Mini-Mental State Exam (MMSE) Alzheimer’s / Dementia Test: Administration, Accuracy and Scoring

The most common tool for assessing the severity of a person’s Alzheimer’s disease, or related dementia, is the Mini-Mental State Exam. It’s also known as the Folstein Test or MMSE. While designed to be administered in a doctor’s office or clinical setting, the Mini-Mental State Exam is a short and effective test that can also be taken at home. You can download a copy of the test from the National Institute of Health by clicking here. You can also download a different version of the test from the Australian government here.

Scoring the test is very straightforward, and family members or loved ones can manage the administration and scoring process without special training. However, consulting with a medical professional to interpret the scoring and layer on other diagnostic approaches is recommended.

What follows in the rest of this article is everything you need to know about the exam.

What is the Mini-Mental State Exam?

The Mini-Mental State Exam (MMSE) is a test used to measure thinking ability and cognitive impairment. If you suspect that you or a loved one might be developing Alzheimer’s disease or another dementia, the MMSE is a step toward making a diagnosis. The test is also used by researchers who study Alzheimer’s disease to differentiate the stages of dementia.

A low score on the MMSE does not mean there is a guarantee of dementia or Alzheimer’s. It’s important to remember that no true diagnosis can be made without further tests from a doctor. A low score simply means one should make a doctor’s appointment for an expert evaluation.

How Does It Work?

The Mini-Mental State Exam (MMSE) poses a series of questions that test brain function. The answers can help uncover cognitive deficiencies that are common in dementia patients. These can include problems in the following areas:

• Memory
• Concentration
• Motor skills
• Language competency
• Orientation to time and place
• Spatial awareness
• Problem solving

To get an idea of how those brain functions are tested by the MMSE, here are some sample questions:

• What city, state and country are we in?
• Name three unrelated objects.
• Repeat the following: “No ifs, ands, or buts.”
• What is this called? (The tester shows the subject a pencil or watch.)

Test subjects receive a point for each correct answer. A score of 23 or below on a the MMSE’s 30-point scale is considered indicative of dementia. As mentioned above, this is not a diagnosis of dementia, but rather an indication that one should be evaluated by an expert. A neurologist would factor the MMSE score in a with other data, such as medical history, brain scans, neurological exams and even genetic testing.

Pros and Cons

Any test will have its advantages and disadvantages, and the Mini-Mental State Exam (MMSE) is no exception.

MMSE Pros:

• Useful in multiple ways – The MMSE is primarily used to screen for suspected dementia, but it can also help estimate the stage and severity of dementia for someone who has the disease, and it can show changes over time if taken at regular intervals, like every year or six months.
• Easy to administer – No special equipment or training is necessary.
• Short and simple – The test only takes about 10 minutes to complete.

MMSE Cons:

• Education bias – Highly educated people with dementia can score 24 or more, while people below an eighth-grade education level who do not have dementia can score 23 or below.
• Not sensitive to Mild Cognitive Impairment – The MMSE is not always precise when it comes to Mild Cognitive Impairment or early dementia. In other words, people in the beginning stages of dementia may score well above 24.

Accuracy

Studies The Mini-Mental State Exam (MMSE) is most accurate when it comes to determining the severity of existing dementia, but it can be used for multiple purposes. According to this analysis of 34 dementia studies and five mild cognitive impairment studies, when the MMSE was used in memory care settings it had a sensitivity of 80%, which means it accurately identified if someone had dementia 80% of the time, and it had a specificity of 81%, which means it accurately identified if someone did not have dementia 81% of the time. When the MMSE was used in primary care offices, it had a sensitivity of 78% and a specificity of 88%. When it was used in a non-clinical community setting, the analysis found the MMSE had a sensitivity of 85% and a specificity of 86%.

While these percentages are high, they also show the MMSE delivers incorrect readings a significant amount of the time. This is why the MMSE, like all dementia tests, should not be used on its own to make a diagnosis.

How to Administer

The Mini-Mental State Exam (MMSE) is best administered by a neurologist, or other healthcare professional, in an office environment. However, one can download and print a copy of the test and perform it at home, which should only take about 10 minutes. Here are some basic guidelines for taking the test at home:

Step 1 – Download and print the Mini-Mental State Exam. There are multiple versions online, and they all ask roughly the same questions. The link above contains a good version that is easy to score.

Step 2 – The test taker should be comfortably seated in a quiet and well-lit room. The test administrator should also be seated in the room, and then ask for attention. Do not set a timer.

Step 3 – The administrator gives the taker a piece of paper and a pencil or pen. The MMSE  is mostly filled out by the administrator, who asks questions and records answers that are either correct or not. There are, however, a few questions that will require writing and drawing by the test subject. These include “Write a sentence,” where the score is based on whether the sentence is coherent and contains a subject and verb, and “Draw intersecting shapes,” where the subject is shown a picture of two pentagons intersecting and asked to recreate the image.

Step 4 – Give the test taker as much time as needed. The MMSE generally takes about 10 minutes to complete, but there is no time limit. Do not rush in any way. In fact, the administrator should be as positive and encouraging as possible.

Step 5 – Review the results. The test is graded as you go, and administrators should be able to tell pretty clearly whether a question was answered correctly or not. It will probably be relatively simple to calculate a score but, again, the MMSE is meant to be administered and scored by a professional.

Step 6 – If more than a few questions were answered incorrectly, take the finished test to a primary care doctor, who can review it and decide whether a referral to an expert like a neurologist is appropriate.

Interpreting the Results

The final score of the MMSE is simply the total number of correct answers. There are 30 questions, so 30 is the highest possible score. Score of 23 or below are indicative of dementia. The table below breaks down the results into stages of dementia.

Alternatives and  Comparisons

Compared to the Clock-Drawing Test

The Clock-Drawing Test is a straightforward way to determine if someone shows signs of dementia. This test asks subjects to draw a clock showing the time as “10 past 11.” Someone with dementia will draw the clock incorrectly in several ways. This is a much easier means of seeing if someone needs to be evaluated further for dementia and can be taken at home in just a few minutes with nothing but a piece of paper and a pencil. The Mini-Mental State Exam, on the other hand, is more complicated and meant to be administered by a healthcare professional, like a nurse or neurologist.

Compared to the SAGE

The Self-Administered Gerocognitive Exam is, as it says, self-administered. It often includes the clock test described above but also other questions like identifying well-known animals and calculating math problems such as, “How many quarters are in $6.25?” This is an easier and very reliable exam that is meant to be printed out at home and completed before visiting a doctor to talk about possible dementia. The scoring, also, is slightly more complicated for the Mini-Mental State Exam than the SAGE. If you are afraid that a loved one is showing early signs of dementia, the SAGE test is also a good way to know whether it’s simple forgetfulness or a possible sign of something worse. Try the SAGE test.