Mini-Mental State Examination (MMSE) Questions and Structure
Core Components of the MMSE
The MMSE is a brief cognitive screening tool that assesses multiple cognitive domains through specific questions and tasks, taking approximately 7-10 minutes to administer, with a maximum score of 30 points. 1
Cognitive Domains Assessed
The MMSE evaluates the following domains through structured questions and tasks 2:
Orientation (10 points total): Questions assess orientation to time (5 points) and place (5 points), asking the patient to identify the current year, season, date, day of week, month, and their current location including country, state, city, building, and floor 2
Registration (3 points): The examiner names three unrelated objects and asks the patient to repeat them immediately, testing immediate memory 2
Attention and Concentration (5 points): The patient is asked to either spell "WORLD" backwards or perform serial sevens (subtracting 7 from 100 repeatedly five times) 2
Recall (3 points): After a brief delay, the patient is asked to recall the three objects from the registration task 2
Language (8 points): Multiple language tasks are included - naming two common objects shown by the examiner, repeating a phrase, following a three-stage verbal command, reading and obeying a written command, and writing a complete sentence 2
Constructional Ability (1 point): The patient copies a design of two intersecting pentagons 2
Important Clinical Context
The MMSE should be used primarily for tracking cognitive response and change over time in established dementia cases, not as a primary screening tool for early cognitive impairment. 3
Key Limitations to Consider
Poor sensitivity for mild cognitive impairment: Over half of patients scoring above 25/30 on the MMSE exhibited at least moderate memory impairment on dedicated memory testing, and 43% of those scoring 29-30/30 (near-perfect) showed moderate to severe memory deficits 4
The MMSE has only 55% sensitivity for detecting mild dementia, despite 100% specificity, meaning it frequently misses early-stage cognitive impairment 5
Scores are significantly affected by age, education level, and cultural background, requiring interpretation in context of these demographic factors 6, 2
The test is highly verbal and language items are relatively easy, lacking utility for identifying mild language deficits 2
Score Interpretation
Scores of 25-30 are generally considered normal, though 25/30 falls at the threshold for potential cognitive impairment and warrants additional assessment 6
Scores of 23 or below are more strongly associated with dementia 6
Serial testing is more informative than single measurements, with average decline in Alzheimer's disease of approximately 3-4 points per year 6
Clinical Recommendations
For initial cognitive screening in primary care, the Mini-Cog (2-4 minutes) is preferred over the MMSE, with higher sensitivity (76%) and no copyright restrictions. 1
The Montreal Cognitive Assessment (MoCA) has superior sensitivity (90%) for detecting mild cognitive impairment compared to the MMSE and should be used when more comprehensive assessment is needed 1
The MMSE remains recommended as one of the primary tools for tracking cognitive response and change over time in patients with established dementia, as it has been extensively used in clinical trials of cholinesterase inhibitors 3
Any cognitive screening score must be interpreted within a comprehensive evaluation including medical history, functional assessment, neuropsychiatric evaluation, and laboratory testing - scores alone are not diagnostic 1