Mini Mental Status Test

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The Mini-Mental-Status-Test (abbr. MMST ) was developed in 1975 by Folstein and colleagues to offer a screening method suitable for everyday clinical practice for the determination of cognitive deficits. Since its introduction into everyday clinical practice, it has proven to be a reliable tool for the initial assessment of a patient as well as for monitoring the progress. This has made it the most widely used tool in diagnosing dementia and Alzheimer's disease . The MMST is often referred to as the Folstein test ; the abbreviation Mini-Mental or the English name Mini-Mental-State-Examination (MMSE) is also common.

Test procedure

execution

two crossed pentagons that are used in the test

The mini mental status test is carried out as an interview with the patient. Based on 9 task complexes, central cognitive functions are checked (temporal and spatial orientation, memory and memory skills, attention, language and language comprehension, as well as reading, writing, drawing and arithmetic). The implementation usually takes about eleven minutes. The tasks of the MMST include answering questions as well as carrying out simple actions (e.g. "What year is it?", Repeating, folding sheets of paper and laying them on the floor). In detail, the tasks are:

  1. Ask about the current time and, if necessary, additional questions regarding the year, month, day of the week, day, season (for each 1 point)
  2. Inquiry about the current whereabouts (not the place of residence) and additional questions regarding the state, city or district, town or district, name of the hospital (or similar), floor or ward (for each 1 point)
  3. memorize and repeat three terms (apple, penny, table) (for each 1P)
  4. to subtract seven from 100 and from the result the same and so on, five times (for each correct intermediate result 1 point, even if the previous result was wrong, but again correct seven was subtracted) (93, 86, 79, 72, 65)
  5. repeat the three memorized terms from exercise 3 (for each 1P)
  6. correctly name a pen and a wristwatch that are shown (1P each)
  7. correctly repeat the phrase "no ifs and ors" (1P)
  8. to follow the three instructions correctly; take a sheet of paper, fold it, lay it on the floor (1P each)
  9. read the request "EYES CLOSE" from a sheet of paper and follow it (1P)
  10. to formulate and write down any sentence. Correct spelling and grammar are not required, but the sentence must contain at least one subject and one predicate and be thought up spontaneously without any specifications (1P)
  11. draw two pentagons that intersect. A template is offered. (1P)

The following points must be observed during the implementation in order to avoid falsification of the result:

  1. Ensuring a disturbance-free atmosphere during the examination (e.g. “helpful” relatives can falsify the test result in both directions).
  2. Sensory restrictions such as reduced visual and hearing performance can significantly influence the test result. Such restrictions must be excluded or eliminated before starting the test (glasses, hearing aid).
  3. A non-irritant hospital environment can lead to a decrease in brain performance (minimum in the third week of hospitalization). The measurable intelligence quotient can deteriorate by up to 20 points.
  4. Pain interferes with alertness.
  5. Shame or shyness in the examination situation can have a negative impact on the result as well as the parallel confrontation with possibly newly diagnosed diseases.

evaluation

The patient receives one point for each successfully completed task. The points are totaled after the test has ended. The scale ranges from 0 to 30 points, with 30 standing for unrestricted and 0 for the most severely damaged cognitive functions. The limit for normal cognitive function is often set at 24 points. Lower values ​​justify the suspicion of at least mild dementia. Values ​​below 10 indicate severe dementia. The test evaluation also only takes a few minutes.

Evaluation and criticism

The mini-mental status test is a highly economical and particularly easy-to-perform method for rapid screening for dementia, which records two of the three central dementia diagnostic criteria (memory disorders, impairment of at least one other cognitive function). When using it, however, the extreme susceptibility of the test to interference (see above) must be taken into account. In addition, the MMST only provides a rough assessment of cognitive deficits, which, if a critical test value is available, must be supported and checked by further procedures. The classification of the degrees of severity was originally developed for studies on Alzheimer's dementia, but in practice the criteria are also relevant for other forms of dementia. The MMST is not an instrument for the early detection of dementia and does not help to differentiate between the various forms of dementia (Alzheimer's, vascular, frontal dementia).

In addition to the neurodegenerative brain changes caused by dementia, depression can also lead to considerable impairment of cognitive functions. If the MMST turns out to be positive, careful diagnostic demarcation from depression (and especially from age-related depression) is essential. Nonetheless, the mini mental status test is an efficient screening method in the event of suspected dementia and “its use is preferable to dispensing with any testing” (Berger, p. 303). In addition, it is very well suited to monitor the progression of dementia and, if necessary, to check the success of therapeutic measures (follow-up).

Other procedures

  • DemTect (screening process, especially for early detection)
  • Watch sign test
  • Test for the early detection of dementia with differentiation of depression (TFDD)
  • Clinical Dementia Rating (CDR), a procedure for assessing the severity of dementia, especially the “non-cognitive” impairments
  • Functional Assessment Staging (FAST), severity assessment in early and late stages of dementia
  • Montreal Cognitive Assessment (MoCA)
  • Self-Administered Gerocognitive Exam (SAGE)

Web links

literature

  • M. Berger (Ed.): Mental illnesses. Clinic and Therapy. 2nd Edition. Urban & Fischer, Munich 2004, ISBN 3-437-22480-8 , p. 303f.
  • S. Brunnhuber, S. Frauenknecht, K. Lieb: Intensive course in psychiatry and psychotherapy. Urban & Fischer, Munich 2005, ISBN 3-437-42131-X , p. 122f.
  • RM Crum, JC Anthony, SS Bassett, MF Folstein: Population-based norms for the Mini-Mental State Examination by age and educational level. In: JAMA. Volume 269, Number 18, May 1993, pp. 2386-2391, doi : 10.1001 / jama.1993.03500180078038 , PMID 8479064 .
  • MF Folstein, SE Folstein, PR McHugh: Mini-Mental State. A practical method for grading the state of patients for the clinician. In: Journal of Psychiatric Research. 12, 1975, pp. 189-198, doi : 10.1016 / 0022-3956 (75) 90026-6 , PMID 1202204 .
  • J. Kessler, HJ Markowitsch, P. Denzler: Mini-Mental-Status-Test (MMST). Beltz Test GMBH, Göttingen 2000. [German adaptation]

Individual evidence

  1. ↑ Test documents at the DGHO (PDF file; 22 kB)
  2. ↑ ST Creavin et al .: Mini ‐ Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. In: Cochrane Database Syst Rev, 13 (1), 2016, CD011145, doi : 10.1002 / 14651858.CD011145.pub2
  3. ↑ a b E. Stechl et al: Practical Guide to Dementia. Recognize - understand - treat. Mabuse-Verlag, 2012, ISBN 978-3-86321-038-0 , p. 183.
  4. ↑ J. Kessler, P. Calabrese, E. Kalbe, F. Berger: DemTect. A new screening procedure to support the diagnosis of dementia. In: Psycho. 2000; 6, pp. 343-347.
  5. ↑ Shulman, KI, Gold, DP, Cohen, CA & Zucchero, CA: Clock-drawing and dementia in the community: A longitudinal study . International Journal of Geriatric Psychiatry, 8 (1993), 487-496, doi : 10.1002 / gps.930080606
  6. ↑ R. Ihl, B. Grass-Kapanke, P. Lahrem, J. Brinkmeyer, S. Fischer, N. Gaab, C. Kaupmannsennecke: Development and validation of a test for the early detection of dementia with depression delimitation (TFDD). In: Fortschr Neurol Psychiatr . 2000, 68 (9), pp. 413-422. doi : 10.1055 / s-2000-11799
  7. ^ CP Hughes, L. Berg, W. Danziger, LA Coben, RL Martin: A New Clinical Scale for the Staging of Dementia. In: Br J Psychiatry . 1982, 140 (6), pp. 566-572. PMID 7104545
  8. ^ B. Reisberg: Functional Assessment Staging (FAST). In: Psychopharmacol Bull . 1988, 24 (4), pp. 653-659. PMID 3249767
  9. ↑ Handbook for the Reisberg scales ( Memento from March 23, 2017 in the Internet Archive ), Hogrefe-Verlag
  10. ^ ZS Nasreddine, NA Phillips, V. Bédirian, S. Charbonneau, V. Whitehead, I. Collin, JL Cummings, H. Chertkow: The Montreal Cognitive Assessment, MoCA. A brief screening tool for mild cognitive impairment. In: Journal of the American Geriatrics Society . 53 (4), 2005, pp. 695-699, doi : 10.1111 / j.1532-5415.2005.53221.x .
  11. ↑ S. Gluhm, J. Goldstein, K. Loc, A. Colt, CV Liew, J. Corey-Bloom: Cognitive performance on the mini-mental state examination and the montreal cognitive assessment across the healthy adult lifespan. In: Cognitive and Behavioral Neurology . 26 (1), 2013, pp. 1–5, doi : 10.1097 / WNN.0b013e31828b7d26 , PMC 3638088 (free full text).
  12. ↑ Douglas W. Scharre, Shu-Ing Chang, Robert A. Murden, James Lamb, David Q. Beversdorf: Self-administered Gerocognitive Examination (SAGE): A Brief Cognitive Assessment Instrument for Mild Cognitive Impairment (MCI) and Early Dementia . In: Alzheimer Disease & Associated Disorders . tape 24 , no. 1 , January 2010, ISSN  0893-0341 , p. 64-71 , doi : 10.1097 / WAD.0b013e3181b03277 .