Mental state examination

Jonsson L, Lindgren P, Wimo A, Jonsson B, Winblad B (1999a). Costs of Mini Mental State Examination — related cognitive impairment. Pharmaeoeconomics 16, 409—16. 

The Folstein Mini-Mental State Examination (MMSE) can help to establish a history of deficits in two or more areas of cognition and establish a baseline against which to evaluate change in severity. The average expected decline in an untreated patient is 2 to 4 points per year. 

Folstein, M. F., Robins, L. N., Helzer, J. E. (1983). The Mini-Mental State Examination. Archives of General Psychiatry, 40, 812. 

Elderly patients after admission to a hospital often first show mental signs and symptoms, then show behavioural disturbances (Saravay et al. 2004). Thus if early mental signs and symptoms are identified and acted on, behavioural disturbances and subsequent extended length of hospital stay may be prevented. For cognitive testing many screening instruments are available. The most widely used is probably Mini Mental State Examination (MMSE). 

The diagnosis of mania is made on the basis of clinical history plus a mental state examination. Key features of mania include elevated, expansive or irritable mood accompanied by hyperactivity, pressure of speech, flight of ideas, grandiosity, hyposomnia and distractibility. Such episodes may alternate with severe depression, hence the term "bipolar illness", which is clinically similar to that seen in patients with "unipolar depression". In such cases, the mood can range from sadness to profound melancholia with feelings of guilt, anxiety, apprehension and suicidal ideation accompanied by anhedonia (lack of interest in work, food, sex, etc.). 

The Mini Mental State Examination (Folstein et ah, 1975) has been adapted and studied for use with children (Ouvrier et ah, 1993 Besson and Labbe, 1997) and other screening tools to assess cognitive function in children have also been developed (Ouvrier et ah, 1999). These tools are invaluable, as so often altered mental status in a child can be related to impaired cognitive function or early delirium. 

Besson, P.S., and Labbe, E.E. (1997) Use of the modified mini-mental state examination with children. / Child Neurol 12 455 60. 

Ouvrier, R.A., Goldsmith, R.E, Ouvrier, S., and Williams, I.C. (1993) The value of the mini-mental state examination in childhood a preliminary study. / Child Neurol 8 145—148. 

Assessment methods that determine mental functioning (attention, orientation, memory, speech, understanding of speech, psychomotor functions) in a simple, practical way are recommended for a rough estimation of the severity of dementia. The best-known instrument is the Mini-Mental State Examination (MMSE. Folstein et al.. 1975), which allows the grading of dementia on a 30-point scale on the basis of a simple 5 10-min examination. Other, rather more involved procedures include the Dementia Rating Scale (DRS) of Mattis (1976) and the Alzheimer Disease Assessment Scale (ADAS) of Rosen et al. (1984). The... 

Mattis, S. Mental state examination for organic mental syndromes in the elderly patient. In Beliak. L., Karasu. T.B. feds) Geriatric PsvckiatrY. Grune Stratton. New York, 1976, pp. 77-121. 

Recognition of presenting signs and/or symptoms that dictate the need for further medical evaluation (e.g., a known history of recurring or chronic medical illness, prominent physical symptoms, evidence of an organic mental disorder on the Mini-Mental State Examination, substance abuse disorder)... 

For measurement of cognitive outcomes in Alzheimer s disease, the MMSE (Mini Mental State Examination) instrument, scored out of 30 (best), is used. Mild Alzheimer s disease is usually associated with an MMSE of 21-26. Moderate Alzheimer s disease is usually associated with an MMSE of 10-20 (NICE, 2006). 

Clark, C. M., Sheppard, L., Fillenbaum, G. G., Galasko, D., Morris, J. C., Koss, E., et al. (1999). Variability in annual Mini-Mental State Examination score in patients with probable Alzheimer s disease A clinical perspective of data from the Consortium to Establish a Registry for Alzheimer s Disease. Archives of Neurology, 56(7), 857-862. 

The Mini-Mental State Examination. Archives of General Psychiatry 40 812 Freitag MH, Peila R, Masaki K et al. (2006). Midlife pulse pressure and incidence of dementia the Honolulu-Asia Aging Study. Stroke 37 33-37... 

The severity of cognitive deficits in patients suffering from, or suspected of having, dementia can be quantified by a simple 30-point schedule, the mini mental-state examination (MMSE) of Folstein. A score of 21-26 denotes mild, 10-20 moderate and less than 12 severe Alzheimer s disease. The MMSE can also be used to monitor progress. 

---