BY DR ZAINAB ABDULZAEEZ UMAR DEPARTMENT OF FAMILY MEDICINE AMINU KANO TEACHING HOSPITAL

SYNOPSIS  INTRODUCTION  PREPARATION  PROCESS  SCORING  INTERPRETATION  CONCLUSION  DEMOSTRATION

INTRODUCTION The MMSE was developed in 1975 by M Folstein et al as a screening tool to test cognitive function of older people The Mini Mental State Examination (MMSE) is the most commonly used test for complaints of memory problems. It can be used by clinicians to help diagnose dementia and to help assess its progression and severitymemory problemsprogression

(MMSE) or Folstein test is a sensitive, valid and reliable 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment. Administration of the test takes between 5–10 minutes and examines functions including registration,attention and calculation, recall,language, ability to follow simple commands and orientation registrationattention and calculationrecalllanguage ability to follow simple commandsorientation

PREPARATION Before administering the MMSE it is important to make the patient comfortable Establish rapport with the patient. Materials needed

process  General guideline Record name and date the test is performed Record response for each question Ask each question maximum of 10secs Do not hint, prompt for an answer or provide physical clues.

SCORING MMSE Orientation 10 Registration 3 Attention and calculation 5 Recall 3 Language o Naming 2 o Repetition 1 o Comprehension 3 o Reading 1 o Writing 1 o Visuo-spatial task 1

Orientation in Time (5) What year is this? What season? What month? What day of the week? What date?

Orientation to Place (5) What country are we now? What state are we in? What Local Government Area is this? What city/area is this? What floor are we on? (or what ward/room are we in?)

Registration (3) Listen carefully. I’m going to say 3 words. You say them back after I stop. Ready? CAR MANGO BOOK Now repeat those words back to me Now keep those words in mind. I’m going to ask you to say them again in a few minutes

Attention and Calculation (5) Serial 7’s: I’d like you to subtract 7 from 100. Then keep subtracting 7 from each answer until I tell you to stop. What is 100 take away (minus) 7?….Keep going OR: Spell “WORLD” forward, then backward

Recall (3) What were those words I asked you to remember? No hints

Naming objects (2) Tests ability to recognize and name 2 common objects- ex. Biro, Watch, tie Point to a Biro and a watch. Have the patient name them as you point.(2 points)

Repetition (1) Now I am going to ask you to repeat what I say…Ready? Have the patient repeat the phrase “No ifs, ands, or buts”

Comprehension (3) Have the Patient follow a 3-stage command: Take the paper in your right hand Fold the paper in half Put the paper on the floor

Reading (1) Please read this and do what it says: “CLOSE YOUR EYES” (write it in large letters)

Writing (1) Please write a sentence of your choice Point given if sentence is comprehensible and contains a subject and verb Ignore spelling errors when scoring

Drawing/Visuospatial Task (1) Please copy this design Give one point if all sides and angles are preserved and if the intersecting sides form a quadrangle

Interpreting the Score 27-30: normal 21-26: mild cognitive impairment 11-20: moderate cognitive impairment 0-10: severe Varies with age, education, population

Limitation of MMSE Results are dependent on Age Language skills Educational level Sensory deficit(hearing and vision) Motor deficit(tremors, paralysis) Does not test all areas of cognition(eg frontal lobe)

conclusion MMSE is a well established, fast and reliable way of gauging cognitive functioning The process of undertaking MMSE can identify health issues and provide information useful for planning care

DEMOSTRATION

Ensure that hearing or visual aids are available with adequate lighting and ventilation Praising success may help to maintain the rapport and is acceptable. However, persisting on items the patient finds difficult should be avoided