What is the role of the Mini-Mental Status Exam (MMSE) in the diagnosis of delirium, dementia, and amnesia?

Updated: Sep 19, 2018
  • Author: Richard D Shin, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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At times, it may be difficult to distinguish between acute delirium, psychiatric crisis, or a chronic process with exacerbation such as dementia. It is safest to presume delirium until an alternative process can be proven through testing and/or clinical observation.

A brief bedside neurologic examination, including mental status testing, is an essential part of the workup of AMS when a rapidly treatable cause is not immediately apparent.

The Mini-Mental Status Examination (MMSE) is a formalized way of documenting the severity and nature of mental status changes. [9] The MMSE, as modified from Folstein, is outlined here. The maximum score per item is indicated in parentheses.

  • Orientation (5): What are the year, season, date, day, and month?

  • Orientation (5): Where are we (ie, state, county, town, hospital, and floor)?

  • Registration (3): Name 3 objects (ask the patient to repeat these 3 objects).

  • Attention and calculation (5): The serial 7 test awards 1 point for each correct answer. Stop after 5 answers. Spelling "world" backwards is optional.

  • Recall (3): Ask for the 3 objects (from Registration) to be repeated. One point is scored for each correctly recalled object.

  • Language (2): Name a pencil and a watch.

  • Repetition (1): Repeat the following: "No ifs, ands, or buts."

  • Complex commands (6): Follow a 3-stage command, such as "Take a paper in your right hand, fold it in half, and put it on the floor" (3 points). Next, read and follow these printed commands: "Close your eyes" (1 point); "Write a sentence" (1 point); and "Copy design" (1 point)

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