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  • Updated 10.28.2021
  • Released 05.12.1999
  • Expires For CME 10.28.2024

Mental status examination



The authors have reviewed the literature on mental status examination and discuss testing of various composite cognitive domains.

Key points

• Bedside mental status examination tools have been developed to combine ease of administration with standardized scoring.

• The Mini-Mental Status Examination (MMSE) is the most widely used instrument to rapidly assess the cognitive status of individuals, both in clinical and research settings.

• The Montreal Cognitive Assessment (MoCA) is a newer tool that seems to be more sensitive in mild cognitive impairment.

• The Hong Kong Brief Cognitive Test (HKBC) is useful in population with low educational level.

• The Addenbrookes Cognitive Assessment III (ACE-III) identifies everyday functional impairments.

Historical note and terminology

Mental status examinations span a wide range of sophistication, from observation of the patient during history-taking and physical examination to extensive neuropsychological testing in standardized settings. Bedside mental status examination tools have been developed to combine ease of administration with standardized scoring. One of the first test batteries was created by Klein and Mayer-Gross (24). Other test batteries include: Kahns Mental Status Questionnaire (23), Short Portable Mental Status Questionnaire (34), Mattis Dementia Rating Scale (29), Cognitive Capacity Screening Examination (22), Mini-Mental Status Examination (MMSE) (16), Modified Mini-Mental State Examination (3MS) (46), Montreal Cognitive Assessment (MoCA) (31), and Addenbrookes Cognitive Assessment III (ACE-III) (21).

The best known of these tools is the MMSE.

Mini-Mental State Examination
Normal score is 25 to 30 points in a group of elderly persons. Lower scores generally indicate impaired cognitive function. (Contributed by Dr. Troels Kjaer.)

The MMSE was primarily developed to screen for organic behavioral signs and facilitate the diagnosis of general organic mental syndromes (eg, dementia) or specific organic mental disorders (eg, Alzheimer disease). As efficient treatment of these conditions has become available, the MMSE has been used to evaluate treatment effect. The MoCA scale seems to be more sensitive in the early stages of Alzheimer disease and mild cognitive impairment.

Disease specific tools that are more sensitive and specific have also been developed. They are generally a little more complicated to administer but are simpler than full neuropsychological examinations. A widely used example is The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-COG). This is a widely used cognitive scale in clinical trials and is considered one of the gold standards to evaluate treatment in Alzheimer disease and mild cognitive impairment (36).

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