The Mini-Mental State Exam (MMSE) is a brief, structured test of mental status that takes about 10 minutes to complete.
Introduced by Marshall Folstein and others in 1975, the MMSEis themost commonly used test to assess problems with memoryand other cognitive functions.
Learn what the test involves, as well as how to score it and how accurate it is in identifying dementia.
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What Does MMSE Scoring Mean?
Scores on the MMSE range from 0 to 30, with scores of 25 or higher being traditionally considered normal. Scores less than 10 generally indicate severe impairment, while scores between 10 and 20 indicate moderate dementia. People with early stageAlzheimer's disease tend to score in the 20 to 25 range.
| Score | Degree of Impairment | Day-to-Day Functioning |
| 25-30 | Clinically significant but mild impairments may be present but can be considered within the "normal" range | Mild deficits likely only affect the most demanding activities of daily life (ADL) |
| 20-25 | Mild cognitive impairments or possible early-stage to mild dementia | May require some supervision, support, and assistance with daily activities |
| 10-20 | Clear impairments, possibly indicating middle-stage to moderate dementia | May require 24-hour supervision |
| 0-10 | Severe impairments to the extent that the person may not be testable; Likely indicating late-stage to severe dementia | Likely to require 24-hour supervision as well as assistance with ADL |
Scores typically decline with advancing age and increase with higher educational level. It's possible to achieve a very high score but still have significant cognitive deficits, especially in areas such as executive functioning that the MMSE is not designed to assess.
How Does the MMSE Work?
The Mini-Mental State Examination involves 11 questions that check for thinking, communication, understanding, and memory impairments. Specifically, the MMSE assesses six areas of mental abilities:
- Orientation of time and place: Orientation to time and space is tested by asking the person if they know the time and date, where they are, the day of the week, the month, the year, and the season.
- Attention and concentration: The person's ability to concentrate throughout the exam is evaluated, as well as with tasks like spelling a word backward or counting backward from 100.
- Short-term memory recall: Short-term memory is tested with such tasks as asking the person to memorize a series of items and then repeat them back.
- Language skills: Word recall is tested, for example, by showing the person an object and asking them to name it.
- Visuospatial abilities: Visuospatial abilities (a person's perception of 3D objects and their relationship to each other) are tested by asking the person to describe the spatial relationship, or distance, between two objects.
- Ability to understand and follow instructions: The person may be given a series of tasks while their ability to follow instructions is evaluated.
There is no need to prepare for the MMSE if you have been asked to take it. The MMSE is generally administered in a healthcare provider's office and takes about 10 minutes to complete.
How Accurate Is the MMSE?
There are two primary uses of the MMSE. First, it is a widely used, validated, and reliable method of screening for Alzheimer's disease. As a screening test, however, it is not meant to substitute for a thorough diagnostic workup.
Sensitivity and specificity of the MMSE, key properties of every screening test, are reasonably good.
Sensitivity refers to the test's accuracy in identifying individuals with the disease (i.e., persons with Alzheimer's test as positive). Specificity refers to the test's effectiveness in identifying people who do not have the disease (i.e., persons without the disease test as negative).
The second important use of the MMSE is as a means of evaluatingcognitive changes in an individual over time.
Periodic testing with the MMSE can help assess a person's response to treatment, which can help guide future treatment.
A study shows an Alzheimer's patient's MMSE score worsens by more than 5 points in two years without treatment.
The MMSE 2
In 2010, the MMSE 2 was published. It includes many of the same tasks as the MMSE but updates a few of the original tasks to improve accuracy and ease of translation into other languages.
Pros and Cons of the MMSE
In addition to the advantages already mentioned, the MMSE has been translated into many languages and has even been adapted for use by visually-impaired persons.
Disadvantages include the need to adjust scores for age, education, and ethnicity, as well as potential copyright issues.
While originally the MMSE was widely distributed for free, the current official version must be ordered through the copyright owner since 2001, Psychological Assessment Resources.
Summary
The MMSE is one of the most commonly used screening tests that evaluates thinking, communication, comprehension, and memory proficiency. Results come in the form of a score that ranges from 30, which is considered normal cognition, to 0, which indicates severe cognitive impairments and potentially late-stage dementia.
If you receive results from this test that concern you, don't hesitate to ask your physician questions about what they mean, as well as if they have evaluated for any possible reversible causes of dementia. Finally, the MMSE should be combined with several other screening and medical tests if it is being used to diagnose dementia.
12 Things to Ask the Healthcare Provider After a Dementia Diagnosis
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Eftychios A, Nektarios S, Nikoleta G. Alzheimer disease and music-therapy: An interesting therapeutic challenge and proposal. Adv Alzheimer's Dis. 2021 Mar;10(1):1-18. doi:10.4236/aad.2021.101001
Pradier C, Sakarovitch C, Le duff F, et al. The mini mental state examination at the time of Alzheimer's disease and related disorders diagnosis, according to age, education, gender and place of residence: a cross-sectional study among the French National Alzheimer database. PLoS ONE. 2014;9(8):e103630. doi:10.1371/journal.pone.0103630
Arevalo-rodriguez I, Smailagic N, Roqué i figuls M, et al. Mini-Mental State Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev. 2015;(3):CD010783. doi:10.1002/14651858.CD010783.pub2
Philipps V, Amieva H, Andrieu S, et al. Normalized Mini-Mental State Examination for assessing cognitive change in population-based brain aging studies. Neuroepidemiology. 2014;43(1):15-25. doi:10.1159/000365637
Behl P, Edwards JD, Kiss A, et al. Treatment effects in multiple cognitive domains in Alzheimer's disease: a two-year cohort study. Alzheimers Res Ther. 2014;6(4):48. doi:10.1186/alzrt280
Albert SM. MMSE 2.0: a new approach to an old measure. Neuroepidemiology. 2014;43(1):26-7. doi:10.1159/000366428
MMSE-2. Psychological Assessment Resources.
Additional Reading
Pradier C, Sakarovitch C, Le Duff F, Layese R, Metelkina A, Anthony S, et al. (2014) The Mini Mental State Examination at the Time of Alzheimer's Disease and Related Disorders Diagnosis, According to Age, Education, Gender and Place of Residence: A Cross-Sectional Study among the French National Alzheimer Database. PLoS ONE 9(8): e103630.
- Psychological Assessment Resources. MMSE-2. Mini-Mental State Exam- 2nd Edition.
By Andrew Rosenzweig, MD
Andrew Rosenzweig, MD, MPH, is an Alzheimer's disease expert and the chief clinical officer for MedOptions.
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