Mini Mental State Examination
The MMSE is a good instrument for assessing cognitive function, but takes up to 10
minutes and cannot fit easily into a standard consultation.
Orientation
What is the (year) (season) (date) (day) (month)?
Where are we: (country) (city) (part of city) (number
of flat/house) (name of street)?
Registration
Name three objects: one second to say each.
Then ask the patient to name all three after you have
said them.
Give one point for each correct answer.
Then repeat them until he learns all three.
Count trials and record.
TRIALS
Attention and calculation
Serial 7s: one point for each correct.
Stop after five answers.
Alternatively spell 'world' backwards.
5
5
Recall
Ask for the three objects repeated above.
Give one point for each correct.
Language
Name a pencil and watch (two points).
Repeat the following: 'No ifs, ands or buts' (one
point).
Follow a three-stage command: 'Take a paper in your
right hand, fold it in half and put it on the floor' (three
points).
Read and obey the following: Close your eyes (one
point).
Write a sentence (one point).
Copy a design (one point).
Total score
INSTRUCTIONS FOR ADMINISTRATION OF MINI MENTAL STATE
EXAMINATION
Orientation
1. Ask the date. Then ask specifically for parts omitted, for example, 'Can you also
tell me what season it is?' Score 1 point for each correct.
2. Ask in turn, 'Can you tell me the name of this place?' (town, country, etc). Score
1 point for each correct.
Registration
Ask the patient if you may test his or her memory. Then say the names of three
unrelated objects, clearly and slowly, about one second for each. After you have
said all three, ask him or her to repeat them. This first repetition determines the
score (0-3) but keep saying them until he or she can repeat all three, up to six
trials. If he or she does not eventually learn all three, recall cannot be meaningfully
tested.
Attention and calculation
Ask the patient to begin with 100 and count backwards by 7. Stop after five
subtractions (93, 86, 79, 72, 65). Score the total number of correct answers. If the
patient cannot or will not perform this task, ask him or her to spell the word 'world'
backwards. The score is the number of letters in correct order, eg dlrow 5, dlowr 3.
Recall
Ask the patient if he or she can recall the three words you previously asked him or
her to remember. Score 0-3.
Language
Naming: Show the patient a wrist-watch and ask him or her what it is. Repeat for
pencil. Score 0-2.
Repetition: Ask the patient to repeat the sentence after you. Allow only one trial.
Score 0 or 1.
Three-stage command: Give the patient a piece of plain blank paper and repeat the
command. Score 1 point for each part 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 him or her to read it and do what it
says. Score 1 point only if he or she actually closes his eyes.
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 is to be written spontaneously. It
must contain a subject and verb and be sensible. Correct grammar and punctuation
are not necessary.
Copying: On a clean piece of paper, draw intersecting pentagons (as below), each
side about one inch and ask him or her to copy it exactly as it is. All ten angles
must be present and two must intersect to score 1 point. Tremor and rotation are
ignored.
A score of 20 or less generally suggests dementia but may also be found in acute
confusion, schizophrenia or severe depression. A score of less than 24 may indicate
dementia in some patients who are well educated and who do not have any of the
above conditions. Serial testing may be of value to demonstrate a decline in
cognitive function in borderline cases
http://www.alzheimers.org.uk/Working_with_people_with_dementia/Primary_care
/Dementia_diagnosis_and_management_in_primary_care/mmse.html
Abbreviated Mental test Score
This is a quick and easy test that can be used in the consultation.
EACH QUESTION SCORES ONE POINT
1. Age
2. Time to nearest hour
3. An address - for example 42 West Street - to be
repeated by the patient at the end of the test
4. Year
5. Name of hospital, residential institution or home
address, depending on where the patient is situated
6. Recognition of two persons - for example, doctor,
nurse, home help etc
7. Date of birth
8. Year first world war started
9. Name of present monarch
10. Count backwards from 20 to 1
Total score
A SCORE OF LESS THAN SIX SUGGESTS DEMENTIA
If you think someone has dementia:
Use the abbreviated mental test score (above). This is only a rough guide to diagnosis.
Carry out routine blood tests.
If in doubt, refer to specialist - a general psychiatrist, old age psychiatrist, or neurologist
depending on age of patient and who is available locally.
If diagnosis is confirmed:
Encourage the carer to join the Alzheimer's Disease Society or Alzheimer Scotland - Action
on Dementia.
Services: refer to Social Services for assessment.
Benefits: your patient should claim attendance allowance or disability living allowance care
component and discount on their council tax bill. Provide the appropriate certificate.
Ensure follow up.
http://www.ehr.chime.ucl.ac.uk/demcare/amts.html
