PROMs

Mini-mental State Examiniation (MMSE) Flow

Mini-Mental State Examination flow

Introduction

The Mini-Mental State Exam (MMSE) is a 30-point questionnaire that's widely used test of cognitive function among the elderly [1]; it includes tests of orientation, attention, memory, language and visual-spatial skills.

The Mini-Mental State Examination flow contains the Mini-mental State Examiniation (MMSE) questionnaire and associated calculation. After form submission, the Mini-Mental State Examination calculation is executed automatically. It's easy to extend this flow with conditional logic based on the interpretation of the Mini-Mental State Examination calculation.

Mini-mental State Examiniation (MMSE) questionnaire

Questionnaire

Category Questions Scoring

Orientation to time (/5)
What is the year?
What is the season?
What is the date?
What is the day?
What is the month?

Orientation to place (/5)
Where are we now (state)?
Where are we now (county)?
Where are we now (town/city)?
Where are we now (hospital)?
Where are we now (floor)?

Registration (/3)
The examiner names three unrelated objects clearly and slowly (eg: apple, key, house), then the instructor asks the patient to name all three of them.

Attention and calculation (/5)
“I would like you to count backward from 100 by sevens.” (93, 86, 79, 72, 65, …)

Recall (/3)
“Earlier I told you the names of three things. Can you tell me what those were?” (=registration recall)
The amount of words that the patient was able to repeat.

Language (/8)
Show the patient two simple objects, such as a wristwatch and a pencil, and ask the patient to name them. (/2)
“Repeat the phrase: ‘No ifs, ands, or buts.’” (/1)
“Take the paper in your right hand, fold it in half, and put it on the floor.” (/3)
“Please read this and do what it says.” (Written instruction is “Close your eyes.”) (/1)
“Make up and write a sentence about anything.” (/1)

Construct (/1)
“Please copy this picture (two overlapping pentagons).” (/1)

Interpretations

Any score of 24 or more (out of 30) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (10–18 points) or mild (19–23 points) cognitive impairment. The raw score may also need to be corrected for educational attainment and age. That is, even a maximum score of 30 points can never rule out dementia. 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 [2,3]. 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.

References

[1] Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98. doi: 10.1016/0022-3956(75)90026-6. PMID: 1202204.\
[2] Weiner DK, Peterson BL, Logue P, Keefe FJ. Predictors of pain self-report in nursing home residents. Aging (Milano). 1998 Oct;10(5):411-20. doi: 10.1007/BF03339888. PMID: 9932145.\
[3] Hadjistavropoulos T. Assessing pain in older persons with severe limitations in ability to communicate. In: Gibson SJ, Weiner D, editors. Pain in the elderly. Seattle: IASP Press; 2005. pp. 135–51. doi: 10.1097/AJP.0b013e31802be869.

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