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  • Updated 04.21.2019
  • Released 05.12.1999
  • Expires For CME 04.21.2022

Mental status examination

Introduction

Overview

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 Addenbrooke’s 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: Kahn’s Mental Status Questionnaire (23), Short Portable Mental Status Questionnaire (33), Mattis Dementia Rating Scale (28), Cognitive Capacity Screening Examination (22), Mini-Mental Status Examination (MMSE) (16), Modified Mini-Mental State Examination (3MS) (44), Montreal Cognitive Assessment (MoCA) (30), and Addenbrooke’s 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.

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