Instructions For Administration Of Mini Mental State Examination
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1
2Instructions for Administration of
Capital
Mini-Mental State Examination
Health
(MMSE)
What Is the MMSE?
1
The Mini-Mental State Examination (MMSE)
is a widely used, well-validated screening tool for cognitive
impairment. It briefly measures orientation to time and place, immediate recall, short-term verbal memory,
calculation, language, and construct ability. Each area tested has a designated point value, with the maximum
possible score on the MMSE being 30/30. Since 1993 the MMSE has been available with an attached table
2
that enables patient–specific norms to be identified on the basis of age and educational level.
Please use
this table (labelled “Lower Quartiles”) to identify the expected normal score for your patient when
adjusted for age and educational level.
Recording the MMSE
Record the patient’s educational level in the space labelled “number of years of schooling”. Circle the
adjusted normal score for your patient in the table at the bottom of the page. Record that number in the space
labelled “Mini-Mental Normal” on the ESAS Graph (and on any other specified data sheet that your program
may use). Upon completion of the MMSE the score achieved by the patient should be clearly recorded on the
top half of the MMSE form and also in the space designated on the ESAS Graph for the MMSE score of that
date. The score is recorded using a denominator of 30 unless the patient was unable to complete the test due
to a physical handicap (e.g. blindness) --in which case the value of the questions not able to be completed is
subtracted from 30 and the resulting number used as the denominator for the test score. If a denominator of
less than 30 is used, the nature of the physical handicap should be indicated on the MMSE form.
The appropriate descriptor of the patient’s level of consciousness should also be circled on the MMSE form.
Alert = remains awake easily. Drowsy = finds it difficult to stay awake. Stupor = is difficult to rouse. Coma =
unable to rouse.
When to Do the MMSE
The MMSE is completed on admission and weekly thereafter, and at any time when there is a concern about
cognitive ability. This tool is most valuable when cognitive impairment is not suspected. The MMSE is far more
sensitive in detecting cognitive impairment than is the use of informal questioning or “overall impression” of
patient orientation.
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How to Do the MMSE
When the purpose and value of the MMSE is explained well it is readily accepted by most patients and
family members. Therefore, it is extremely important to take time to explain the rationale for using this
tool before commencing with the questions it contains. Most patients value their cognitive abilities very
highly and many are already well aware of the impact that medications or their disease state can have on
these abilities. Explaining that the MMSE may be of great help in detecting reversible impairment of these
faculties is usually enough to facilitate its acceptance by patients and their families –and, in any case, it is
information with which the patient has a right to be provided. Before administering the MMSE it is important to
make the patient comfortable and establish a rapport with the patient. During its administration praising
successes may help to maintain this rapport and so is quite acceptable. Persisting on items the patient finds
difficult should be avoided. Following are the details of how to administer and score the MMSE:
1 Folstein MF, Folstein S, McHugh PR: “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician.
Journal of Psychiatric Research 1975; 12: 189-198.
2 Crum RM, Anthony JC, Bassett SS, Folstein MF: Population-based norms for the Mini-Mental State Examination by age and educational level.
Journal of the American Medical Association 1993; 269: 2386-2391.
CH-0379 Ju1 2001
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