Mini-Mental State Examination (MMSE)

A widely used screening tool for assessing cognitive function and detecting cognitive impairment.

Directions for administration of the MMSE:

Before the questionnaire is administered, try to get the person to sit down facing you. Assess the person’s ability to hear and understand very simple conversation, e.g. What is your name? If the person uses hearing or visual aids, provide these before starting.

Introduce yourself and try to get the person’s confidence. Before you begin, get the person’s permission to ask questions, e.g. Would it be alright to ask you some questions about your memory? This helps to avoid catastrophic reactions.

Ask each question a maximum of three times. If the subject does not respond, score 0.

If the person answers incorrectly, score 0. Accept that answer and do not ask the question again, hint, or provide any physical clues such as head shaking, etc.

If the person answers: What did you say?, do not explain or engage in conversation. Merely repeat the same directions a maximum of three times.

If the person interrupts (e.g. What is this for?), reply: I will explain in a few minutes, when we are finished. Now if we could proceed please… we are almost finished.

ORIENTATION

What is the (year), (season), (date), (day) and (month)?

1 point is available for each correct response for a possible total of 5.

5 correct answers

4 correct answers

3 correct answers

2 correct answers

1 correct answer

0 correct answers

ORIENTATION

Where are we (state), (country), (town), (hospital/office) and (floor/type of room)?

1 point is available for each correct response for a possible total of 5.

5 correct answers

4 correct answers

3 correct answers

2 correct answers

1 correct answer

0 correct answers

REGISTRATION

Choose three random objects and say them out loud (ex: apple, train, fridge)

Ask the patient to repeat the objects you just listed. Give 1 point for each correct answer.

3 correct answers

2 correct answers

1 correct answer

0 correct answers

ATTENTION AND CALCULATION

Ask the patient to count backwards from 100 by 7. (ex: 100, 93, 86, 79..)

1 point for each correct answer, stop after 5 correct. Up to 5 points.

5 correct answers

4 correct answers

3 correct answers

2 correct answers

1 correct answer

0 correct answers

ATTENTION AND CALCULATION

Alternatively, you can ask the patient to spell “world” backward for up to 5 points.

Do not record points for both types of attention/calculation tasks.

5 correct answers

4 correct answers

3 correct answers

2 correct answers

1 correct answer

0 correct answers

RECALL

Ask the patient to tell you the 3 objects from the previous question in the exam.

Give one point for each correct answer, for up to 3 points.

3 correct answers

2 correct answers

1 correct answer

0 correct answers

LANGUAGE

Point to a pencil and a watch and ask the patient what the name of the items are.

Give one point for each correct answer, for up to 2 points.

2 correct answers

1 correct answer

0 correct answers

LANGUAGE

Ask the patient to repeat the following "No ifs, and, or buts"

Give one point for a correct answer.

1 correct answer

0 correct answers

LANGUAGE

Give a 3 stage command: "take a paper in your hand, fold it in half, and put it on the floor" (have paper available on table)

Give one point for each command followed for up to 3 points.

3 correct answers

2 correct answers

1 correct answer

0 correct answers

LANGUAGE

On a piece of paper print the command "CLOSE YOUR EYES". Have this paper faced down. Instruct the patient to read and obey the command on the paper and then hand it to them.

Give one point for following the command.

1 correct answer

0 correct answers

LANGUAGE

Ask the patient to write one sentence (they can write whatever they want).

Give one point for following the command..

1 correct answer

0 correct answers

LANGUAGE

Ask the patient to copy this design shown.

Give one point for following the command correctly.

1 correct answer

0 correct answers

Interpretation

Sources:

Gallegos M, Morgan ML, Cervigni M, Martino P, Murray J, Calandra M,Razumovskiy A, Caycho-Rodríguez T, Gallegos WLA. 45 Years of the mini-mental state examination (MMSE): A perspective from ibero-america. Dement Neuropsychol. 2022 Jul 29;16(4):384-387. doi: 10.1590/1980-5764-DN-2021-0097. PMID: 36530763; PMCID: PMC9745978.
Arevalo-Rodriguez, Ingrid et al. “Mini-Mental State Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI).” The Cochrane database of systematic reviews vol. 2015,3 CD010783. 5 Mar. 2015, doi:10.1002/14651858.CD010783.pub2.