUCTIONAL ABILITY 6.LANGUAGE 7.ABILITY TO UNDERSTAND AND FOLLOW COMMANDS MINI MENTAL STATUS EXAMINATION (MMSE)

5. PLS REFER TO THE FOLLOWING FILES MINIMENTAL.PDF STANDARDIZED MMSE - GUIDELINES-V2.PDF STANDARDIZED MMSE - GUIDELINES-V2.PDF THE MMSE TEST INCLUDES: SIMPLE QUESTIONS AND PROBLEMS IN A NUMBER OF AREAS: THE TIME AND PLACE OF THE TEST REPEATING LISTS OF WORDS ARITHMETIC SUCH AS THE SERIAL SEVENS LANGUAGE USE AND COMPREHENSION BASIC MOTOR SKILLS. ( ASKS CLIENT TO COPY A DRAWING OF TWO PENTAGONS

6. PLS REFER TO THE FOLLOWING FILES MINIMENTAL.PDF STANDARDIZED MMSE -GUIDELINES- V2.PDF STANDARDIZED MMSE -GUIDELINES- V2.PDF Score Degree of Impairment Formal Psychometric Assessment Day-to-Day Functioning 25-30Questionably significant If clinical signs of cognitive impairment are present, formal assessment of cognition may be valuable. May have clinically significant but mild deficits. Likely to affect only most demanding activities of daily living. 20-25MildFormal assessment may be helpful to better determine pattern and extent of deficits. Significant effect. May require some supervision, support and assistance. 10-20ModerateFormal assessment may be helpful if there are specific clinical indications. Clear impairment. May require 24-hour supervision. 0-10SeverePatient not likely to be testable. Marked impairment. Likely to require 24-hour supervision and assistance with ADL

7. HOW TO ADMINISTER MMSE BEFORE THE QUESTIONNAIRE IS ADMINISTERED TRY TO GET THE PERSON TO SIT DOWN FACING YOU. ASSESS THE PERSON’S ABILITY TO HEAR AND UNDERSTAND VERY SIMPLE CONVERSATION, E.G. WHAT IS YOUR NAME? IF THE PERSON USES HEARING OR VISUAL AIDS, PROVIDE THESE BEFORE STARTING. INTRODUCE YOURSELF AND TRY TO GET THE PERSON’S CONFIDENCE. BEFORE YOU BEGIN, GET THE PERSON’S PERMISSION TO ASK QUESTIONS, E.G. WOULD IT BE ALL RIGHT TO ASK YOU SOME QUESTIONS ABOUT YOUR MEMORY? THIS HELPS TO AVOID CATASTROPHIC REACTIONS. ASK EACH QUESTION A MAXIMUM OF THREE TIMES. IF THE PERSON DOES NOT RESPOND, SCORE ZERO.

8. HOW TO ADMINISTER MMSE IF THE PERSON ANSWERS INCORRECTLY, SCORE ZERO. ACCEPT THAT ANSWER AND DO NOT ASK THE QUESTION AGAIN, HINT, OR PROVIDE ANY PHYSICAL CLUES SUCH AS HEAD SHAKING, ETC. IF THE PERSON ANSWERS WHAT DID YOU SAY?, DO NOT EXPLAIN OR ENGAGE IN CONVERSATION, MERELY REPEAT. MERELY REPEAT THE SAME DIRECTIONS A MAXIMUM OF THREE TIMES. IF THE PERSON INTERRUPTS (E.G. QUERIES WHAT IS THIS FOR?), JUST REPLY: I WILL EXPLAIN IN A FEW MINUTES, WHEN WE ARE FINISHED. NOW IF WE COULD PROCEED PLEASE, WE ARE ALMOST FINISHED

9. EQUIPMENT REQUIRED TO ADMINISTER THE INSTRUMENT: WATCH A PENCIL REVERSE OF THE SMMSE SCORE SHEET WITH CLOSE YOUR EYES WRITTEN IN LARGE LETTERS TWO FIVE-SIDED FIGURES INTERSECTING TO MAKE A FOUR-SIDED FIGURE, A SPACE FOR THE PERSON TO WRITE DOWN A SENTENCE.

10. CATEGORIES IN MMSE Category Possible points Description Orientation to time5 From broadest to most narrow. Orientation to time hs been correlated with future decline Orientation to place5 From broadest to most narrow. This is sometimes narrowed down to streets, and sometimes to floor. Registration3Repeating named prompts Attention and calculation 5 Serial sevens or spelling "world" backwards. It has been suggested that serial sevens may be more appropriate in a population where English is not the first language.

11. MMSE Category Possible points Description Recall3Registration recall Language2Naming a pencil and a watch Repetition1Speaking back a phrase Complex commands6Varies. Can involve drawing figure shown. NOTE: Please Use the PDF File of MMSE for: 1. explanation/ discussion 2. utilization of the form in the Clinical Area

12. POINTS TO CONSIDER IN INTERPRETATION 1. A MAXIMAL SCORE OF 30 POINTS CAN NEVER RULE OUT DEMENTIA. 2. LOW TO VERY LOW SCORES CORRELATE CLOSELY WITH THE PRESENCE OF DEMENTIA, ALTHOUGH OTHER MENTAL DISORDERS CAN ALSO LEAD TO ABNORMAL FINDINGS ON MMSE TESTING. 3. THE PRESENCE OF PURELY PHYSICAL PROBLEMS CAN ALSO INTERFERE WITH INTERPRETATION IF NOT PROPERLY NOTED; FOR EXAMPLE, A PATIENT MAY BE PHYSICALLY UNABLE TO HEAR OR READ INSTRUCTIONS PROPERLY, OR MAY HAVE A MOTOR DEFICIT THAT AFFECTS WRITING AND DRAWING SKILLS.

13. INTERPRETATION Score Degree of Impairment Formal Psychometric AssessmentDay-to-Day Functioning 25-30Questionably significant If clinical signs of cognitive impairment are present, formal assessment of cognition may be valuable. May have clinically significant but mild deficits. Likely to affect only most demanding activities of daily living. 20-25MildFormal assessment may be helpful to better determine pattern and extent of deficits. Significant effect. May require some supervision, support and assistance. 10-20ModerateFormal assessment may be helpful if there are specific clinical indications. Clear impairment. May require 24- hour supervision. 0-10SeverePatient not likely to be testable.Marked impairment. Likely to require 24-hour supervision and assistance with ADL

14. REFERENCES FOLSTEIN, MF; FOLSTEIN, SE; MCHUGH, PR (1975). ""MINI-MENTAL STATE". A PRACTICAL METHOD FOR GRADING THE COGNITIVE STATE OF PATIENTS FOR THE CLINICIAN". JOURNAL OF PSYCHIATRIC RESEARCH 12 (3): 189–98. SUBACUTE CARE LINK (WWW.IHPA.GOV.AU/INTERNET/IHPA/PUBLISHING.NSF/CONTENT/SUBACUTE-CARE)WWW.IHPA.GOV.AU/INTERNET/IHPA/PUBLISHING.NSF/CONTENT/SUBACUTE-CARE HTTP://WWW.SCO.EDU/ASSETS/1813/COURSE_5_B_HANDOUT.PDF.