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Mini Mental State Exam (MMSE)

Of all the mental status exams assessing memory, concentration, and other cognitive skills, the most common one used in the evaluation of Alzheimer’s disease is the Mini Mental State Exam (MMSE). The MMSE is a research-based set of questions that provides a score about a person’s general level of impairment.

The Mini Mental State Exam is generally a reliable, valid measure of cognitive impairment. However, highly educated people tend to score higher on the MMSE even when they do have Alzheimer’s disease. The MMSE takes only 5 to 10 minutes to complete. Although it might seem like a simple procedure, only trained clinicians — such as physicians, nurses, and psychologists — should give and score the MMSE. The MMSE asks questions that assess five areas:

Orientation
The clinician asks the person the following questions:

1. What is the year?

2. What is the season?

3. What is the date? What is the day?

4. What is the month?

5. What state are we in?

6. What county are we in?

7. What town are we in? What (hospital, or other building) are we in? What floor are we on? 

Short-Term Memory (Retention)
The clinician names three objects (for example, apple, table, and hat) and asks the person to repeat the three words all at once. If the person can’t do this correctly, the clinician can repeat the words until the person learns them (a maximum of six tries is permitted).

Attention
The person is asked to count backwards from 100 by 7s, or to spell the word “world” backwards.

Short-Term Memory (Recall)
The person is asked to repeat the three objects named earlier (apple, table, and hat).

Language
The assessment of language involves six tasks:

1. First, the clinician holds up a pencil and a watch (separately) and asks the person to name the objects.

2. Second, the person is asked to repeat the phrase, “No ifs, ands, or buts.”

3. Third, the person is asked to follow a three-stage command (Take this paper in your right hand, fold it in half, and hand it back to me.).

4. Fourth, the person is given a piece of paper with the command “Close your eyes” written on it and is asked to do what the paper says.

5. Fifth, the person is asked to write a spontaneous sentence.

6. Sixth, the person is asked to copy a simple design.

Scoring
The maximum score on the Mini Mental State Exam is 30. In general, scores fall into four categories:

24 – 30: “normal” range
20 – 23
: mild cognitive impairment or possible early-stage/mild Alzheimer’s disease
10 – 19: middle-stage/moderate Alzheimer’s disease
0 – 9: late-stage/severe Alzheimer’s disease

Although the Mini Mental State Exam and its scoring guidelines are useful, the MMSE shouldn’t be used independently to make a diagnosis, nor should any other singular aspect of the diagnostic process. A diagnosis of Alzheimer’s can only be made after a complete diagnostic workup rules out any other possible cause for the person’s symptoms.

Sources: Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198. Hill, C. L., & Spengler, P. M. (1997). Dementia and depression: A process model for differential diagnosis. Journal of Mental Health Counseling, 19, 23-39.
Zarit, S. H., & Zarit, J. M. (1998). Mental disorders in older adults: Fundamentals of assessment and treatment. New York: The Guilford Press.