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

Answer

Instructions for administering the MMSE are as follows:

Orientation: Ask for the date. Specifically, ask for any omitted information. Give 1 point for each correct response.
Registration: Ask permission to test memory. Name 3 unrelated objects clearly and slowly about 1 second apart. After all 3 objects have been named, ask the patient to repeat them. The first repetition determines the score. Keep repeating the items, as many as 6 times, until the patient can repeat all 3 of them. (This step is also required for the Recall test.)
Attention and calculation: Ask the patient to begin with 100 and count backwards by 7s. Stop after 5 subtractions and score correct answers. If the patient cannot calculate, ask him or her to spell "world" backwards. The score is the number of letters in correct order.
Recall: Ask the patient to recall the 3 objects previously asked to remember (from Registration). Zero to 3 points may be scored.
Language: To test skills in naming objects, show a wristwatch and a pencil to the patient, and ask the patient to name each item. Zero to 2 points may be scored.
Repetition: Ask the patient to repeat a sentence. Allow 1 trial. Zero to 1 point may be scored.
Complex 3-stage command: Give the patient a piece of paper and repeat the command. Score 1 point for each portion of the command that is performed correctly.
Reading: Print clearly on a piece of paper in large letters the command "Close your eyes." Ask the patient to read and perform the command. Score 1 point if the eyes are closed.
Writing: Provide a blank piece of paper and ask the patient to write a sentence of his/her own choosing. It must contain a subject and a verb to be scored 1 point. Punctuation does not matter for the purpose of scoring.
Copying: On a clean piece of paper, draw intersecting pentagons, each side measuring 1 inch, and ask the patient to copy the figures exactly. All 10 angles must be present, and the 2 figures must intersect to score 1 point. Any rotation of the figures or tremor is ignored.

A score of less than 24 suggests the presence of delirium, dementia, or another problem affecting the patient's mental status and may indicate the need for further evaluation.

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Coronal T1-weighted MRI scan in a patient with moderate Alzheimer disease. Brain image reveals hippocampal atrophy, especially on the right side.

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

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