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The Mini Mental State
Examination (MMSE)
The Mini Mental State Examination (MMSE) is the most
commonly used test for complaints of memory problems. It can
be used by clinicians to help diagnose dementia and to help
assess its progression and severity. This factsheet looks at how
the MMSE is used and provides information about the test so
that the person taking it knows what to expect.
How is it used?
The MMSE is a series of questions and tests, each of which scores
points if answered correctly. If every answer is correct, a maximum
score of 30 points is possible. The MMSE tests a number of different
mental abilities, including a person’s memory, attention and language.
The MMSE is a tool that is used by clinicians such as a GP or a
neuropsychologist (a psychologist who specialises in the brain and its
function) to help them diagnose and assess dementia. It is only one
part of these processes and clinicians will often consider a person’s
MMSE score alongside the results of other tests (see factsheet 426,
Diagnosis and assessment).
In general, scores of 27 or above (out of 30) are considered normal.
However, getting a score below this does not always mean that a
person has dementia – their mental abilities might be impaired for
another reason or they may have a physical problem such as difficulty
hearing, which makes it harder for them to take the test.
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The MMSE can also be used to assess changes in a person who
has already been diagnosed with dementia. It can help to give an
indication of how severe a person’s symptoms are and how quickly
their dementia is progressing. On average, people with Alzheimer’s
disease who are not receiving treatment lose two to four MMSE points
each year.
MMSE score and treatment
The MMSE score is one of the things a doctor considers when deciding
if drugs will help a person with dementia. The severity of a person’s
dementia gives an indication of which drugs may be of benefit.
Recommendations as to which drugs may be used at each stage of
dementia are issued by the National Institute for Health and Clinical
Excellence (NICE).
The latest (2011) NICE guidance recommends that for mild-to-
moderate Alzheimer’s disease (MMSE score 10–26), the person
should be considered for treatment with donepezil (Aricept),
rivastigmine (Exelon) or galantamine (Reminyl). The same NICE
guidance recommends the use of a different kind of drug, memantine
(Ebixa), for people with severe Alzheimer’s disease (MMSE score less
than 10) and for some of those with moderate disease (MMSE score
10–20).
Considerations
It is important to note that a person’s MMSE score can be affected by
their level of education. This is because for highly educated people the
questions may be too easy and for poorly educated people some may
be too difficult. This means that a highly educated person with mild
dementia may score in the normal range, whereas a poorly educated
person with no problems in cognition may score in the dementia
range. The person’s cultural background could also affect their score
as some of the questions may be easier for people from certain
cultures to answer – for example questions that require knowledge
relevant to English history.
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For people with learning disabilities, difficulty speaking, or for those
who are not fluent enough in a language in which the MMSE can be
given, a different method should be used to assess dementia severity
when treatment is being considered. This is to ensure that people from
different ethnic or cultural backgrounds and people with disabilities
have equal access to treatment.
A person’s MMSE score should also be considered in the light of the
particular difficulties that they experience. For example, a person with
posterior cortical atrophy (PCA – a rare type of Alzheimer’s disease)
might score in the normal range, despite having significant
symptoms and problems. This is because the MMSE is weighted
towards measuring memory and orientation (on which people with
PCA are relatively strong), but has few questions examining vision or
literacy (which are the main problems experienced by people with
PCA). This could lead to the person not being considered for
treatment as their MMSE score gives the impression that their
difficulties are very mild.
Sample questions
The MMSE is made up of a range of different questions and tests.
Below are four sample questions that give an indication of the style of
the MMSE.
1 Orientation to time
‘What is the date?’
2 Registration
‘Listen carefully. I am going to say three words. You say them back
after I stop. Ready? Here they are... apple [pause], penny [pause],
table [pause]. Now repeat those words back to me.’
[Repeat up to 5 times, but score only the first trial.]
3 Naming
‘What is this?’ [Point to a pencil or pen.]
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4 Reading
‘Please read this and do what it says.’ [Show examinee the following
words on the stimulus form: Close your eyes.]
Sample questions reproduced by special permission of the Publisher,
Psychological Assessment Resources, Inc., 16204 North Florida
Avenue, Lutz, Florida 33549, from the Mini Mental State Examination,
by Marshal Folstein and Susan Folstein, Copyright 1975, 1998, 2001
by Mini Mental LLC, Inc. Published 2001 by Psychological Assessment
Resources, Inc. Further reproduction is prohibited without permission
of PAR, Inc. The MMSE can be purchased from PAR, Inc. by calling
(813) 968-3003.
For details of Alzheimer’s Society services in your area, visit
alzheimers.org.uk/localinfo
For information about a wide range of dementia-related topics, visit
alzheimers.org.uk/factsheets
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Registered charity no. 296645. A company limited by guarantee and registered
in England no. 2115499
Factsheet 436LP
Last reviewed: January 2012
Next review due: January 2014
Reviewed by: Dr Sebastian Crutch,
Neuropsychologist, Dementia
Research Centre, Institute of
Neurology, UCL, London and Professor
Louise Robinson, Professor of
Primary Care and Ageing, Newcastle
University, Newcastle
This factsheet has also been reviewed
by people affected by dementia.
A list of sources is available on
request.
Alzheimer’s Society National
Dementia Helpline
England, Wales and Northern Ireland:
0300 222 11 22
9am–5pm Monday–Friday
10am–4pm Saturday–Sunday
alzheimers.org.uk
Alzheimer’s Society is the UK’s
leading support and research charity
for people with dementia, their
families and carers.
This publication contains information and general advice. It should not be used
as a substitute for personalised advice from a qualified professional. Alzheimer’s
Society does not accept any liability arising from its use. We strive to ensure that
the content is accurate and up to date, but information can change over time.
Please refer to our website for the latest version and for full terms and conditions.
© Alzheimer’s Society, 2013. All rights reserved. Except for personal use, no part
of this work may be distributed, reproduced, downloaded, transmitted or stored
in any form without the written permission of Alzheimer’s Society.