Mini mental status examination

Mini mental status Examination

1. MINI MENTAL STATUS EXAMINATION Mrs.D.Melba Sahaya Sweety.D Msc.Nursing GIMSAR

2. INTRODUCTION The  Mini–Mental State Examination  ( MMSE ) or  Folstein test  is a 30 -point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment, It was developed by   Dr. Marshall Folstein in the year of 1975 The Mini-Mental State Exam (MMSE) is a widely used test of cognitive function among the elderly; it includes tests of orientation, attention, memory, language and visual-spatial skills. The mini-mental state examination is proprietary and takes about 10-15 minutes to administer.

3. DEFINITION The Mini-Mental status Examination is a cognitive test to screen for the presence of cognitive impairment example Dementia

4. It is useful in helping differentiate between a variety of systemic conditions, as well as neurologic and psychiatric disorders ranging from delirium and dementia to bipolar disorder and schizophrenia. PURPOSE OF MMSE

5. It provides measures of orientation,registration & short-term memory,attention , voluntary movement &language functioning. The shortened version of the mini mental state examination is an accurate predictor of dementia. It has also been recommended for the screening of cognition in  depressed  patients PURPOSE OF MMSE

6. GUIDELINES OF ADMINISTERING MMSE  Try to get the person to sit down facing you. A ssess the person’s ability to hear and understand very simple conversation, e.g. what is your name? if the person uses hearing or visual aids, provide these before starting. I ntroduce yourself and try to get the person’s confidence. B efore you begin, get the person’s permission to ask questions, e.g. would it be all right to ask you some questions about your memory? this helps to avoid catastrophic reactions. A sk each question a maximum of three times.

7. GUIDELINES OF ADMINISTERING MMSE I f the person answers incorrectly , give score zero. A ccept that answer and do not ask the question again H int, or provide any physical clues such as head shaking, etc. I f the person answers what did you say?, do not explain or engage in conversation, merely repeat. I f the person interrupts (e.g. queries what is this for?), just reply: I will explain in a few minutes, when we are finished. now if we could proceed please, we are almost finished

8. CATEGORIES OF MMSE  

9. CATEGORIES OF MMSE Look the age of the patient. Observe the physical features of the patient that are associated with certain conditions, such as the almond-shaped eyes associated with Down syndrome. Check the grooming level of the patient Whether the patient is dressed appropriately for the situation and the weather. APPEARANCE

10. Monitor how comfortable the patient are in social situations . O bserve the body language of the patient. The examiner will look for movements that are characteristic of certain conditions, such as excessive movement or muscle contractions. Observe how the patient make eye contact, for instance notice whether the patient stare intensely or avoid eye contact altogether. CATEGORIES OF MMSE APPEARANCE

11. ORIENTATION Temporal Orientation Which year is this? What Season it is ? What is today’s date? What is the Day of the week? Which Month is this ? Geographical Orientation Where are we now? Which State we live in? What is the name of this County ? What is the name of your Town? What is the name of this city? What is the name of this Hospital ? What Floor are we on? CATEGORIES OF MMSE Can orient patient if they missed an item- ask the same question again at the end of the session – did they remember ? Maximum score is 5 for each orientation

12. The examiner names three unrelated objects clearly and slowly, then the instructor asks the patient to name all three of them. The patient’s response is used for scoring. The examiner repeats them until patient learns all of them, if possible. [Example Examiner names 3 objects ( eg apple, table, car) Patient asked to repeat ( 1 point for each correct)]. Maximum score is 3 CATEGORIES OF MMSE REGISTRATION

13. “I would like you to count backward Subtract 7 from 100, then repeat from result. Continue 5 times: 100 93 86 79 65 Alternative: “Spell WORLD backwards.” (D-L-R-O-W) Maximum score is 5 CATEGORIES OF MMSE ATTENTION AND CALCULATION

14. Earlier I told you the names of three things. Can you tell me what those were?” Maximum score is 3 CATEGORIES OF MMSE RECALL

15. Naming: Show the patient two simple objects, such as a wristwatch and a pencil, and ask the patient to name them. 1 point for each Maximum score is 2 Repetition:   Ask the person to repeat the following. No „ifs‟ & or „buts‟ (1point). Allow only one trial Maximum score is 1 Command:   Give a 3 stage command. Score 1 for each stage. Eg . "Place index finger of right hand on your nose and then on your left ear". Maximum score is 3 LANGUAGE CATEGORIES OF MMSE

16. Reading: Write „CLOSE YOUR EYES‟ in large letters & show it to the patient. Ask him or her to read the message & do what it says (give 1 point if they actually close their eyes).Score is 1   Writing: Ask the individual to write a sentence of their choice on a blank piece of paper. The sentence must contain a subject & a verb, & must make sense. Spelling punctuations & grammar are not important Maximum score is 1  Copying : Ask the patient to copy a pair of intersecting pentagons:. Maximum score is 1 LANGUAGE CATEGORIES OF MMSE

17. The Mini-mental state examination is scored on a scale of 0-30 with scores > 25 interpreted as normal cognitive status. Severe cognitive impairment: ≤9 Moderate cognitive impairment : 10-18 Mild cognitive impairment: 19-23 No cognitive impairment: 24-30 Interpretation of the mental status examination must take into account the patient's native language, education level, and culture as these factors can affect performance. [ SCORING AND INTERPERTATION OF MMSE

18. Relatively quick and easy to perform Requires no additional equipment Can provide a method of monitoring deterioration over time ADVANTAGES OF MMSE

19. Biased against people with poor education due to elements of language and mathematical testing Bias against visually impaired Limited examination of visuospatial cognitive ability Poor sensitivity at detected mild/early dementia   DISADVANTAGES OF MMSE

20. Copyrighted and should the most up to date version should officially only be accessed via the Psychological Assessment Resourcing (PAR) Patients new to a region may not geographic orientation aspect of the test False positives can lead to anxiety ,labelling and stigma DISADVANTAGES OF MMSE

21. MINI MENTAL STATUS EXAMINATION FORMAT