Clinical interpretation of the mini-mental state

Abstract

The Mini-Mental Status Examination (MMSE) is a brief, structured test of cognitive function. The test is often used as a screening or case-finding instrument for the detection of organic mental disorders or cognitive impairment. However, many clinicians incorporate the MMSE into their clinical mental status examination. In both contexts, cutoff scores are often utilized to interpret the results, with scores below the cutoff being interpreted as evidence of cognitive dysfunction, and scores above the cutoff being interpreted as evidence against such dysfunction. However, when the test is done as part of a mental status examination, the application of a cutoff score fails to take account of prior clinical information, which is critical to the interpretation of all diagnostic tests. In this paper, an alternative approach to interpretation is proposed. In the proposed method, guidelines for interpretation are based on the probability of being free of organic disease at each potential score. Scores are interpreted in terms of their consistency or inconsistency with a prior diagnostic impression. This takes prior clinical information and clinical judgment into account. Although different from the traditional way of interpreting the MMSE, the proposed method can be implemented on an intuitive level and does not require mathematical calculations, which are inconvenient at the bedside.