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Test to measure cognitive impairment

Mini–Mental State Exam
Synonyms Folstein test
Purpose measure cognitive damage

The Mini–Mental Country Exam (MMSE) or Folstein test is a 30-point questionnaire that is used extensively in clinical and inquiry settings to measure cognitive impairment.[one] Information technology is commonly used in medicine and allied health to screen for dementia. It is also used to estimate the severity and progression of cognitive harm 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 handling. The MMSE'due south purpose has been non, on its own, to provide a diagnosis for any item nosological entity.[2]

Administration of the test takes between v and 10 minutes and examines functions including registration (repeating named prompts), attention and calculation, retrieve, language, ability to follow simple commands and orientation.[3] It was originally introduced by Folstein et al. in 1975, in lodge to differentiate organic from functional psychiatric patients[4] [5] but is very similar to, or fifty-fifty straight incorporates, tests which were in utilise previous to its publication.[6] [7] [8] This test is not a mental condition exam. 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 cess of Alzheimer's disease. Due to its brusque assistants period and ease of use, it is useful for cognitive cess in the clinician's role space or at the bedside.[9] Disadvantages to the utilization of the MMSE is that it is affected past demographic factors; age and pedagogy exert the greatest effect. The most oftentimes noted disadvantage of the MMSE relates to its lack of sensitivity to mild cognitive harm and its failure to adequately discriminate patients with mild Alzheimer'due south disease from normal patients. The MMSE has besides received criticism regarding its insensitivity to progressive changes occurring with severe Alzheimer's illness. 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.[10]

Other tests are also used, such as the Hodkinson[11] Abbreviated Mental Test score (1972), Geriatric Mental Country Test (GMS),[12] or the General Practitioner Assessment of Cognition, bedside tests such every bit the 4AT (which also assesses for delirium), and computerised tests such as CoPs[13] and Mental Attributes Profiling Organisation,[14] as well as longer formal tests for deeper analysis of specific deficits.

Test features [edit]

Interlocking pentagons used for the last question

The MMSE test includes simple questions and problems in a number of areas: the time and place of the exam, repeating lists of words, arithmetic such as the serial sevens, linguistic communication use and comprehension, and basic motor skills. For example, one question, derived from the older Bender-Gestalt Examination, asks to copy a drawing of two pentagons (shown on the right or above).[iv]

A version of the MMSE questionnaire can be found on the British Columbia Ministry of Health website.[15]

Although consequent application of identical questions increases the reliability of comparisons fabricated using the scale, the test can exist customized (for instance, for use on patients that are blind or partially immobilized.) Also, some have questioned the utilise of the test on the deaf.[16] However, the number of points assigned per category is usually consistent:

Category Possible points Description
Orientation to time 5 From broadest to almost narrow. Orientation to time has been correlated with time to come decline.[17]
Orientation to place 5 From broadest to most narrow. This is sometimes narrowed down to streets,[18] and sometimes to floor.[xix]
Registration three Repeating named prompts
Attention and calculation 5 Serial sevens, or spelling "world" backwards.[20] It has been suggested that serial sevens may be more appropriate in a population where English is not the first language.[21]
Call back iii Registration call up
Language 2 Naming a pencil and a sentinel
Repetition 1 Speaking back a phrase
Circuitous commands vi Varies. Tin involve cartoon figure shown.

Interpretations [edit]

Whatever score of 24 or more (out of thirty) indicates a normal cognition. Beneath this, scores tin indicate astringent (≤9 points), moderate (ten–18 points) or mild (19–23 points) cerebral damage. The raw score may likewise need to exist corrected for educational attainment and age.[22] Even a maximum score of 30 points can never rule out dementia and there is no potent evidence to support this examination equally a stand up-alone former test for identifying high run a risk individuals who are likely to develop Alzheimer's.[23] Low to very low scores may correlate closely with the presence of dementia, although other mental disorders tin likewise atomic number 82 to abnormal findings on MMSE testing. The presence of purely physical problems can also interfere with interpretation if non 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 cartoon skills.

In club to maximize the benefits of the MMSE the following recommendations from Tombaugh and McIntyre (1992) should be employed:

  1. The MMSE should be used equally a screening device for cerebral impairment or a diagnostic adjunct in which a low score indicates the need for further evaluation. It should non serve as the sole criterion for diagnosing dementia or to differentiate between various forms of dementia.[23] However, the MMSE scores may be used to allocate the severity of cerebral impairment or to document serial change in dementia patients.
  2. The post-obit 4 cut-off levels should be employed to classify the severity of cognitive harm: no cognitive impairment 24-30; mild cognitive impairment 19-23; moderate cognitive damage 10-eighteen; and severe cerebral impairment ≤nine.
  3. The MMSE should not be used clinically unless the person has at least a class eight education[ description needed ] and is fluent in English. While this recommendation does non disbelieve the possibility that future inquiry may evidence that number of years of education constitutes a risk cistron for dementia, it does acknowledge the weight of prove showing that low educational levels substantially increase the likelihood of misclassifying normal subjects every bit cognitively impaired.
  4. Serial 7's and WORLD should not exist considered equivalent items. Both items should be administered and the higher of the two should be used. In scoring series 7's 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 astern.
  5. The words apple tree, penny and table should be used for registration and recall. If necessary, the words may be administered up to 3 times in order to obtain perfect registration, but the score is based on the commencement trial.
  6. 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 private lives should be asked rather than the name of the floor where the testing is taking place.

The MMSE may help differentiate unlike types of dementias. People with Alzheimer'south affliction may score significantly lower on orientation to time and place, and recall compared to who have dementia with Lewy bodies, vascular dementia and Parkinson'due south disease dementia.[24] [25] [26]

Copyright issues [edit]

The MMSE was outset published in 1975 equally an appendix to an commodity written by Marshal F. Folstein, Susan Folstein, and Paul R. McHugh.[iv] It was published in Volume 12 of the Periodical of Psychiatric Inquiry, published past Pergamon Press. While the MMSE was attached as an appendix to the article, the copyright ownership of the MMSE (to the extent that it contains copyrightable content[27]) remained with the iii authors. Pergamon Press was afterward taken over by Elsevier, who also took over copyright of the Journal of Psychiatric Enquiry.[28]

The authors later transferred all their intellectual holding rights, including the copyright of the MMSE, to MiniMental registering the transfer with the U.Due south. Copyright Office on June 8, 2000.[29] In March 2001, MiniMental entered into an exclusive agreement with Psychological Assessment Resource granting PAR the sectional rights to publish, license, and manage all intellectual property rights to the MMSE in all media and languages in the world.[30] Despite the many free versions of the test that are available on the net, PAR claims that the official version is copyrighted and must be ordered only through information technology.[31] [32] At least one legal good has claimed that PAR'southward copyright claims are weak.[27] The enforcement of copyright on the MMSE has been compared to the phenomenon of "stealth" or "submarine" patents, in which a patent applicant waited until an invention gained widespread popularity before allowing the patent to issue, and just and so commenced enforcement. Such applications are no longer possible, given changes in patent police force.[31] The enforcement of the copyright has led to researchers looking for alternative strategies in assessing knowledge.[33]

PAR accept also asserted their copyright against an alternative diagnostic examination, "Sweet 16", which was designed to avoid the copyright issues surrounding the MMSE. Sweet 16 was a xvi-item cess adult and validated by Tamara Fong and published in March 2011; like the MMSE it included orientation and three-object recall. Assertion of copyright forced the removal of this test from the Internet.[34]

Editions [edit]

In February 2010, PAR released a second edition of the MMSE; 10 foreign language translations (French, German, Dutch, Spanish for the The states, Spanish for Latin America, European Spanish, Hindi, Russian, Italian, and Simplified Chinese) were besides created.[35]

See also [edit]

  • Abbreviated mental test score (AMTS)
  • Addenbrooke's Cognitive Examination (ACE)
  • Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
  • Mental status exam (MSE)
  • Montreal Cognitive Assessment (MoCA)
  • NIH stroke scale (NIHSS)
  • Saint Louis University Mental Status Exam (SLUMS)
  • Self-administered Gerocognitive Exam (SAGE)

References [edit]

  1. ^ Pangman, VC; Sloan, J; Guse, 50. (2000). "An Examination of Psychometric Properties of the Mini-Mental Condition Examination and the Standardized Mini-Mental Status Examination: Implications for Clinical Do". Applied Nursing Research. 13 (4): 209–213. doi:10.1053/apnr.2000.9231. PMID 11078787.
  2. ^ Tombaugh, TN; McIntyre, NJ (1992). "The mini-mental Status Examination: A comprehensive Review". Journal of the American Geriatrics Lodge. 40 (9): 922–935. doi:10.1111/j.1532-5415.1992.tb01992.ten. PMID 1512391. S2CID 25169596.
  3. ^ Tuijl, JP; Scholte, EM; de Craen, AJM; van der Mast, RC (2012). "Screening for cerebral damage in older general hospital patients: comparing of the six-item cognitive test with the Mini-Mental Status Examination". International Journal of Geriatric Psychiatry. 27 (7): 755–762. doi:ten.1002/gps.2776. PMID 21919059. S2CID 24638804.
  4. ^ a b c Folstein, MF; Folstein, SE; McHugh, PR (1975). ""Mini-mental status". A applied method for grading the cognitive state of patients for the clinician". Journal of Psychiatric Inquiry. 12 (3): 189–98. doi:10.1016/0022-3956(75)90026-6. PMID 1202204.
  5. ^ Tombaugh, Tom Due north.; McIntyre, Nancy J. (1992). "The Mini Mental Status Examination: A comprehensive review". Journal of the American Geriatrics Society. 40 (9): 922–935. doi:ten.1111/j.1532-5415.1992.tb01992.x. PMID 1512391. S2CID 25169596.
  6. ^ Eileen Withers; John Hinton (1971). "The Usefulness of the Clinical Tests of the Sensorium". The British Journal of Psychiatry. 119 (548): 9–xviii. doi:ten.1192/bjp.119.548.9. PMID 5556665.
  7. ^ Jurgen Ruesch (1944). "Intellectual Damage in Head Injuries". The American Journal of Psychiatry. 100 (four): 480–496. doi:10.1176/ajp.100.4.480.
  8. ^ David Wechsler (1945). "A Standardized Memory Calibration for Clinical Use". The Periodical of Psychology: Interdisciplinary and Applied. nineteen (i): 87–95. doi:x.1080/00223980.1945.9917223.
  9. ^ Harrell, LE; Marson, D; Chatterjee, A; Parrish, JA (2000). "The Severe Mini-Mental Condition Examination: A New Neuropsychologic Musical instrument for the Bedside Assessment of Severely Dumb with Alzheimer's Disease". Alzheimer Disease and Associated Disorders. 14 (3): 168–175. doi:x.1097/00002093-200007000-00008. PMID 10994658. S2CID 10506318.
  10. ^ Tomburgh; McIntyre (1992). "The Mini-Mental Status Examination: A comprehensive Review". Periodical of the American Geriatrics Society. 40 (9): 922–935. doi:10.1111/j.1532-5415.1992.tb01992.x. PMID 1512391. S2CID 25169596.
  11. ^ Hodkinson, HM (1972). "Evaluation of a mental test score for cess of mental harm in the elderly". Age and Ageing. 1 (4): 233–eight. doi:ten.1093/ageing/1.4.233. PMID 4669880.
  12. ^ McWilliam, Christopher; Copeland, John R. M.; Dewey, Michael E.; Woods, Neil (February 2018). "The Geriatric Mental State (GMS) used in the community: replication studies of the computerized diagnosis AGECAT". Br. J. Psychiatry. 152 (2): 205–208. doi:ten.1192/bjp.152.two.205. PMID 3048522.
  13. ^ CoPs
  14. ^ Mental Attributes Profiling System
  15. ^ "British Columbia Ministry of Health Standard MMSE (PDF)" (PDF). Archived from the original (PDF) on 29 Oct 2013.
  16. ^ Dean, PM; Feldman, DM; Morere, D; Morton, D (Dec 2009). "Clinical evaluation of the mini-mental condition examination with culturally Deaf senior citizens". Arch Clin Neuropsychol. 24 (eight): 753–60. doi:10.1093/arclin/acp077. PMID 19861331.
  17. ^ Guerrero-Berroa E, Luo X, Schmeidler J, et al. (December 2009). "The MMSE orientation for time domain is a strong predictor of subsequent cognitive pass up in the elderly". Int J Geriatr Psychiatry. 24 (12): 1429–37. doi:10.1002/gps.2282. PMC2919210. PMID 19382130.
  18. ^ Morales LS, Flowers C, Gutierrez P, Kleinman Thousand, Teresi JA; Flowers; Gutierrez; Kleinman; Teresi (November 2006). "Item and calibration differential functioning of the Mini-Mental Status Test assessed using the Differential Particular and Test Functioning (DFIT) Framework". Medical Care. 44 (11 Suppl iii): S143–51. doi:10.1097/01.mlr.0000245141.70946.29. PMC1661831. PMID 17060821. {{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. ^ "MMSE". Archived from the original on 2010-02-25. Retrieved 2009-12-10 .
  20. ^ Ganguli M, Ratcliff G, Huff FJ, et al. (1990). "Serial sevens versus world backwards: a comparison of the two measures of attention from the MMSE". J Geriatr Psychiatry Neurol. 3 (4): 203–vii. doi:10.1177/089198879000300405. PMID 2073308. S2CID 23054498.
  21. ^ Espino DV, Lichtenstein MJ, Palmer RF, Hazuda HP; Lichtenstein; Palmer; Hazuda (May 2004). "Evaluation of the mini-mental status examination'due south internal consistency in a customs-based sample of Mexican-American and European-American elders: results from the San Antonio Longitudinal Written report of Crumbling". Journal of the American Geriatrics Society. 52 (v): 822–vii. doi:10.1111/j.1532-5415.2004.52226.ten. PMID 15086669. S2CID 21220067. {{cite periodical}}: CS1 maint: multiple names: authors listing (link)
  22. ^ Crum RM, Anthony JC, Bassett SS, Folstein MF; Anthony; Bassett; Folstein (May 1993). "Population-based norms for the Mini-Mental Status Examination past historic period and educational level". JAMA. 269 (18): 2386–91. doi:10.1001/jama.1993.03500180078038. PMID 8479064. {{cite periodical}}: CS1 maint: multiple names: authors listing (link)
  23. ^ a b Arevalo-Rodriguez, Ingrid; Smailagic, Nadja; Roqué-Figuls, Marta; Ciapponi, Agustín; Sanchez-Perez, Erick; Giannakou, Antri; Pedraza, Olga L.; Bonfill Cosp, Xavier; Cullum, Sarah (2021-07-27). "Mini-Mental State Exam (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI)". The Cochrane Database of Systematic Reviews. 2021 (7): CD010783. doi:10.1002/14651858.CD010783.pub3. ISSN 1469-493X. PMC 8406467. PMID 34313331.
  24. ^ Palmqvist, S; Hansson, O; Minthon, Fifty; Londos, E (December 2009). "Applied suggestions on how to differentiate dementia with Lewy bodies from Alzheimer's disease with common cognitive tests". International Journal of Geriatric Psychiatry. 24 (12): 1405–12. doi:10.1002/gps.2277. PMID 19347836. S2CID 30099877.
  25. ^ Jefferson, AL; Cosentino, SA; Brawl, SK; Bogdanoff, B; Leopold, N; Kaplan, E; Libon, DJ (Summer 2002). "Errors produced on the mini-mental condition examination and neuropsychological test performance in Alzheimer's illness, ischemic vascular dementia, and Parkinson's disease". The Periodical of Neuropsychiatry and Clinical Neurosciences. 14 (3): 311–20. doi:x.1176/appi.neuropsych.14.iii.311. PMID 12154156.
  26. ^ Ala, TA; Hughes, LF; Kyrouac, GA; Ghobrial, MW; Elble, RJ (June 2002). "The Mini-Mental Condition exam may assistance in the differentiation of dementia with Lewy bodies and Alzheimer's illness". International Journal of Geriatric Psychiatry. 17 (6): 503–9. doi:10.1002/gps.550. PMID 12112173. S2CID 19992084.
  27. ^ a b James Grimmelmann. "How Copyright Is Like Cognitive Damage".
  28. ^ "History of Elsevier" (PDF). Elsevier. Archived from the original (PDF) on 2009-01-17. Retrieved 2010-x-29 .
  29. ^ Folstein MF, Folstein SE; McHugh, PR (2000-06-08). Mini-mental condition : a applied method for grading the cognitive land of patients for the clinician. Patent number TX0005228282
  30. ^ U.South. Copyright Part record #ii
  31. ^ a b Powsner S, Powsner D; Powsner (2005). "Cognition, copyright, and the classroom". The American Journal of Psychiatry. 162 (3): 627–eight. doi:x.1176/appi.ajp.162.3.627-a. PMID 15741491.
  32. ^ "Mini-Mental Status Examination. Psychological Assessment Resource, Inc". Archived from the original on 2006-06-27. Retrieved 2006-06-22 .
  33. ^ Holsinger T, Deveau J, Boustani M, Williams JW; Deveau; Boustani; Williams Jr (June 2007). "Does this patient take dementia?". JAMA. 297 (21): 2391–404. doi:x.1001/jama.297.21.2391. PMID 17551132. {{cite journal}}: CS1 maint: multiple names: authors list (link)
  34. ^ John C. Newman, Thou.D.; Robin Feldman, J.D. (December 2011). "Copyright and Open Access at the Bedside". NEJM. 365 (26): 2447–2449. doi:10.1056/NEJMp1110652. PMID 22204721.
  35. ^ PAR. "MMSE-2 home page". Retrieved 2010-10-29 .

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Source: https://en.wikipedia.org/wiki/Mini%E2%80%93Mental_State_Examination

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