What are alternative assessments to the Mini-Mental Status Exam (MMSE) for 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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Answer

In addition, or as an alternative to the MMSE, correctly drawing the face of a clock (to include the circle, numbers, and hands) is a sensitive test of cognitive function. To perform this test, ask the patient to draw a clock with the hands at 8:20. Two or more errors significantly correlate with dementia. No errors rule against dementia.

The "Sweet 16" cognitive assessment tool offers a faster, simpler, and reasonably accurate alternative to the MMSE. [10] Advantages include the absence of a requirement for frail patients to manipulate pen and paper, freedom from props, and better accuracy across varying educational levels. The "Sweet 16" test is less selective (72% vs 89%) than the MMSE but is more sensitive (99% vs 87%). Therefore, a negative test result is highly accurate in ruling out dementia.

Other simple screening tests include asking the patient to spell "world" backwards or performing "serial 7's," which involves starting at the number 100 and subtracting 7 repeatedly in series (ie, 100, 93, 86, 79).


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