🧠 Mini Mental State Examination (MMSE) – A Structured Guide
- Ann Augustin
- 5 days ago
- 5 min read
Updated: 9 hours ago
🧠 What is the MMSE?
MMSE = Mini Mental State Examination.
It is a brief, structured cognitive screening tool used to assess a person's cognitive function.
✅ Purpose of MMSE
To assess cognitive impairment It evaluates functions such as orientation, registration, attention, calculation, recall, language, and visuospatial skills.
To screen for dementia or delirium Helps in identifying cognitive deficits in elderly patients or those with suspected neuropsychiatric conditions.
To monitor progression Used repeatedly over time to track changes in cognitive function, e.g. in dementia follow-ups.
To support diagnosis A part of broader neurocognitive assessment to assist in diagnosing conditions like Alzheimer’s disease, vascular dementia, delirium, and other cognitive disorders.
📅 When should MMSE be done?
When cognitive impairment is suspected
New confusion or memory complaints
Difficulty in daily functioning or self-care
During assessment of elderly patients
Especially if presenting with falls, poor medication adherence, or behavioural changes
In mental health evaluations
To rule out organic causes before psychiatric diagnoses
Before and after treatment for cognitive conditions
E.g. following treatment of delirium or monitoring dementia therapies
👩⚕️ Who should perform MMSE?
Doctors (GPs, psychiatrists, neurologists)
Specialist nurses (e.g. dementia nurse specialists)
Trained allied health professionals (e.g. occupational therapists, clinical psychologists)
🔑 Important: The MMSE should be administered by someone trained to conduct it properly and interpret its results within the clinical context, as scores alone do not provide a diagnosis but guide further evaluation.
🧠 Dementia vs Delirium
Feature | Dementia | Delirium |
Onset | Gradual (months to years) | Acute / sudden (hours to days) |
Course | Progressive, irreversible (in most types) | Fluctuating, often reversible |
Duration | Chronic, long-term | Short-term, usually resolves with treatment of cause |
Attention | Usually intact in early stages | Impaired, cannot focus or maintain attention |
Consciousness | Clear until late stages | Altered, reduced awareness of surroundings |
Cognition | Memory loss, especially recent memory; disorientation in later stages | Disorientation, poor memory, disturbed thinking |
Hallucinations | Less common (except Lewy Body dementia) | Common, especially visual hallucinations |
Sleep-wake cycle | Often normal until late | Disturbed, e.g. reversed sleep-wake cycle |
Reversibility | Generally irreversible | Often reversible if underlying cause treated |
Causes | Neurodegenerative (e.g. Alzheimer’s, vascular dementia) | Acute medical illness (infection, electrolyte imbalance, medications, alcohol withdrawal) |
🔑 Key Points
Delirium = Acute confusional state
Medical emergency needing urgent assessment and treatment of underlying cause.
Dementia = Chronic progressive decline
Not a single disease but a syndrome with multiple causes (Alzheimer’s most common).
👩⚕️ Clinical Implication
Always check for delirium in any sudden confusion, even in patients with pre-existing dementia, as delirium can superimpose on dementia and worsen outcomes if untreated.
🧠 Mini-Mental State Examination (MMSE): A Practical Guide for PLAB 2
The Mini-Mental State Examination (MMSE) is a quick, structured tool to assess cognitive function, widely used in memory clinics, general practice, and OSCE stations like PLAB 2.
🔍 Why is MMSE important in PLAB 2?
Often tested in elderly patients with confusion, memory problems, or dementia screening scenarios.
Assesses orientation, registration, attention, recall, language, and visuospatial ability.
Marks are assigned to each section, with a maximum score of 30.
📝 MMSE Sections, Questions & Marks
Here is a breakdown with questions you can ask for each component:
1. Orientation (10 marks)
Time (5 marks):
Ask:
What is the year?
What is the season? (Spring, Summer, Autumn, Winter)
What is the date today?
What day of the week is it?
What is the month?
Place (5 marks):
Ask:
Where are we now? (Hospital / clinic / GP surgery / home)
What floor or room are we in?
What city/town are we in?
What county are we in?
What country are we in?
2. Registration (3 marks)
Say three unrelated objects clearly, e.g., “Apple, Table, Penny.”
Ask the patient to repeat them back.
Score 1 point for each correct.
Repeat until they learn all three, but only the first attempt is scored.
3. Attention and Calculation (5 marks)
Option A (Serial 7s):
Ask:
“Starting from 100, subtract 7, and keep subtracting 7 each time.”
(93, 86, 79, 72, 65)
Option B (Spelling WORLD backwards):
Ask:
“Please spell WORLD backwards.”
(D – L – R – O – W)
4. Recall (3 marks)
Ask the patient to recall the three words you asked earlier in Registration.
5. Language and Praxis (8 marks)
Naming (2 marks):
Show a pen and a watch, and ask them to name each.
Repetition (1 mark):
Ask: “Please repeat this phrase: ‘No ifs, ands, or buts.’”
3-Stage Command (3 marks):
Give a three-step instruction:
“Take this paper in your right hand, fold it in half, and put it on the floor.”
Reading (1 mark):
Show them a written instruction: “Close your eyes.”
Ask them to read and do it.
Writing (1 mark):
Ask: “Please write a sentence for me.”
Must contain a subject and verb and make sense.
6. Copying (1 marks)
Show two intersecting pentagons and ask: “Please copy this drawing.”
🔑 Mnemonic to Remember MMSE Components
“ORACLE” ➔ When conducting the MMSE, after asking Registration questions, always follow with Attention and Calculation questions, and then proceed to the Recall questions.
O – Orientation (10)
R – Registration (3)
A – Attention & Calculation (5)
C – Copying (1)
L – Language (8)
E – REcall (3)
MMSE Scoring and Severity Interpretation
1. Total Score
Maximum possible score: 30
2. General Interpretation
Score Range | Interpretation |
25 – 30 | Normal cognition (though mild deficits can still exist, especially in highly educated individuals) |
21 – 24 | Mild cognitive impairment |
10 – 20 | Moderate cognitive impairment |
< 10 | Severe cognitive impairment |
________________________________________
🧠 1️⃣ Quick MMSE – Short Version:
Use this when you have 2–4 mins only (like in PLAB 2).
👉 The key aim is to screen for significant cognitive impairment. You cannot give a precise severity stage, but you can decide if more testing is needed.
🔹 What to ask in Short MMSE
A) Orientation:
“What is today’s date?”
“What day of the week is it?”
“Where are we now?” (hospital/home/clinic/town)
✅ → Covers Time & Place (4–5 marks)
B) Registration:
“I’m going to say 3 words: Apple, Table, Penny. Please repeat them back to me.”
✅ → (3 marks)
C) Attention:
“Please spell WORLD backwards.”(D–L–R–O–W) OR
“Start from 100 and keep subtracting 7.”
✅ → (5 marks)
D) Recall:
“Can you please repeat the 3 words I asked you to remember?”
✅ → (3 marks)
E) Basic Language Check (if time):
“What is this?” (point to pen or watch) — naming (2 marks)
“Please repeat: No ifs, ands, or buts.” — repetition (1 mark)
So your Quick MMSE covers about 15–20 marks out of 30.
🧩 2️⃣ How to interpret the Short MMSE
👉 Rule of thumb (not absolute):
Normal: They get most right — e.g., only minor slips on date but good recall.
Impaired: Struggling with orientation, cannot register or recall 3 words, poor attention → suggests moderate-severe cognitive impairment.
You can’t calculate an official staging with only part of the MMSE, but here’s a simple quick guide for your OSCE:
Mini version result | Likely meaning |
Fully oriented, good recall | Likely normal cognition |
Disoriented to time/place or unable to recall words | Mild to moderate impairment |
Major disorientation, no recall, poor attention | Likely moderate-severe dementia |
✅ REMEMBER:Always say — “A full MMSE or alternative cognitive test like ACE-R would be needed to confirm severity and monitor progression.”
📌 3️⃣ What conditions you might pick up
Mild Cognitive Impairment (MCI): Might only have mild recall problems.
Dementia (Alzheimer’s, vascular): Orientation + recall + attention all affected.
Delirium: May fluctuate — sudden confusion, worse at night, clouded attention.
Depression (pseudo-dementia): May say “I don’t know” but answers improve with encouragement.
✏️ Takeaway for PLAB 2
Short MMSE:
Covers Orientation, Registration, Attention, Recall.
Screen only.
If any area abnormal → explain you’ll arrange full MMSE, bloods, imaging, MDT referral.
🔑 KEY LINE:"I have done a brief cognitive screen. Findings suggest possible impairment. I would complete the full MMSE and appropriate investigations to rule out reversible causes and assess severity."
📚 References: