Editing Mini–mental state examination (section)

{{Short description|Test to measure cognitive impairment}}
{{Distinguish|Mental status examination|Mini-international neuropsychiatric interview}}
{{Infobox diagnostic
| name = Mini–mental state examination
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| purpose = measure cognitive impairment
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| synonyms = Folstein test
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| ICD10 = <!--{{ICD10|Group|Major|minor|LinkGroup|LinkMajor}} or {{ICD10PCS|code|char1/char2/char3/char4}}-->
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| MedlinePlus = <!--article_number-->
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The '''mini–mental state examination''' ('''MMSE''') or '''Folstein test''' is a 30-point questionnaire that is used extensively in clinical and research settings to measure [[cognitive impairment]].<ref name="Cochrane">{{cite journal |vauthors=Arevalo-Rodriguez I, Smailagic N, Roqué-Figuls M, Ciapponi A, Sanchez-Perez E, Giannakou A, Pedraza OL, Bonfill Cosp X, Cullum S |title=Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI) |journal=Cochrane Database Syst Rev |volume=2021 |issue=7 |pages=CD010783 |date=July 2021 |pmid=34313331 |pmc=8406467 |doi=10.1002/14651858.CD010783.pub3 |url=}}</ref><ref>{{cite journal |last1=Pangman |first1=VC |last2=Sloan |first2=J |last3=Guse |first3=L. |journal=Applied Nursing Research|title= An Examination of Psychometric Properties of the Mini-Mental Status Examination and the Standardized Mini-Mental Status Examination: Implications for Clinical Practice| volume=13 |number=4| pages=209–213| year=2000|pmid=11078787 | doi=10.1053/apnr.2000.9231}}</ref> It is commonly used in [[medicine]] and allied health to screen for [[dementia]]. It is also used to estimate the severity and progression of cognitive impairment and to follow the course of cognitive changes in an individual over time; thus making it an effective way to document an individual's response to treatment. The MMSE's purpose has been not, on its own, to provide a diagnosis for any particular [[nosology|nosological]] entity.<ref>{{cite journal |pages=922–935 |first1=TN |last1=Tombaugh |last2=McIntyre |first2=NJ | journal=Journal of the American Geriatrics Society| title=The mini-mental Status Examination: A comprehensive Review| volume=40|issue=9 | year=1992 | doi=10.1111/j.1532-5415.1992.tb01992.x | pmid=1512391|s2cid=25169596 }}</ref>

Administration of the test takes between 5 and 10 minutes and examines functions including registration (repeating named prompts), attention and calculation, [[Recollection|recall]], [[language]], ability to follow simple commands and [[orientation (mental)|orientation]].<ref>{{cite journal| last1=Tuijl |first1=JP |last2=Scholte |first2=EM |last3=de Craen |first3=AJM |last4=van der Mast |first4=RC| journal=International Journal of Geriatric Psychiatry| title= Screening for cognitive impairment in older general hospital patients: comparison of the six-item cognitive test with the Mini-Mental Status Examination| volume=27|issue=7 | pages=755–762| year=2012 | doi=10.1002/gps.2776|pmid=21919059 |s2cid=24638804 }}</ref> It was originally introduced by Folstein ''et al.'' in 1975, in order to differentiate organic from functional psychiatric patients<ref name=Folstein>{{cite journal |last1=Folstein |first1=MF |last2= Folstein |first2=SE |last3=McHugh |first3=PR |title="Mini-mental status". A practical method for grading the cognitive state of patients for the clinician |journal=Journal of Psychiatric Research |volume=12 |issue=3 |pages=189–98 |year=1975 |pmid=1202204 |doi=10.1016/0022-3956(75)90026-6|s2cid=25310196 }}</ref><ref>{{cite journal |first1=Tom N. |last1=Tombaugh |first2=Nancy J. |last2=McIntyre |journal=Journal of the American Geriatrics Society|title= The Mini Mental Status Examination: A comprehensive review|volume=40|issue=9 | pages=922–935| year=1992 |doi=10.1111/j.1532-5415.1992.tb01992.x |pmid=1512391|s2cid=25169596 }}</ref> but is very similar to, or even directly incorporates, tests which were in use previous to its publication.<ref>{{cite journal |author1=Eileen Withers |author2=John Hinton |title=The Usefulness of the Clinical Tests of the Sensorium |journal=The British Journal of Psychiatry |volume=119 |pages=9–18 |year=1971 |doi= 10.1192/bjp.119.548.9|pmid=5556665 |issue=548|s2cid=19654792 }}</ref><ref>{{cite journal |author=Jurgen Ruesch |title=Intellectual Impairment in Head Injuries |journal=The American Journal of Psychiatry | volume=100 |issue=4 |pages=480–496 |doi=10.1176/ajp.100.4.480 |year=1944 }}</ref><ref>{{cite journal |author=David Wechsler  |title=A Standardized Memory Scale for Clinical Use |journal=The Journal of Psychology: Interdisciplinary and Applied | volume=19 |issue=1 |pages=87–95 |year=1945 |doi=10.1080/00223980.1945.9917223}}</ref> This test is not a [[mental status examination]]. The standard MMSE form which is currently published by Psychological Assessment Resources is based on its original 1975 conceptualization, with minor subsequent modifications by the authors.

Advantages to the MMSE include requiring no specialized equipment or training for administration, and has both validity and reliability for the diagnosis and longitudinal assessment of [[Alzheimer's disease]]. Due to its short administration period and ease of use, it is useful for cognitive assessment in the clinician's office space or at the bedside.<ref>{{cite journal|last1=Harrell |first1=LE |last2=Marson |first2=D |last3=Chatterjee |first3=A |last4=Parrish |first4=JA| journal=Alzheimer Disease and Associated Disorders| title= The Severe Mini-Mental Status Examination: A New Neuropsychologic Instrument for the Bedside Assessment of Severely Impaired with Alzheimer's Disease| volume=14| number=3| pages=168–175| year= 2000 | doi=10.1097/00002093-200007000-00008|pmid=10994658 |s2cid=10506318 }}</ref> Disadvantages to the utilization of the MMSE is that it is affected by demographic factors; age and education exert the greatest effect. The most frequently noted disadvantage of the MMSE relates to its lack of sensitivity to mild cognitive impairment and its failure to adequately discriminate patients with mild Alzheimer's disease from normal patients. The MMSE has also received criticism regarding its insensitivity to progressive changes occurring with severe Alzheimer's disease. The content of the MMSE is highly verbal, lacking sufficient items to adequately measure visuospatial and/or constructional praxis. Hence, its utility in detecting impairment caused by focal lesions is uncertain.<ref>{{cite journal |last1=Tomburgh |last2=McIntyre| journal=Journal of the American Geriatrics Society| title=The Mini-Mental Status Examination: A comprehensive Review|volume=40| number=9| pages=922–935| year=1992|doi=10.1111/j.1532-5415.1992.tb01992.x| pmid=1512391|s2cid=25169596}}</ref>

Other tests are also used, such as the Hodkinson<ref>{{cite journal |last1=Hodkinson |first1=HM |title=Evaluation of a mental test score for assessment of mental impairment in the elderly |journal=Age and Ageing |volume=1 |issue=4 |pages=233–8 |year=1972 |pmid=4669880 |doi=10.1093/ageing/1.4.233}}</ref> [[abbreviated mental test score]] (1972), Geriatric Mental State Examination (GMS),<ref>{{Cite journal|last1=McWilliam|first1=Christopher|last2=Copeland|first2=John R. M.|last3=Dewey|first3=Michael E.|last4=Wood|first4=Neil|date=February 2018|title=The Geriatric Mental State (GMS) used in the community: replication studies of the computerized diagnosis AGECAT|url=https://www.cambridge.org/core/journals/psychological-medicine/article/geriatric-mental-state-gms-used-in-the-community-replication-studies-of-the-computerized-diagnosis-agecat/6CDE64454DC7EC9635D64B34A14277D4|journal=Br. J. Psychiatry|language=en|volume=152|issue=2|pages=205–208|doi=10.1192/bjp.152.2.205|pmid=3048522|s2cid=19457831 |url-access=subscription}}</ref> or the [[General Practitioner Assessment of Cognition]], bedside tests such as the [[4AT]] (which also assesses for [[delirium]]), and computerised tests such as CoPs<ref>[http://www.lucid-research.com/p/125/lucid-cops CoPs ]</ref> and Mental Attributes Profiling System,<ref>[http://www.futureworlds.eu/wiki/Mental_Attributes_Profiling_System Mental Attributes Profiling System]</ref> as well as longer formal tests for deeper analysis of specific deficits.