Editing Mini–mental state examination (section)

==Interpretations==
Any score of 24 or more (out of 30) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (10–18 points) or mild (19–23 points) cognitive impairment. The raw score may also need to be corrected for educational attainment and age.<ref>{{cite journal |author=Crum RM, Anthony JC, Bassett SS, Folstein MF |title=Population-based norms for the Mini-Mental Status Examination by age and educational level |journal=JAMA |volume=269 |issue=18 |pages=2386–91 |date=May 1993 |pmid=8479064 |doi= 10.1001/jama.1993.03500180078038|last2=Anthony |last3=Bassett |last4=Folstein }}</ref> Even a maximum score of 30 points can never rule out dementia and there is no strong evidence to support this examination as a stand-alone one-time test for identifying high risk individuals who are likely to develop Alzheimer's.<ref name=":0">{{Cite journal|last1=Arevalo-Rodriguez|first1=Ingrid|last2=Smailagic|first2=Nadja|last3=Roqué-Figuls|first3=Marta|last4=Ciapponi|first4=Agustín|last5=Sanchez-Perez|first5=Erick|last6=Giannakou|first6=Antri|last7=Pedraza|first7=Olga L.|last8=Bonfill Cosp|first8=Xavier|last9=Cullum|first9=Sarah|date=2021-07-27|title=Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI)|journal=The Cochrane Database of Systematic Reviews|volume=2021|issue=7|pages=CD010783|doi=10.1002/14651858.CD010783.pub3|issn=1469-493X|pmc=8406467|pmid=34313331}}</ref> Low to very low scores may correlate closely with the presence of dementia, although other mental disorders can also lead to abnormal findings on MMSE testing. The presence of purely physical problems can also interfere with interpretation if not properly noted; for example, a patient may be physically unable to hear or read instructions properly or may have a motor deficit that affects writing and drawing skills.

In order to maximize the benefits of the MMSE the following recommendations from Tombaugh and McIntyre (1992) should be employed:
# The MMSE should be used as a screening device for cognitive impairment or a diagnostic adjunct in which a low score indicates the need for further evaluation. It should not serve as the sole criterion for diagnosing dementia or to differentiate between various forms of dementia.<ref name=":0" /> However, the MMSE scores may be used to classify the severity of cognitive impairment or to document serial change in dementia patients. 
# The following four cut-off levels should be employed to classify the severity of cognitive impairment: no cognitive impairment 24–30; mild cognitive impairment 19–23; moderate cognitive impairment 10–18; and severe cognitive impairment ≤9.
# The MMSE should not be used clinically unless the person has at least a grade-eight education{{clarify|date=August 2019}} and is fluent in English. While this recommendation does not discount the possibility that future research may show that number of years of education constitutes a risk factor for dementia, it does acknowledge the weight of evidence showing that low educational levels substantially increase the likelihood of misclassifying normal subjects as cognitively impaired.
# Serial sevens and WORLD should not be considered equivalent items. Both items should be administered and the higher of the two should be used. In scoring serial sevens, each number must be independently compared to the prior number to ensure that a single mistake is not unduly penalized. WORLD should be spelled forward (and corrected) prior to spelling it backward.
# The words "apple", "penny", and "table" should be used for registration and recall. If necessary, the words may be administered up to three times in order to obtain perfect registration, but the score is based on the first trial.
# The "county" and "where are you" orientation to place questions should be modified: the name of the county where a person lives should be asked rather than the county of the testing site, and the name of the street where the individual lives should be asked rather than the name of the floor where the testing is taking place.
The MMSE may help differentiate different types of dementias. People with Alzheimer's disease may score significantly lower on orientation to time and place as well as recall, compared to those who have dementia with Lewy bodies, vascular dementia, or Parkinson's disease dementia.<ref>{{cite journal|last=Palmqvist|first=S|author2=Hansson, O|author3=Minthon, L|author4=Londos, E|date=December 2009|title=Practical suggestions on how to differentiate dementia with Lewy bodies from Alzheimer's disease with common cognitive tests.|journal=International Journal of Geriatric Psychiatry|volume=24|issue=12|pages=1405–12|doi=10.1002/gps.2277|pmid=19347836|s2cid=30099877}}</ref><ref>{{cite journal|last=Jefferson|first=AL|author2=Cosentino, SA|author3=Ball, SK|author4=Bogdanoff, B|author5=Leopold, N|author6=Kaplan, E|author7=Libon, DJ|date=Summer 2002|title=Errors produced on the mini-mental status examination and neuropsychological test performance in Alzheimer's disease, ischemic vascular dementia, and Parkinson's disease.|journal=The Journal of Neuropsychiatry and Clinical Neurosciences|volume=14|issue=3|pages=311–20|doi=10.1176/appi.neuropsych.14.3.311|pmid=12154156}}</ref><ref>{{cite journal|last=Ala|first=TA|author2=Hughes, LF|author3=Kyrouac, GA|author4=Ghobrial, MW|author5=Elble, RJ|date=June 2002|title=The Mini-Mental Status exam may help in the differentiation of dementia with Lewy bodies and Alzheimer's disease.|journal=International Journal of Geriatric Psychiatry|volume=17|issue=6|pages=503–9|doi=10.1002/gps.550|pmid=12112173|s2cid=19992084}}</ref>