Cognitive decline as we get older is no longer considered a normal part of aging. However, older adults are at greater risk of decline than the rest of the population due to the effects of factors such as hypertension, elevated cholesterol, cardiac arrhythmias as well as diseases that show up later in life such as Alzheimer’s, Parkinson’s and other dementias.
Cognitive impairment often leads to a decline in physical functioning as well as affects the quality of life for older adults. Dementia is a major illness and cause of disability among the geriatric population.
Therefore, early identification of cognitive decline is essential and treatment should be prompt.
What is the MMSE?
The most commonly used brief measure of cognitive functioning is the Mini Mental State Exam or MMSE. It is a short questionnaire with 11 questions that is used to screen for cognitive impairment, especially in the elderly.
It is most commonly used to screen for Alzheimer’s and dementia but has also been used for depression. It is a key component in a comprehensive evaluation for dementia.
The MMSE takes only about 10 minutes to administer and 5 minutes to score, so it is a very quick yet reliable method to assess the status of an individual’s cognitive functioning.
It tests five areas of cognitive function: orientation, attention, memory, language and visual-spatial skills.
For example, to evaluate a person’s orientation to time they are asked to state the year, season, date, day and the month with each response earning one point each. This test is not a mental status examination. It is a screening test and is not meant to take the place of a comprehensive diagnostic workup.
The MMSE has been used with adults from 18 to 100 years of age.
The MMSE has been validated and extensively used in both clinical practice and research since it was first introduced by Folstein et al in 1975.
It provides a global score which correlates with daily function; the maximum score is 30 and generally a score of 24 or lower indicates cognitive impairment.
The MMSE is used in medical practice to screen for dementia-to estimate the degree of impairment at a specific time, but it also is used as a means to follow and document a person’s response to treatment over time.
Research has shown that the MMSE is an effective screening tool for cognitive impairment with older adults whether they are dwelling in the community, a hospital, or are institutionalized.
Cognitive functioning in the elderly is best assessed when it is done routinely and systematically, thereby catching cognitive decline as it happens and changing treatment response as needed.
Scoring The MMSE
Scores on the MMSE range from 0 to 30 with any score 25 or higher considered to be intact (normal) cognitive functioning. Scores of 21 to 24 indicate mild cognitive impairment; 10 to 20 points are in the moderately impaired range and scores of 9 or lower indicate severe cognitive impairment.
The raw score may also need to be adjusted for education and age; for example, a college educated person needs to score 26 points or lower for cognitive impairment but someone with a 7th grade education would not be considered impaired unless they scored 22 or lower.
Low to very low scores closely correlate with the presence of dementia. However, other mental or emotional disorders (such as depression) can also lead to low scores and need to be differentiated.
Physical problems may interfere with the scoring unless these are accounted for (example: someone who is unable to hear or read the instructions correctly, or someone that has a motor deficit that affects their writing and drawing skills).
Advantages and Disadvantages
As already mentioned, there are numerous advantages to utilizing the MMSE as a screening tool for dementia. It has proven reliability and validity, and it is quick to administer and score.
It can be used repeatedly to monitor an individual’s cognitive decline. Furthermore, it has been translated into many foreign languages and has been adapted for the visually-impaired.
Although they are minor, there are some disadvantages to using the MMSE.
One such disadvantage is the necessary score adjustments for age, education and ethnicity. Despite the many free versions on the internet, there could be copyright issues as this test has been copyrighted since 2000; prior to that time the test had been distributed for free.
Lastly, the test is heavily reliant on verbal responses, reading and writing. This could give false low scores to individuals who have a hearing impairment, visual impairment (unless the adapted version is used), intubated patients, low English literacy or others with communication disorders.
Is There an Updated Version?
Yes, the 2nd edition to the MMSE (MMSE-2) has been available since February 2010. The new edition includes the standard version plus it has both a brief form and an expanded form.
The expanded form is more useful for populations with milder forms of cognitive impairment. The brief form takes only 5 minutes to administer.
The MMSE-2 is currently available in 10 foreign language translations including German, Dutch, French, Spanish (3 versions), Chinese, Russian, Italian and Hindi.
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