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The mini-mental state examination (MMSE), also called the Folstein test, provides a quick assessment of a patient's cognitive state. This test allows a care provider to objectively assess a patient who may have cognitive impairments to determine their severity. It can also be performed as part of a routine examination to establish a baseline for future reference. Declining scores on the MMSE can be a sign that a patient is having neurological problems.
This test has been very widely used among older adults. Care providers may administer a mini-mental state examination when people first enter a hospital, clinic, or nursing facility to determine their level of alertness. It is possible to repeat a test if a patient appears to be in cognitive decline and the care provider wants to check again. Scores can be recorded in medical charts for future reference.
There are 30 questions on the test, which typically take around 10 minutes to answer. In a modified version of the mini-mental state examination, several additional test questions are included, and it may take slightly longer. These questions determine the patient's level of orientation, both physically and mentally, and also assess memory and math skills. The care provider can assign a score on the basis of one to 30, which will determine the patient's level of cognitive impairment.
Patients can be asked if they know where they are in a series of questions to illustrate that the patient knows where the hospital is, what the name of the town is, and so forth. Other questions have patients memorize and repeat words, draw shapes, and answer other simple prompts. The mini-mental state examination is designed for English-speaking patients, but care providers can produce variants in other languages if a patient doesn't speak English, or is not very fluent in English. Other modifications may be necessary for patients who are illiterate or innumerate, as some of the questions require spelling or counting.
Scores of 25 or higher indicate the patient appears to be functioning well, without any problems. If the score falls between 20 and 24, it may indicate a mild level of cognitive impairment, while scores between 10 and 20 are considered moderate. Anything lower than nine indicates severe impairment. In addition to scoring the patient on the mini-mental state examination, the care provider may also take note of anything unusual or distinctive in behavior. For example, if a patient is obviously agitated and disoriented, this is important to know.
My sister is a music therapist and has worked in nursing homes. When assessing clients, she has administered the mini-mental and said it's a pretty good indication of a person's status, but felt it should never be administered until a patient has been in the environment for a few days. She said just coming out of the hospital into an unfamiliar environment can be very traumatic for an older person and can really throw their cognitive function for a loop.
She said she liked to do them about a week after the patient arrived, to give the person a chance to acclimate to the environment.