MINI MENTAL STATUS EXAMINATION

Aim: To screen the presence of any cognitive impairment (mild or severe) proposed by Dr.
Marshall Folstein (1975).

Introduction: Ulric Neisser(1967), "Cognition is the activity of knowing: the acquisition,

organization, and use of knowledge."

Cognition refers to the mental processes involved in acquiring knowledge and understanding
through thought, experience, and the senses. It includes various functions such as perception,
memory, judgment, reasoning, problem-solving, and decision-making. Cognitive processes
are essential for everyday functioning and enable individuals to interpret and interact with
their environment.

Cognitive impairment refers to when a person has trouble remembering, learning new things,
concentrating, or making decisions that affect their everyday life. Cognitive impairment
ranges from mild to severe, with severe impairment significantly impacting a person's ability
to perform daily activities.

One widely recognized definition of cognitive impairment is given by the U.S. National
Institute on Aging (NIA):

“Cognitive impairment is when a person has trouble remembering, learning new things,
concentrating, or making decisions that affect their everyday life.”

The International Classification of Diseases, Tenth Revision (ICD-10), defines cognitive

impairments as deficits in cognitive functions due to a disturbance in the brain, leading to
difficulties in memory, learning, concentration, and decision-making (World Health
Organization. 2010). Cognitive impairments occur when there is a decline in one or more
cognitive domains, impacting an individual's ability to perform everyday activities. These
impairments can range from mild cognitive deficits to severe conditions such as dementia.
Cognitive impairments can result from various conditions, including neurodegenerative
diseases, traumatic brain injury, and psychiatric disorders. With Lezak, Howieson, and
Loring (2012) further elaborate that cognitive impairments can affect various domains, such
as executive functions, language, visuospatial abilities, and motor skills, significantly
impacting an individual's daily life and functioning.

The Mini-Mental State Examination (MMSE) is a widely used test that helps assess cognitive
impairment. It evaluates various areas of cognitive function. Here are the five main areas
measured by the MMSE:

1. Orientation: This domain involves the ability to identify oneself, the time, and the place
accurately It includes awareness of personal identity, time, and location (Salthouse, 2010)
2. Registration: This involves the ability to take in and recall new information. It is crucial
for learning and memory (Baddeley, 2007).
3. Attention and Calculation. This domain covers the ability to concentrate and performs
mental calculations. It includes tasks such as serial subtraction and digit span (Posner &
Petersen, 1990)
 4. Recall: This involves retrieving information from memory after a delay. It is a measure of
short. term memory and retention (Tulving, 2002)
5. Language: This domain assesses various aspects of language skills, including naming
objects, repeating phrases, following verbal commands, reading, writing, and
comprehension (Ellis & Young, 1996)

METHODOLOGY -
PARTICIPANT DETAILS:
Name- XYZ
Sex - M
Age- 24 years
Occupation: MBA Student

MATERIALS REQUIRED: MMSE Manual, Scoring Sheet, Stationary

TEST DESCRIPTION: The Mini-Mental State Examination (MMSE) is a widely used

cognitive screening tool that measures cognitive impairment. Developed by Dr. Marshal
Folstein, Dr. Susan Folstein, and Dr. Paul McHugh in 1975, the MMSE consists of 11 items
that measures five domains orientation, registration, attention and calculation, recall, and
language. The MMSE is used to screen for cognitive impairment, estimate the severity of
cognitive dysfunction, and monitor changes in cognitive status over time. The maximum
score is 30. The test is suitable for adults aged 18 and above and can be administered by a
trained professional.

PROCEDURE:

PRE-ARRANGEMENTS: The subject was seated at a quiet, table. Typical testing situations
for administering the test was ensured. Adequate space, Lighting, relevant materials were
provided.

INSTRUCTIONS:
1. Orientation (10 points)
 Date (5 points):
o Ask for the date: "What is today's date?"
o Follow-up questions: "Can you also tell me what season it is?" "What is the day of the
week?" "What is the month?" "What is the year?"
o One point for each correct answer.
 Location (5 points):
o Ask: "Can you tell me the name of this hospital?" (or town, county, etc., depending on
context)
o One point for each correct answer.

2. Registration (3 points)
 Object Recall:
o Say three unrelated objects clearly and slowly (e.g., "apple, book, car").
o Ask the patient to repeat them: "Please repeat the three words I just said."
o Score the number of correct objects named on the first try (0-3).
o If needed, repeat the objects up to six trials until all are learned.
o Record the number of trials required to learn all three words.
o Inform the patient: "Try to remember the words, as I will ask for them in a little while."

3. Attention and Calculation (5 points)

 Serial Sevens:
o Ask the patient: "Please start with 100 and count backward by sevens."
o Stop after five subtractions (93, 86, 79, 72, 65).
o Score the total number of correct answers.
 Alternative Task (if needed):
o If unable to perform the subtraction, ask: "Please spell the word 'world' backward."
o Score the number of letters in the correct order (e.g., dlrow=5, dlorw=3).

4. Recall (3 points)
 Recall Test:
o Ask: "Can you recall the three words I asked you to remember earlier?"
o Score the total number of correct answers (0-3).

5. Language and Praxis (9 points)

 Naming (2 points):
o Show a wristwatch and ask: "What is this?"
o Show a pencil and ask: "What is this?"
o Score one point for each correct answer.
 Repetition (1 point):
o Ask the patient to repeat: "No ifs, ands, or buts."
o Allow only one trial. Score 0 or 1.
 3-Stage Command (3 points):
o Give a piece of blank paper: "Take this paper in your right hand, fold it in half, and put it
on the floor."
o Score one point for each part correctly executed.
 Reading (1 point):
o Print "Close your eyes" on a blank piece of paper.
o Ask the patient to read and do what it says.
o Score one point only if the patient closes their eyes.
 Writing (1 point):
o Give a blank piece of paper: "Please write a sentence for me."
o The sentence must contain a subject and a verb and make sense.
Copying (1 point):
o Show the picture of two intersecting pentagons.
o Ask the patient to copy the figure exactly.
o All ten angles must be present, and two must intersect to score one point.

ACTUAL ADMINISTRATION: The MMSE is quick, taking about 10 minutes to

administer. It's useful in a variety of settings, including hospitals, clinics, and during routine
check-ups to track cognitive changes over time. However, it is not diagnostic on its own and
should be part of a broader assessment, including medical history, physical exams, and other
cognitive tests.
BEHAVIOURAL OBSERVATION: The participant was co-operative and maintained
adequate eye-contact she was attentive and completed the test in about minutes.

INTROSPECTIVE REPORT: Participant found the test very interesting and took complete
interest in taking the test.

SCORING:

SCORE DEGREE OF FORMAL DAY TO DAY

IMPAIRMENT PSYCHOMETRIC ASSESSMENT
ASSESSMENT
25-30 Questionably If clinical signs of May have clinically
significant/ normal cognitive impairment significant but mild
cognitive function are present, formal effects. Likely to affect
assessment of only most demanding
cognition may be activities of daily
valuable. living.
21-24 Mild Formal assessment Significant effect. May
may be helpful to require some support,
better determine assistance and
pattern and extent of supervision.
deficits.
10-20 Moderate Formal assessment Clear impairment, may
may be helpful if there require 24 hour
are specific clinical supervision.
indications.
0-9 Severe Patients not likely to Marked impairment.
be testable. Likely to require 24-
hour supervision and
assistance with ADL.
RESULTS:
COGNITIVE DOMAIN SCORE
1. Orientation 10
2. Registration 3
3. Attention and calculation 5
4. Recall 3
5. Language and Praxis 8

IMPRESSION: The aim of the test is to assess the presence of any cognitive impairment
(mild or severe) proposed by Dr. Marshall Folstein (1975).
Ulric Neisser(1967), "Cognition is the activity of knowing: the acquisition, organization, and
use of knowledge."
Cognitive impairment refers to when a person has trouble remembering, learning new things,
concentrating, or making decisions that affect their everyday life.
The participant scored 29 out of 30 which is within the normal range. This indicates that the
participant does not indicate signs of cognitive impairment. The interpretation of the 5
domains are as follows:

 Orientation (Score: 10)- Participant scored 10 out of 10. The individual is fully oriented
to time, place, and person. This indicates that they have a strong awareness of their
environment and current circumstances.

 Registration (Score: 3)- Participant scored 3 out of 3. The individual can correctly repeat
three words immediately after they are presented. This suggests that their immediate memory
is intact.

 Attention and Calculation (Score: 5)- Participant scored 5 out of 5. indicating a

moderate ability to perform tasks requiring attention and calculation, such as serial
subtractions or spelling a word backward. There may be some difficulties in maintaining
sustained attention or performing mental arithmetic.

 Recall (Score: 3)- Participant scored 3 out of 3, indicating she can recall all three words
previously presented. This indicates good short-term memory and the ability to retain
information over a brief period.

 Language and Praxis (Score: 8)- Participant scored 8 out of 9. The high score in this
domain suggests strong language skills, including the ability to name objects, repeat phrases,
and follow complex commands. Praxis, or the ability to perform purposeful motor actions, is
also well-preserved. However, the presence of an error in the repetition criteria indicates a specific
difficulty in accurately repeating sentences or phrases verbatim.

CONCLUSION: The participant scored 29 out of 30, which is within the normal range. This
indicates that the participant does not indicate signs of cognitive impairment.
REFERENCES:
 Crum, R. M., Anthony, J. C., Bassett, S. S., & Folstein, M. F. (1993). Population-based
norms for the Mini-Mental State Examination by age and educational level. JAMA,
269(18), 2386-2391.
 Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state": A practical
method for grading the cognitive state of patients for the clinician. Journal of Psychiatric
Research, 12(3), 189-198.