Mini mental state score

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  • The original version of the mini mental state score (MMSS) that you should use in research studies is copyright and will cost as of 2009 about $1 per patient from PAR.
  • There are variations downloadable from the internet that for example get the intersecting pentagons wrong (but may not infringe copyright !)
  • The Alzheimer's Society web-site is an example of a web site which has had the document removed and shows in this case an allowed sample of 4 questions. However as there are now more sensitive and specific alternative instruments in identifying dementia that can be scored as quickly, a move to these in medical practice is increasingly likely.
  • When using the test for neurological assessment the following tricks will help
    • Do both the calculation and spell backwards parts of the test. They actually test quite different cognitive domains. You score the highest but a poor score in say calculation when the patient was an accountant is rather informative
    • Dysphasia is common in dementia. After a patient has identified a watch correctly, asking them to identify the winder, if answered wrong, might suggest dementia if you have global deficits. However if it is the only thing wrong it may suggest focal neuropathology before the head scan comes back.
    • A prompt for intersecting pentagons is
      MMSS prompt.png

A clinical score designed to assess cognition.[1] Well-researched and convenient standard clinical tool to evaluate changes in cognition with time. A somewhat better score for evaluating cognition than the abbreviated mental test score, although problematical if used alone to evaluate dementia. There are better instruments but they are impractical to administer in day to day clinical practice. It has known floor and ceiling effects and has been modified to take into account culture. In clinical practice it can also give some insight into the cognitive dimensions impaired in a particular patient. Indeed a reasonably comprehensive neurological assessment of higher function can be made much quicker by incorporating it (and a clock test) into your standard neurological assessment.

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It is part of the pathway for cognitive evaluation in possible dementia recommended for British geriatricians and old age psychiatrists (2006)


References