The Mini Mental Status Exam
The mini mental status exam, also known as the mini mental state exam or MMSE, is a screening tool for cognitive impairment.
It is not a new Alzheimer’s test but rather a tried and true method of testing for cognitive impairment.
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The MMSE test for Alzheimer’s consists of a 30 point questionnaire that tests the following areas:
- Orientation
- Word Recall
- Attention and Calculation
- Language Ability
- Visuospatial Orientation
In practice, I have seen that the best use of this test is to measure cognitive changes over time.
It is also effective for evaluating the effectiveness of new medications. We would test prior to the initiation of a new medication or treatment and then test again 4-6 weeks after the changes.
You would hope to see either an improvement or a slowing of the decline that had previously been charted.
In this manner, the mini mental status exam can help you determine which treatments are working and which are not making any difference.
Drawbacks of the Mini Mental Status Exam
There are some drawbacks for the test, including that the scores have to be adjusted for age, ethnicity and educational level of the patient.
The test has been translated into several languages and even adapted for visual impairment.
Although the mini mental status exam is a great screening tool, it should never take the place of a full diagnostic work up.
Remember that exam only tests for cognitive impairment, but not the base cause of that cognitive impairment.
Who Gives the MMSE?
The test should be given by a qualified practitioner that has been specially trained in administering and evaluating the test results.
In our facility, it was our Director of Social Services, who held a Master’s Degree in Social Work and specialized in geriatric care, who administered the test.
Most doctors are not specially trained, so be prepared for them to refer you to a specially trained nurse or social worker to administer the test.
Interpreting Test Scores
Test results have to be individually interpreted for each patient. Scores traditionally decrease with age and increase with educational level of the patient.
A score of 25-30 generally means no cognitive impairment. A score of less than 10 indicates severe impairment. Moderate cognitive decline usually scores in the 19-24 range, and those patients with mid level Alzheimer’s typically score in the 10-19 range.
There are many variables to be taken into consideration when interpreting these numbers. It is possible to score very high and yet still have significant cognitive decline, especially with younger individuals with advanced levels of education.
What You Can Do To Help
As a family caregiver, you should
not be present during the test. It is important that your family member is well rested and has eaten prior to the test, so that fatigue and low blood sugar do not alter test results.
It is never advisable for you to administer the test at home by yourself. You are better off requesting that your doctor order the test so that someone qualified can administer and interpret the results.
If your family member’s physician orders medication changes, it is advisable to perform a baseline mini mental status exam prior to the initiation of the new medications and again 4 – 6 weeks afterwards.
If your physician does not order the MMSE, it is perfectly within your right to ask that he does.
All medications come with side effects and if the mini mental does not indicate improvement or slowing decline, there is no reason to have your family member continue most medications prescribed for Alzheimer’s.
The most important thing to remember is that the mini mental status exam is a screening tool of cognitive function. There are many conditions that can cause cognitive decline and Alzheimer’s is just one of them.
It is best to use the exam as a tool to measure progression of cognitive changes over time and should never be used as a diagnostic tool in and of itself.
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