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MMSE Variants and Subscores

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Cognitive Screening Instruments

Abstract

The Mini-Mental State Examination (MMSE) is long established as an instrument for the screening of cognitive complaints. Its utility has prompted the development of a number of variants and subscores. Of the MMSE variants, many are shorter than the original MMSE to facilitate use in time-limited situations but hopefully without loss of clinical utility. In contrast, the modified MMSE or 3MS is longer, assessing a broader range of cognitive functions. MMSE adaptations for those with hearing or visual impairment, for telephone use, and to identify cognitive problems in Parkinson’s disease have been described. MMSE subscores which may help to identify vascular dementia and dementia with Lewy bodies have also been described. These MMSE variants and subscores provide additional tools for the assessment of cognitive complaints, sometimes related to specific clinical situations. There are fewer data regarding their use than for the MMSE.

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References

  1. Folstein MF, Folstein SE, McHugh PR. Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.

    Article  PubMed  CAS  Google Scholar 

  2. Tombaugh TN, McIntyre NJ. The Mini-Mental State Examination: a comprehensive review. J Am Geriatr Soc. 1992;40:922–35.

    PubMed  CAS  Google Scholar 

  3. Mossello E, Boncinelli M. Mini-Mental State Examination: a 30-year story. Aging Clin Exp Res. 2006;18:271–3.

    PubMed  Google Scholar 

  4. Steis MR, Schrauf RW. A review of translations and adaptations of the Mini-Mental State Examination in languages other than English and Spanish. Res Gerontol Nurs. 2009;2:214–24.

    Article  PubMed  Google Scholar 

  5. Parker C, Philp I. Screening for cognitive impairment among older people in black and minority ethnic groups. Age Ageing. 2004;33:447–52.

    Article  PubMed  Google Scholar 

  6. Anthony JC, LeResche L, Niaz U, Von Korff MR, Folstein MF. Limits of the “Mini-Mental State” as a screening test for dementia and delirium among hospital patients. Psychol Med. 1982;12:397–408.

    Article  PubMed  CAS  Google Scholar 

  7. Wind AW, Schellevis FG, Van Staveren G, Scholten RP, Jonker C, Van Eijk JT. Limitations of the Mini-Mental State Examination in diagnosing dementia in general practice. Int J Geriatr Psychiatry. 1987;12:101–8.

    Article  Google Scholar 

  8. Feher EP, Mahurin RK, Doody RS, Cooke N, Sims J, Pirozzolo FJ. Establishing the limits of the Mini-Mental State. Examination of ‘subtests’. Arch Neurol. 1992;49:87–92.

    Article  PubMed  CAS  Google Scholar 

  9. Benedict RH, Brandt J. Limitation of the Mini-Mental State Examination for the detection of amnesia. J Geriatr Psychiatry Neurol. 1992;5:233–7.

    PubMed  CAS  Google Scholar 

  10. Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993;269:2386–91.

    Article  PubMed  CAS  Google Scholar 

  11. Mathuranath PS, Nestor PJ, Berrios GE, Rakowicz W, Hodges JR. A brief cognitive test battery to differentiate Alzheimer’s disease and frontotemporal dementia. Neurology. 2000;55:1613–20.

    Article  PubMed  CAS  Google Scholar 

  12. Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke’s Cognitive Examination Revised: a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry. 2006;21:1078–85.

    Article  PubMed  Google Scholar 

  13. Molloy DW, Alemayehu E, Roberts R. Reliability of a Standardized Mini-Mental State Examination compared with the traditional Mini-Mental State Examination. Am J Psychiatry. 1991;148:102–5.

    PubMed  CAS  Google Scholar 

  14. Molloy DW, Standish TI. A guide to the Standardized Mini-Mental State Examination. Int Psychogeriatr. 1997;9 Suppl 1:87–94; discussion 143–150.

    Article  PubMed  Google Scholar 

  15. Vertesi A, Lever JA, Molloy DW, et al. Standardized Mini-Mental State Examination. Use and interpretation. Can Fam Physician. 2001;47:2018–23.

    PubMed  CAS  Google Scholar 

  16. Ward A, Caro JJ, Kelley H, Eggleston A, Molloy W. Describing cognitive decline of patients at the mild or moderate stages of Alzheimer’s disease using the Standardized MMSE. Int Psychogeriatr. 2002;14:249–58.

    Article  PubMed  Google Scholar 

  17. Teng EL, Chui HC. The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry. 1987;48:314–8.

    PubMed  CAS  Google Scholar 

  18. Bassuk SS, Murphy JM. Characteristics of the Modified Mini-Mental State Exam among elderly persons. J Clin Epidemiol. 2003;56:622–8.

    Article  PubMed  Google Scholar 

  19. Heckbert SR, Longsteth Jr WT, Psaty BM, et al. The association of antihypertensive agents with MRI white matter findings and with Modified Mini-Mental State Examination in older adults. J Am Geriatr Soc. 1997;45:1423–33.

    PubMed  CAS  Google Scholar 

  20. Rapp SR, Espeland MA, Hogan P, et al. Baseline experience with Modified Mini Mental State Exam: the Women’s Health Initiative Memory Study (WHIMS). Aging Ment Health. 2003;7:217–23.

    Article  PubMed  CAS  Google Scholar 

  21. McDowell I, Kristjansson B, Hill GB, Hebert R. Community screening for dementia: the Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. J Clin Epidemiol. 1997;50:377–83.

    Article  PubMed  CAS  Google Scholar 

  22. Bland RC, Newman SC. Mild dementia or cognitive impairment: the Modified Mini-Mental State examination (3MS) as a screen for dementia. Can J Psychiatry. 2001;46:506–10.

    PubMed  CAS  Google Scholar 

  23. Bravo G, Hebert R. Age- and education-specific reference values for the Mini-Mental and modified Mini-Mental State Examinations derived from a non-demented population. Int J Geriatr Psychiatry. 1997;12:1008–18.

    Article  PubMed  CAS  Google Scholar 

  24. Tombaugh TN. Test-retest reliable coefficient and 5-year change scores for the MMSE and 3MS. Arch Clin Neuropsychol. 2005;20:485–503.

    Article  PubMed  Google Scholar 

  25. Tschanz JT, Welsh-Bohmer KA, Plassman PL, et al. An adaptation of the modified mini-mental state examination: analysis of demographic influences and normative data: the Cache County Study. Neuropsychiatry Neuropsychol Behav Neurol. 2002;15:28–38.

    PubMed  Google Scholar 

  26. Loewenstein DA, Barker WW, Harwood DG, et al. Utility of a modified Mini-Mental State Examination with extended delayed recall in screening for mild cognitive impairment and dementia among community dwelling elders. Int J Geriatr Psychiatry. 2000;15:434–40.

    Article  PubMed  CAS  Google Scholar 

  27. Tangalos EG, Smith GE, Ivnik RJ, et al. The Mini-Mental State Examination in general medical practice: clinical utility and acceptance. Mayo Clin Proc. 1996;71:829–37.

    Article  PubMed  CAS  Google Scholar 

  28. Cefalu CA. The 28-point mini-mental status examination. Md Med J. 1994;43:431.

    PubMed  CAS  Google Scholar 

  29. Magaziner J, Bassett SS, Hebel JR. Predicting performance on the Mini-Mental State Examination. Use of age- and education-specific equations. J Am Geriatr Soc. 1987;35:996–1000.

    PubMed  CAS  Google Scholar 

  30. Matthews FE, Stephan BC, Khaw KT, et al. Full-scale scores of the Mini Mental State Examination can be generated from an abbreviated version. J Clin Epidemiol. 2011;64:1005–13.

    Article  PubMed  Google Scholar 

  31. Galasko D, Klauber MR, Hofstetter CR, Salmon DP, Lasker B, Thal LJ. The Mini-Mental State Examination in the early diagnosis of Alzheimer’s disease. Arch Neurol. 1990;47:49–52.

    Article  PubMed  CAS  Google Scholar 

  32. Belmin J, Pariel-Madjlessi S, Surun P, et al. The cognitive disorders examination (Codex) is a reliable 3-minute test for detection of dementia in the elderly (validation study in 323 subjects). Presse Med. 2007;36:1183–90.

    Article  PubMed  Google Scholar 

  33. Onishi J, Suzuki Y, Umegaki H, Kawamura T, Imaizumi M, Iguchi A. Which two questions of Mini-Mental State Examination (MMSE) should we start from? Arch Gerontol Geriatr. 2007;44:43–8.

    Article  PubMed  Google Scholar 

  34. Paveza GJ, Cohen D, Blaser CJ, Hapogian M. A brief form of the Mini-Mental State Examination for use in community care settings. Behav Health Aging. 1990;1:133–9.

    Google Scholar 

  35. Koenig HG. An abbreviated Mini-Mental State Exam for medically ill older adults. J Am Geriatr Soc. 1996;44:215–6.

    PubMed  CAS  Google Scholar 

  36. Callahan CM, Unverzagt FW, Hui SL, Perkins AJ, Hendrie HC. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care. 2002;40:771–81.

    Article  PubMed  Google Scholar 

  37. Chen MR, Guo QH, Cao XY, Hong Z, Liu XH. A preliminary study of the Six-Item Screener in detecting cognitive impairment. Neurosci Bull. 2010;26:317–21.

    Article  PubMed  Google Scholar 

  38. Wilber ST, Carpenter CR, Hustey FM. The Six-Item Screener to detect cognitive impairment in older emergency department patients. Acad Emerg Med. 2008;15:613–6.

    Article  PubMed  Google Scholar 

  39. Galvin JE, Roe CM, Powlishta KK, et al. The AD8: a brief informant interview to detect dementia. Neurology. 2005;65:559–64.

    Article  PubMed  CAS  Google Scholar 

  40. Galvin JE, Roe CM, Coats MA, Morris JC. Patient’s rating of cognitive ability: using the AD8, a brief informant interview, as a self-rating tool to detect dementia. Arch Neurol. 2007;64:725–30.

    Article  PubMed  Google Scholar 

  41. Carpenter CR, DesPain B, Keeling TN, Shah M, Rothenberger M. The Six-Item Screener and AD8 for the detection of cognitive impairment in geriatric emergency department patients. Ann Emerg Med. 2011;57:653–61.

    Article  PubMed  Google Scholar 

  42. Carcaillon L, Amieva H, Auriacombe S, Helmer C, Dartigues JF. A subtest of the MMSE as a valid test of episodic memory? Comparison with the Free and Cued Reminding Test. Dement Geriatr Cogn Disord. 2009;27:429–38.

    Article  PubMed  Google Scholar 

  43. Dubois B, Touchon J, Portet F, Ousset PJ, Vellas B, Michel B. “The 5 words”: a simple and sensitive test for the diagnosis of Alzheimer’s disease [in French]. Presse Med. 2002;31:1696–9.

    PubMed  CAS  Google Scholar 

  44. Commenges D, Gagnon M, Letenneur L, Dartigues JF, Barberger-Gateau P, Salamon R. Improving screening for dementia in the elderly using, Mini-Mental State Examination subscores, Benton’s Visual Retention Test, and Isaacs’ Set Test. Epidemiology. 1992;3:185–8.

    Article  PubMed  CAS  Google Scholar 

  45. Clionsky MI, Clionsky E. Development and validation of the Memory Orientation Screening Test (MOST™): a better screening test for dementia. Am J Alzheimers Dis Other Demen. 2010;25:650–6.

    Article  PubMed  Google Scholar 

  46. Schultz-Larsen K, Lomholt RK, Kreiner S. Mini-Mental Status Examination: a short form of MMSE was as accurate as the original MMSE in predicting dementia. J Clin Epidemiol. 2007;60:260–7.

    Article  PubMed  Google Scholar 

  47. Mitchell AJ, Malladi S. Screening and case-finding tools for the detection of dementia. Part I: evidence-based meta-analysis of multidomain tests. Am J Geriatr Psychiatry. 2010;18:759–82.

    Article  PubMed  Google Scholar 

  48. Haubois G, Annweiler C, Launay C, Fantino B, de Decker L, Allali G, Beauchet O. Development of a short form of Mini-Mental State Examination for the screening of dementia in older adults with a memory complaint: a case control study. BMC Geriatr. 2011;11:59.

    Article  PubMed  Google Scholar 

  49. Haubois G, de Decker L, Annweiler C, Launay C, Allali G, Herrmann FR, Beauchet O. Derivation and validation of a short form of the Mini-Mental State Examination (SMMSE) for the screening of dementia in older adults with a memory complaint. 2012 (submitted).

    Google Scholar 

  50. Kim TH, Jhoo JH, Park JH, et al. Korean version of mini mental status examination for dementia screening and its short form. Psychiatry Invest. 2010;7:102–8.

    Article  Google Scholar 

  51. Harrell LE, Marson D, Chatterjee A, Parrish JA. The Severe Mini-Mental State Examination: a new neuropsychologic instrument for the bedside assessment of severely impaired patients with Alzheimer disease. Alzheimer Dis Assoc Disord. 2000;14:168–75.

    Article  PubMed  CAS  Google Scholar 

  52. Tate RL. A compendium of tests, scales, and questionnaires. The practitioner’s guide to measuring outcomes after acquired brain impairment. Hove: Psychology Press; 2010. p. 170.

    Google Scholar 

  53. Raiha I, Isoaho R, Ojanlatva A, Viramo P, Sulkava R, Kivela SL. Poor performance in the mini-mental state examination due to causes other than dementia. Scand J Prim Health Care. 2001;19:34–8.

    Article  PubMed  CAS  Google Scholar 

  54. Uhlmann RF, Teri L, Rees TS, Mozlowski KJ, Larson EB. Impact of mild to moderate hearing loss on mental status testing. Comparability of standard and written Mini-Mental State Examinations. J Am Geriatr Soc. 1989;37:223–8.

    PubMed  CAS  Google Scholar 

  55. De Silva ML, McLaughlin MT, Rodrigues EJ, Broadbent JC, Gray AR, Hammond-Tooke GD. A Mini-Mental Status Examination for the hearing impaired. Age Ageing. 2008;37:593–5.

    Article  PubMed  Google Scholar 

  56. Busse A, Sonntag A, Bischkopf J, Matschinger H, Angermeyer MC. Adaptation of dementia screening for vision-impaired older persons: administration of the Mini-Mental State Examination (MMSE). J Clin Epidemiol. 2002;55:909–15.

    Article  PubMed  Google Scholar 

  57. Jefferis J, Collerton J, Taylor JP, et al. The impact of visual impairment on Mini-Mental State Examination scores in the Newcastle 85+ study. Age Ageing. 2012;41:565–8.

    Google Scholar 

  58. Norton MC, Tschanz JA, Fan X, et al. Telephone adaptation of the Modified Mini-Mental State Examination (3MS). The Cache County Study. Neuropsychiatry Neuropsychol Behav Neurol. 1999;12:270–6.

    PubMed  CAS  Google Scholar 

  59. Roccaforte WH, Burke WJ, Bayer BL, Wengel SP. Validation of a telephone version of the mini-mental state examination. J Am Geriatr Soc. 1992;40:697–702.

    PubMed  CAS  Google Scholar 

  60. Metitieri T, Geroldi C, Pezzini A, Frisoni GB, Bianchetti A, Trabucchi M. The Itel-MMSE: an Italian telephone version of the Mini-Mental State Examination. Int J Geriatr Psychiatry. 2001;16:166–7.

    Article  PubMed  CAS  Google Scholar 

  61. Newkirk LA, Kim JM, Thompson JM, Tinklenberg JR, Yesavage JA, Taylor JL. Validation of a 26-point telephone version of the Mini-Mental State Examination. J Geriatr Psychiatry Neurol. 2004;17:81–7.

    Article  PubMed  Google Scholar 

  62. Garre-Olmo J, Lax-Pericall C, Turro-Garriga O, et al. Adaptation and convergent validity of a telephone-based Mini-Mental State Examination [in Spanish]. Med Clin (Barc). 2008;131:89–95.

    Article  Google Scholar 

  63. Vanacore N, De Carolis A, Sepe-Monti M, et al. Validity of the Italian telephone version of the mini-mental state examination in the elderly healthy population. Acta Neurol Belg. 2006;106:132–6.

    PubMed  Google Scholar 

  64. Ciemins EL, Holloway B, Con PJ, McClosky-Armstrong T, Min SJ. Telemedicine and the Mini-Mental State Examination: assessment from a distance. Telemed J E Health. 2009;15:476–8.

    Article  PubMed  Google Scholar 

  65. Jefferson AL, Cosentino SA, Ball SK, et al. Errors produced on the mini-mental state examination and neuropsychological test performance in Alzheimer’s disease, ischemic vascular dementia, and Parkinson’s disease. J Neuropsychiatry Clin Neurosci. 2002;14:311–20.

    Article  PubMed  Google Scholar 

  66. Mahieux F, Michelet D, Manifacier M-J, Boller F, Fermanian J, Guillard A. Mini-Mental Parkinson: first validation study of a new bedside test constructed for Parkinson’s disease. Behav Neurol. 1995;8:15–22.

    Google Scholar 

  67. Larner AJ. Mini-Mental Parkinson (MMP) as a dementia screening test: comparison with the Mini-Mental State Examination (MMSE). Curr Aging Sci. 2012;5:136–9.

    Google Scholar 

  68. Larner AJ. Dementia in clinical practice: a neurological perspective. Studies in the dementia clinic. London: Springer; 2012. p. 27.

    Book  Google Scholar 

  69. Parrao-Diaz T, Chana-Cuevas P, Juri-Claverias C, Kunstmann C, Tapia-Nunez J. Evaluation of cognitive impairment in a population of patients with Parkinson’s disease by means of the mini mental Parkinson test [in Spanish]. Rev Neurol. 2005;40:339–44.

    PubMed  CAS  Google Scholar 

  70. Serrano-Dueñas M, Calero B, Serrano S, Serrano M, Coronel P. Metric properties of the mini-mental Parkinson and SCOPA-COG scales for rating cognitive deterioration in Parkinson’s disease. Mov Disord. 2010;25:2555–62.

    Article  PubMed  Google Scholar 

  71. Caslake CR, Summers F, McConachie D, et al. Mini-Mental Parkinson’s test as a cognitive screening tool in people with Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2009;80:e3 (abstract).

    Article  Google Scholar 

  72. Zhelev YE, Raycheva MR, Petrova MI, Traykov LD. Cognitive decline in a longitudinally followed group of patients with idiopathic Parkinson’s disease and mild cognitive impairment. Eur J Neurol. 2010;17 Suppl 3:97 (abstract P1066).

    Google Scholar 

  73. Magni E, Binetti G, Padovani A, Cappa SF, Bianchetti A, Trabucchi M. The Mini-Mental State Examination in Alzheimer’s disease and multi-infarct dementia. Int Psychogeriatr. 1996;8:127–34.

    Article  PubMed  CAS  Google Scholar 

  74. Ala T, Hughes LF, Kyrouac GA, Ghobrial MW, Elble RJ. The Mini-Mental State exam may help in the differentiation of dementia with Lewy bodies and Alzheimer’s disease. Int J Geriatr Psychiatry. 2002;17:503–9.

    Article  PubMed  Google Scholar 

  75. Salmon DP, Galasko D, Hansen LA, et al. Neuropsychological deficits associated with diffuse Lewy body disease. Brain Cogn. 1996;31:148–65.

    Article  PubMed  CAS  Google Scholar 

  76. Downes JJ, Priestley NM, Doran M, Ferran J, Ghadiali E, Cooper P. Intellectual, mnemonic and frontal functions in dementia with Lewy bodies: a comparison with early and advanced Parkinson’s disease. Behav Neurol. 1998;11:173–83.

    PubMed  Google Scholar 

  77. Calderon J, Perry R, Erzinclioglu S, Berrios GE, Dening T, Hodges JR. Perception, attention and working memory are disproportionately impaired in dementia with Lewy bodies compared with Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2001;70:157–64.

    Article  PubMed  CAS  Google Scholar 

  78. Hanyu H, Shimizu S, Hirao K, et al. Differentiation of dementia with Lewy bodies from Alzheimer’s disease using Mini-Mental State Examination and brain perfusion SPECT. J Neurol Sci. 2006;250:97–102.

    Article  PubMed  Google Scholar 

  79. Larner AJ. MMSE subscores and the diagnosis of dementia with Lewy bodies. Int J Geriatr Psychiatry. 2003;18:855–6.

    Article  PubMed  CAS  Google Scholar 

  80. Larner AJ. Use of MMSE to differentiate Alzheimer’s disease from dementia with Lewy bodies. Int J Geriatr Psychiatry. 2004;19:1209–10.

    Article  Google Scholar 

  81. Newman JC, Feldman R. Copyright and open access at the bedside. N Engl J Med. 2011;365:2447–9.

    Article  PubMed  CAS  Google Scholar 

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  1. Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK

    R. Rhys Davies M.A., BM, BCh, Ph.D. & Andrew J. Larner M.D.

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    A. J. Larner

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Davies, R.R., Larner, A.J. (2013). MMSE Variants and Subscores. In: Larner, A. (eds) Cognitive Screening Instruments. Springer, London. https://doi.org/10.1007/978-1-4471-2452-8_3

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