Performing Mini-Mental State Examination

Definition

The Mini-mental State Examination (MMSE) or Folstein test is a widely used screening test using a 30-point questionnaire to measure the cognitive impairment in older adults.

Use in clinical practice

1. Careful interpretation of results of MMSE together with disease, dementia with history and physical assessment can assist in diagnosis of: Cognitive impairment resulting from Alzheimer’s disease, dementia with Levy bodies or depression.
2. Repeated measurements can be used to assess change over time and response to treatment.

Articles needed

1. A blank/white paper.
2. A pencil.
3. A wrist watch.
4. Standardized questionnaire.

Administering the MMSE

• Have the patient seated comfortably.
• Give simple and clear explanation and instructions about the examination.
• Encourage conversation to get the patient relaxed.
• Ensure the patient’s readiness to take the simple test.
• Administer the MMSE, carefully and unhurriedly.
• Ask the questions in the order listed and mark the score for each response.

Questionnaire

Patient’s Name:

Date:

Instructions: Ask the questions in the order listed. Score one point for each correct response within each question or activity.

The Mini Mental Status Examination (MMSE) is a widely used tool to assess cognitive function. It includes a series of questions and tasks that evaluate various cognitive domains. Here’s a sample questionnaire:

1. Orientation (10 points)

• What is the year? Season? Date? Day of the week? Month? (5 points)
• Where are we now: State? County? Town/City? Hospital? Floor? (5 points)

2. Registration (3 points)

• The examiner names three unrelated objects (e.g., “apple,” “table,” “penny”) and asks the patient to repeat them.

3. Attention and Calculation (5 points)

• Count backward from 100 by sevens (e.g., 93, 86, 79, etc.).
• Alternatively, spell the word “WORLD” backward.

4. Recall (3 points)

• Ask the patient to recall the three objects mentioned earlier.

5. Language and Praxis (9 points)

• Name two objects shown by the examiner (e.g., a pencil and a watch).
• Repeat the phrase: “No ifs, ands, or buts.”
• Follow a three-step command: “Take this paper in your right hand, fold it in half, and place it on the floor.”
• Read and obey a written instruction (e.g., “Close your eyes”).
• Write a sentence of their choice (must contain a subject and a verb).
• Copy a design (e.g., two intersecting pentagons).

The total score is 30 points, with lower scores indicating potential cognitive impairment

Advantages

1. MMSE is a valuable tool to identify changes in a patient’s cognitive function.
2. Requires little time to complete and is a key component of a comprehensive dementia work up.
3. Determining whether a patient has dementia is important to start on effective medications early.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
7. R.Sreevani, A Guide to Mental Health & Psychiatric Nursing, 6th Edition, 2024, Jaypee Publishers, ISBN 978-9366161686
8. Sheila L. Videbeck, Psychiatric Nursing, Seventh Edition , 2017, Wolters Kluwer Publications, ISBN: 978- 1496355911
9. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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