Mini Mental state examination

MINI MENTAL STATE EXAMINATION

1. PRESENTED BY R.VIJAYALAKSHMI IV th BHMS PRACTICE OF MEDICINE SEMINAR MINI MENTAL STATE EXAMINATION

2. MMS ??

3. It is a simple test to assess the derangements in cognitive functions . It is commonly used to screen dementia. Cognition – The process of acquiring knowledge & understanding through thought, experience & senses.

4. HISTORY Founder : Dr. Marshall Folstein Year : 1975

5. COMPONENTS: Orientation Memory & Recall Speech & Language Fund of information Abstract thought Judgement Calculation Visuospatial skills

6. Orientation is adjustment or alignment of oneself or one’s idea to the surrounding or circumstance. Orientation is tested by asking the patient his / her name, location, time (day of the week & date ).

7. Memory is the ability of brain to collect, retain & subsequently recall information. STAGES : Encoding (Processing & combining received information). Storage (Creation of permanent record of encoded information). Recall (Calling back the stored information when needed).

8. Memory of a patient can be accessed by asking the patient to repeat 3 words immediately after hearing (e.g. Apple, Table, coin). Recall can be accessed by asking the patient to repeat the words told earlier after 10 – 15 minutes.

9. Speech is the ability to express one’s thoughts & feelings by articulated sounds. Language is the method of human communication, either spoken or written, containing words in a structured & conventional way.

10. Speech is accessed by observing the articulation, rate & rhythm, changes in pitch & accentuation of syllables & words. Language is accessed by observing the content of patient’s written & verbal output, response to spoken commands & ability to read.

11. 3 STEP COMMANDS

12. Fund of information can be accessed by asking the patient about historic or current events (e.g., The Chief minister of our state or The Prime minister of our country).

13. Abstract thinking is the ability to think about objects, principles & ideas that are not physically present. Abstract thinking can be tested by asking the patient to describe the similarities between two various objects or concepts (e.g., apple & orange or table & chair etc.)

14. Judgement is the ability to make or come to a sensible conclusion. Abnormalities of judgement are usually detected during the patient interview. A more detailed information can be elicited by asking the patient to describe how he / she would respond to situation having a variety of potential outcomes (e.g., What would you do if you find a house on fire).

15. Ask the patient to count 7 backwards from 100. Stop after 5 numbers. An alternate for this is ask the patient to spell the word “WORLD” backwards i.e., D, L, R, O, W.

16. Visuospatial skill refers to a person’s capacity to identify visual & spatial relationship among objects. Visuospatial function can be deducted by asking the patient to draw a clock or overlapping pentagons.

17. Total score : 30 Points Score of 20 – 24 suggests Mild dementia. Score of 13 – 20 suggests Moderate dementia. Score of less than 12 suggests severe dementia. In Alzheimer's disease on an average MMSE score reduces about 2-4 every year.

18. INFERENCE SCORE Intact 25 Borderline intact 22 Mild impairment 19 Moderate impairment 15 Moderately severe impairment 7 Severe impairment 5 Very severe impairment 1

19. ADVANTAGES Quick to test (takes less than 15 minutes). Can be done without any use of additional equipment. Requires little critical thinking for interpretation. It is a best method for documenting current mental status of a patient and useful as a baseline assessment to which the future scores can be compared.

20. LIMITATIONS It does not serve as a diagnostic tool. Influenced by auditory, visual & motor impairment. It can’t access dementia in people with lower literacy rates.