Dementia Stages: The Mini Mental Status Exam
Dementia stages can be difficult to gauge, but the Mini Mental Status Exam (MMSE) is a widely used tool to assess cognitive function and detect the severity of dementia. Learn more about the MMSE and how it can help caregivers understand and manage dementia in their loved ones.
Dementia Stages Can Be Detected and Gauged by the Mini Mental Status Exam
A test for dementia stages
The Mini Mental State Exam (also known as the MMSE or the Folstein exam) can detect and gauge the dementia stages.
This is one of the more popular tests for dementia that takes only five to ten minutes to administer. Of course, if the person taking the test has one of the more advanced stages of dementia, it may take longer. It is also a tool that measures the effectiveness of a treatment dementia patients receive. It may be able to gauge a response to a new medication.
Please note… the Mini Mental State Exam is a copyrighted product. Copyright held by Psychological Assessment Resources – PAR). The Cognistat test is as well. It is not possible to put the actual test on my website. But it is possible to tell you what the test includes. And how it is possible to conduct a similar test on yourself or the aging senior in your life.
The MMSE test includes…Simple questions and Problems. These assess several different areas:
Time
Place of the test
Repeating lists of words
Arithmetic such as the serial sevens
Language use
Comprehension
Basic motor skills.
For example, one question asks to copy a drawing of two pentagons.
The Mini Mental State Exam assesses five different cognitive (mental) functional abilities:
- Orientation to time and place
- Registration the ability to repeat named prompts.
- Attention Span and Arithmetic
- Memory and recall- going back to the named objects in the registration section.
- Language- asked to repeat a phrase
There are a total of 30 points possible. Give 1 point for each correctly answered question or task preformed.
Here is an adapted version of the test. Ask these questions and record answers.
- What year, season, month, date, and day of the week it is? (score 1 point for each correct answer. There is a maximum of 5 points total. Please take time and ask each of these. Give time for a response.
- What state do you live in? What country? What is that name of the town or (city)? What building you are in (presumably the home)? What room are we in right now? (again, score 1 point for each correct answer – maximum of 5 points total)
- Name three objects… chair, peach, nickel. Ask to have those words repeated back to you. Do this until they can recall all three objects easily (score 1 point for each correct answer – maximum of 3 points)
- Ask to spell the word “world” backwards – “D-L-R-O-W” (score 1 point for each letter put in the correct sequence)
- Now ask the person to repeat the names of the three objects named in number 3 above (score 1 point for each correct answer – maximum of 3 points) ( chair, peach, nickel)
- Point to a pencil or pen and ask to identify that object by saying, “What is this?” (score 1 point if correct)
- Point to a watch and ask to identify that object by saying, “What is this?” (score 1 point if correct)
- Ask to repeat this statement: “No ifs, ands, or buts.” (score 1 point if correct)
- Hand a blank sheet of paper and tell him: “Take this piece of paper, fold it in half, and drop it on the floor.” (score 1 point for each step done correctly – maximum of 3 points)
- Take time to write the words “Close Your Eyes” on a sheet of paper. Ask to read it and tell you what it says. (score 1 point if correct)
- Ask them to write one sentence (score 1 point if this is done correctly – must be a complete sentence, at least one subject, one verb, and makes sense)
- Draw a diagram of intersecting pentagons. A pentagon is a 5-sided figure, like a square but with one more side. Have the pentagons overlap a little. You will notice that the overlapping, intersecting pentagons will intersect at two points. Ask that they copy your drawing as closely as possible. (score 1 point only if the person draws both pentagons. If each one has 5 sides, both are closed, and intersect at two points.
Scoring the test/interpretations
Add up all the points. There is a maximum of 30 total points possible. There are different views on the scoring, but as a general rule, this guideline is followed:
- Score 24 or greater – normal cognition
- Score 17-23 – mild, early dementia stages
- Score 10-16 – moderate, or middle dementia stages
- Score less than 10 – severe, late dementia stages
Strengths and Weaknesses of the MMSE
The Mini Mental State Exam has its strengths, but it also has several weaknesses. The test is almost impossible to administer with any validity if the person is unable to read or write. This test relies on communication skills. If a person has difficulty speaking or expressing themselves this can be a problem. Verbal responses are important to the results of the test. Difficulty with hearing and vision can also affect the validity of the test.
Some studies show that the MMSE does a poor job of identifying mild, or early stages of dementia. Also, the type of dementia your loved one might have will affect the results.
For example I often hear family member’s feel very frustrated that the aging senior passed the MMSE.
Alzheimer’s disease patients are the least responsive to the Mini Mental State Exam.
According to one study, 40% of Alzheimer’s patients had a score of at least 24, putting them in the “normal” category. This makes the family sometimes feel as if they are the crazy ones. Because of the behaviors they are seeing at home.
A person with the diagnosis of vascular dementia fairs even worse, with 48% scoring normal. Lewy body dementia does well, with 29% of sufferers scoring 24 or better.
It is important to reiterate here…. how important it is to have a complete and comprehensive evaluation. And to look at all aspects of a person. It is also important for a family member to help educate the health care providers… about the behaviors they are observing, as well.
A family member should not hesitate to make the health care professionals aware that one test is not enough… to make a judgment call on the mental status of a person. And insist on further testing. Especially if they feel that a person is not being given a comprehensive evaluation.
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