Overview of the Mini-Mental State Exam for Alzheimer's

The MMSE Screens for Dementia
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The Mini-Mental State Exam (MMSE) is a brief, structured test of mental status that takes about 10 minutes to complete. Introduced by Marshall Folstein and others in 1975, the MMSE is the most commonly used test to assess problems with ​memory and other cognitive functions. Learn what the test involves, as well as how to score it and how accurate it is in identifying dementia.

The Tasks of the MMSE

The MMSE contains items assessing the following areas:

OrientationTo assess orientation to time, which accounts for 5 of the 30 total points, the person is asked to state the year, season, date, day and month. To assess orientation to place, the person is asked to identify the state, city or town, county, building, and floor on which they are.

Word registration and recall: Three words are said to the test-taker who must repeat them. After this, another task is given, which also serves as a distraction. Following its completion, the three words have to be recalled, which evaluates memory.

Attention and calculation: Attention and calculation skills are evaluated by having the person count backward by sevens, starting at 100, such that the answers are 100, 93, 86, 79, 72, etc. An alternative task is to spell "world" backward.

Language abilities: There are five different tasks in the language section of the MMSE. First, the person is asked to name two different objects when shown them. He then must repeat the sentence: "No ifs, ands, or buts." The third task that evaluates communication is to ask the person to follow a simple, three-part set of directions. Fourth, the ability to understand written communication is evaluated by asking the person to read the sentence, "Close your eyes" and then to ask them to follow that direction. Fifth, they are asked to write any complete sentence on paper. 

Visuospatial ability: This section accounts for one point and is assessed with a single item, namely the copying of 2 intersecting pentagons.

Scoring of the MMSE

Scores on the MMSE range from 0 to 30, with scores of 25 or higher being traditionally considered normal. Scores less than 10 generally indicate severe impairment, while scores between 10 and 19 indicate moderate dementia. People with early-stage Alzheimer's disease tend to score in the 19 to 24 range. However, scores may need to be adjusted or interpreted differently to account for a person's age, education, and race/ethnicity.

Scores typically decline with advancing age and increase with higher educational level. It's possible to achieve a very high score but still have significant cognitive deficits, especially in areas such as executive functioning that the MMSE is not designed to assess.

Usefulness of the MMSE

There are two primary uses of the MMSE. First, it is a widely used, validated, and reliable method of screening for Alzheimer's disease. As a screening test, however, it is not meant to substitute for a thorough diagnostic workup.

Sensitivity and specificity of the MMSE, key properties of every screening test, are reasonably good. Sensitivity refers to the test's accuracy in identifying individuals with the disease (i.e., persons with Alzheimer's test as positive). Specificity refers to the test's effectiveness in identifying people who do not have the disease (i.e., persons without the disease test as negative).

The second important use of the MMSE is as a means of evaluating cognitive changes in an individual over time. Periodic testing with the MMSE can help assess a person's response to treatment, which can help in guiding future treatment. Typically, an Alzheimer's patient's MMSE score declines by 3-4 points per year without treatment.

The MMSE 2

In 2010, the MMSE 2 was published. It includes many of the same tasks as the MMSE but updates a few of the original tasks to improve accuracy and ease of translation into other languages. It also does not allow the spelling of "world" backward anymore.

Overall Advantages and Disadvantages of the MMSE

In addition to the advantages already mentioned, the MMSE has been translated into many languages and has even been adapted for use by visually-impaired persons.

Disadvantages include the need to adjust scores for age, education, and ethnicity, as well as potential copyright issues. While originally the MMSE was widely distributed for free, the current official version must be ordered through the copyright owner since 2001, Psychological Assessment Resources.

A Word From Verywell

The MMSE is one of the most commonly used screening tests to evaluate cognitive functioning. If you receive results from this test that concern you, don't hesitate to ask your physician questions about what they mean, as well as if they have evaluated for any possible reversible causes of dementia. Finally, the MMSE should be combined with several other screening and medical tests if it is being used to diagnose dementia.

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Article Sources
  • Pradier C, Sakarovitch C, Le Duff F, Layese R, Metelkina A, Anthony S, et al. (2014) The Mini Mental State Examination at the Time of Alzheimer's Disease and Related Disorders Diagnosis, According to Age, Education, Gender and Place of Residence: A Cross-Sectional Study among the French National Alzheimer Database. PLoS ONE 9(8): e103630.
  • Psychological Assessment Resources. MMSE-2. Mini-Mental State Exam- 2nd Edition