The Mini Mental State Examination (MMSE)

The Mini Mental State Examination (MMSE) is the most commonly used test for complaints of memory problems or when a diagnosis of dementia is being considered. This factsheet is intended to provide information about the MMSE so that you know what to expect.

Guidance on use

The MMSE is the test that the National Institute for Health and Clinical Excellence (NICE) recommends when deciding whether a drug treatment for Alzheimer's disease should be prescribed. The lower the score (out of a total of 30), the more severe the disease. The latest (2011) NICE guidance recommends the three most widely available drugs for mild-to-moderate Alzheimer's disease, and states that a person should usually score between 10 and 26 points (out of a maximum of 30 points) to be considered for treatment with Aricept (the trade name for donepezil), Exelon (rivastigmine) or Reminyl (galantamine). The same NICE guidance recommends use of a different kind of drug, Ebixa (memantine) for people with severe Alzheimer's disease (MMSE score less than 10) and for some of those with moderate disease (MMSE score 10-20).

The 2011 NICE guidance on use of MMSE is as follows:

When using the Mini Mental State Examination (MMSE) to assess the severity of Alzheimer's disease, healthcare professionals should make sure that people from different ethnic or cultural backgrounds and people with disabilities have equal access to treatment.

In some cases, healthcare professionals should not rely on the MMSE test − or not rely on it alone − to assess the severity of Alzheimer's disease. This may be the case when assessing people who:

have learning disabilities or other disabilities such as deafness or blindness
have difficulty speaking (for example, after a stroke) or other difficulties with communicating
are not fluent enough in a language in which the MMSE test can be given if this means that the MMSE test will not fairly reflect the severity of the disease.

For these people, healthcare professionals should use a different method to judge the severity of Alzheimer's disease when deciding about starting or stopping treatment.

Source: www.nice.org.uk/guidance

In practice, clinicians often consider the MMSE score as only one element in the process of deciding the severity of dementia. (See Factsheet 426, Diagnosis and assessment.)

The test

The MMSE is a series of questions and tests, each of which scores points if answered correctly. If every answer is correct, a maximum score of 30 points is possible. People with Alzheimer's disease generally score 26 points or less.

Important: The MMSE is not a test for Alzheimer's disease or any other cause of dementia. There are many other reasons why someone might score less than 26 points.

Below are four sample questions that give an indication of the style of the MMSE.

1 Orientation to time
'What is the date?'

2 Registration
'Listen carefully. I am going to say three words. You say them back after I stop. Ready? Here they are... APPLE [pause], PENNY [pause], TABLE [pause]. Now repeat those words back to me.'
[Repeat up to 5 times, but score only the first trial.]

3 Naming
'What is this?' [Point to a pencil or pen.]

4 Reading
'Please read this and do what it says.' [Show examinee the following words on the stimulus form.] CLOSE YOUR EYES

Sample questions reproduced by special permission of the Publisher, Psychological Assessment Resources, Inc., 16204 North Florida Avenue, Lutz, Florida 33549, from the Mini Mental State Examination, by Marshal Folstein and Susan Folstein, Copyright 1975, 1998, 2001 by Mini Mental LLC, Inc. Published 2001 by Psychological Assessment Resources, Inc. Further reproduction is prohibited without permission of PAR, Inc.

For details of Alzheimer's Society services in your area, visit alzheimers.org.uk/localinfo
For information about a wide range of dementia-related topics, visit alzheimers.org.uk/factsheets