Folsteins Mini Mental State Examination (MMSE) was first described by Marshall F. Folstein, Suzan Folstein, & Paul R. McHugh (as cited in International Journal of Geriatric Psychiatry, 2009). Marshall Folstein, a neuropsychiatrist, created the MMSE overnight because he was not happy with a patients’ cognitive report written by wife Suzan Folstein, a psychiatrist. He presented the MMSE to the clinical director Paul R. McHugh who acknowledged the significance of MMSE to clinicians and epidemiologists in many countries (Folstein, 1990). MMSE was originally designed to provide a brief, standardized assessment of mental status in psychiatric patients, and now detects and tracks the development of cognitive impairment in conditions such as Alzheimer’s disease (Bowden & Meade, 2005). The aim of MMSE is to screen for cognitive impairment, assess the severity of any impairment, and monitor change by serial testing (Ridha & Rossor, 2010). It does not focus on a client’s mood, thought content, judgment and insight like the mental status examination does, but focuses on the cognitive aspects of a client’s mental purposes (Towsend, 2008). That is why it is called “mini” because it refers to the fact that this tool only concentrates on cognitive features of mental functioning of the client (Jensen & Hansen, 2008). According to Caritas Health Group (n.d.), MMSE is a well validated screening tool for cognitive impairment by briefly measuring orientation, short term verbal memory, immediate recall, calculation, language, and constructs ability. The clients will be asked the year, season, date, month and day of the week, name three objects, use their calculation ability by subtracting seven at least five times from 100 or spell the word world backward, test their recall ability by repeating the three objects mentioned and also test their language and constructing ability. They receive one point for each correct answer (Hickey, 2003).
The test consists of 11 items that are easily given and executed, each corresponding to a cognitive functional area with a total maximum possible score of 30/30 (Costarella, et al., 2010). Scores range from 25-30 for no cognitive impairment, 21-24 for mild dementia, 14-20 for moderate, and less than 13 in severe dementia clients (Rockwood, n.d.). Many clinicians ask additional questions to the client like “What would you do if you were in a crowded building and smelled smoke?” for further assessment, as judgment and insight are not tested by this tool (Santacruz & Swagerty, 2001).
The test is easy except the calculation which is more complex that requires extra time for the individual to think more (Bhakti, et al., 2001). There are some factors that influence the MMSE score that the examiner should consider like; depression, delirium and educational level (Jensen, 2005). In addition, MMSE is also based on the person’s age, gender and IQ and evaluates the predicted score that the client actually achieved (Green, Keaff, Knight & McMahon, 2006). In regard to education, the number of years in school is not the only basis of MMSE screening but also the quality of education that accounts for scoring differences (Peggy, 2002). For example, a farmer may have a lower MMSE score compared to white collar workers, even after adjustment for age, financial dissatisfaction and education (Peggy, 2002).
MMSE is a very simple, easily administered mental status examination that has proved to be a more valid instrument and highly reliable for detecting cognitive impairment than using informal questioning and client’s overall impressions (MidAmerica Neuroscience Institute, 2006). It is a brief screening tool that includes items measuring a range of cognitive skills (Green, et al., 2006). It is the test that the National Health Services will recommend whether the drug treatment for Alzheimer’s disease will be prescribed to the client (Associated Newspapers Ltd., 2010)....
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