Mini-Mental State Examination (Mmse) Form - Iowa

What Is the Mini-Mental State Examination?

The Mini-Mental State Examination - also called the Mini-Mental Status Examination or the MMSE - is a test that was first published in 1975. It is a paper-based 30-point test widely used to detect cognitive issues. The test is often criticized for being biased against the visually impaired and poorly educated people. Besides, the test is not as useful for detecting the early stages of dementia or a mild cognitive impairment (MCI) and for examining visuospatial cognitive abilities. At the same time, the test form is widely used because it is quick to perform (the whole process takes about 5 to 10 minutes), does not require any complicated equipment (you need a form, a few sheets of paper, and a pen), and allows to monitor progress of the patient's mental state over time.

The MMSE Form available for download below is a three-page document. The top part of the first page requires the name of the patient screened and the date of the test. The table that follows contains a list of questions and tasks. These questions include time and place questions, repeating words, arithmetic test, ability to understand and comprehend language, and motor skills check. The person administering the test enters the score for each type of questions and counts the total score. The second page of the form contains detailed mini-mental exam instructions. These provide a detailed explanation of how to conduct and evaluate each part of the test. A table with the interpretation of the test results is provided on the last page of the form.

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Mini-Mental State Examination (MMSE)
Patient’s Name:
Date:
Instructions: Ask the questions in the order listed. Score one point for each correct
response within each question or activity.
Maximum
Patient’s
Questions
Score
Score
5
“What is the year? Season? Date? Day of the week? Month?”
5
“Where are we now: State? County? Town/city? Hospital? Floor?”
The examiner names three unrelated objects clearly and slowly, then
asks the patient to name all three of them. The patient’s response is
3
used for scoring. The examiner repeats them until patient learns all of
them, if possible. Number of trials: ___________
“I would like you to count backward from 100 by sevens.” (93, 86, 79,
5
72, 65, …) Stop after five answers.
Alternative: “Spell WORLD backwards.” (D-L-R-O-W)
“Earlier I told you the names of three things. Can you tell me what those
3
were?”
Show the patient two simple objects, such as a wristwatch and a pencil,
2
and ask the patient to name them.
1
“Repeat the phrase: ‘No ifs, ands, or buts.’”
“Take the paper in your right hand, fold it in half, and put it on the floor.”
3
(The examiner gives the patient a piece of blank paper.)
“Please read this and do what it says.” (Written instruction is “Close
1
your eyes.”)
“Make up and write a sentence about anything.” (This sentence must
1
contain a noun and a verb.)
“Please copy this picture.” (The examiner gives the patient a blank
piece of paper and asks him/her to draw the symbol below. All 10
angles must be present and two must intersect.)
1
30
TOTAL
(Adapted from Rovner & Folstein, 1987)
1
Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf
Provided by NHCQF, 0106-410
Mini-Mental State Examination (MMSE)
Patient’s Name:
Date:
Instructions: Ask the questions in the order listed. Score one point for each correct
response within each question or activity.
Maximum
Patient’s
Questions
Score
Score
5
“What is the year? Season? Date? Day of the week? Month?”
5
“Where are we now: State? County? Town/city? Hospital? Floor?”
The examiner names three unrelated objects clearly and slowly, then
asks the patient to name all three of them. The patient’s response is
3
used for scoring. The examiner repeats them until patient learns all of
them, if possible. Number of trials: ___________
“I would like you to count backward from 100 by sevens.” (93, 86, 79,
5
72, 65, …) Stop after five answers.
Alternative: “Spell WORLD backwards.” (D-L-R-O-W)
“Earlier I told you the names of three things. Can you tell me what those
3
were?”
Show the patient two simple objects, such as a wristwatch and a pencil,
2
and ask the patient to name them.
1
“Repeat the phrase: ‘No ifs, ands, or buts.’”
“Take the paper in your right hand, fold it in half, and put it on the floor.”
3
(The examiner gives the patient a piece of blank paper.)
“Please read this and do what it says.” (Written instruction is “Close
1
your eyes.”)
“Make up and write a sentence about anything.” (This sentence must
1
contain a noun and a verb.)
“Please copy this picture.” (The examiner gives the patient a blank
piece of paper and asks him/her to draw the symbol below. All 10
angles must be present and two must intersect.)
1
30
TOTAL
(Adapted from Rovner & Folstein, 1987)
1
Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf
Provided by NHCQF, 0106-410
Instructions for administration and scoring of the MMSE
Orientation (10 points):
Ask for the date. Then specifically ask for parts omitted (e.g., "Can you also tell me what season it
is?"). One point for each correct answer.
Ask in turn, "Can you tell me the name of this hospital (town, county, etc.)?" One point for each
correct answer.
Registration (3 points):
Say the names of three unrelated objects clearly and slowly, allowing approximately one second for
each. After you have said all three, ask the patient to repeat them. The number of objects the
patient names correctly upon the first repetition determines the score (0-3). If the patient does not
repeat all three objects the first time, continue saying the names until the patient is able to repeat all
three items, up to six trials. Record the number of trials it takes for the patient to learn the words. If
the patient does not eventually learn all three, recall cannot be meaningfully tested.
After completing this task, tell the patient, "Try to remember the words, as I will ask for them in a
little while."
Attention and Calculation (5 points):
Ask the patient to begin with 100 and count backward by sevens. Stop after five subtractions (93,
86, 79, 72, 65). Score the total number of correct answers.
If the patient cannot or will not perform the subtraction task, ask the patient to spell the word "world"
backwards. The score is the number of letters in correct order (e.g., dlrow=5, dlorw=3).
Recall (3 points):
Ask the patient if he or she can recall the three words you previously asked him or her to
remember. Score the total number of correct answers (0-3).
Language and Praxis (9 points):
Naming: Show the patient a wrist watch and ask the patient what it is. Repeat with a pencil. Score
one point for each correct naming (0-2).
Repetition: Ask the patient to repeat the sentence after you ("No ifs, ands, or buts."). Allow only one
trial. Score 0 or 1.
3-Stage Command: Give the patient a piece of blank paper and say, "Take this paper in your right
hand, fold it in half, and put it on the floor." Score one point for each part of the command correctly
executed.
Reading: On a blank piece of paper print the sentence, "Close your eyes," in letters large enough
for the patient to see clearly. Ask the patient to read the sentence and do what it says. Score one
point only if the patient actually closes his or her eyes. This is not a test of memory, so you may
prompt the patient to "do what it says" after the patient reads the sentence.
Writing: Give the patient a blank piece of paper and ask him or her to write a sentence for you. Do
not dictate a sentence; it should be written spontaneously. The sentence must contain a subject
and a verb and make sense. Correct grammar and punctuation are not necessary.
Copying: Show the patient the picture of two intersecting pentagons and ask the patient to copy the
figure exactly as it is. All ten angles must be present and two must intersect to score one point.
Ignore tremor and rotation.
(Folstein, Folstein & McHugh, 1975)
2
Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf
Provided by NHCQF, 0106-410
Interpretation of the MMSE
Method
Score
Interpretation
Single Cutoff
<24
Abnormal
<21
Increased odds of dementia
Range
>25
Decreased odds of dementia
th
21
Abnormal for 8
grade education
Education
<23
Abnormal for high school education
<24
Abnormal for college education
24-30
No cognitive impairment
Severity
18-23
Mild cognitive impairment
0-17
Severe cognitive impairment
Sources:
Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the mini-mental state
examination by age and educational level. JAMA. 1993;269(18):2386-2391.
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;12:189-198.
Rovner BW, Folstein MF. Mini-mental state exam in clinical practice. Hosp Pract. 1987;22(1A):99, 103, 106,
110.
Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc.
1992;40(9):922-935.
3
Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf
Provided by NHCQF, 0106-410

Download Mini-Mental State Examination (Mmse) Form - Iowa

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What Does the MMSE Measure?

Mini-mental state exam form allows measuring cognitive impairments and recording the patient's progress over time. The form provides doctors and researchers with a simple and convenient means to screen for dementia. The test checks the patient's time and place orientation, language functioning, short-term memory, and basic motor skills. Using this test, practitioners can estimate the severity of the cognitive impairment - if any - and monitor its progression. Some MMSE forms are also used to document the patient's response to treatment.

What Is a Normal MMSE Score?

Generally, an MMSE score of 24 to 30 is considered a normal result that shows no cognitive impairment. A score of 18 to 23 denotes a mild cognitive impairment. A score of 0 to 17 hints at a more severe mental condition. However, raw results are rarely used for a diagnosis. They are typically corrected according to the patient's age and level of education.

The tasks performed during the exam include the following activities:

  • Time and place orientation,
  • Repeating words task,
  • Arithmetic test,
  • Test for the ability to understand and comprehend language, and
  • Motor skills check.
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