Is it Alzheimer’s Disease? An overview of the Mini Mental Status Exam
I am often asked what the first steps are to getting tested if you or a loved one has concerns about memory loss. First of all, be very proactive! You would be surprised at how many times I hear a doctor say “It’s just part of old age” or “She seems fine to me.”
Their are many things that mimic symptoms of Alzheimer’s Disease or other forms of Dementia so the first step is to have your primary care doctor perform a focused physical and order some blood work to determine if anything is out of the ordinary. This lab work must include the following: CBC, Basic metabolic profile, TSH, Vitamin B12, and STS. An abnormal Thyroid condition or Vitamin B12 deficiency may be the underlying cause of memory problems. The doctor should also be given access to a list of all the medications as medication toxicity can cause cognitive impairment.
The doctor will need a complete history from both the patient and other loved ones so insist on being in the room during the visit or bring someone close with you. If the person has a history of brain injury or space occupying lesions, a CT or MRI will be necessary as well.
The Mini Mental Status Examination should always be a part of this visit. The main reason for this short test is to establish a baseline of your cognitive functioning. Be sure and ask for a copy of the test after it has been scored for your own records. The test has five sections: Orientation, Registration, Attention & Calculation, Recall, and Language. A perfect score equals 30 points. A score of less than 21 should be a reason for concern. The test in and of itself is looking for problems in memory both short and long term, language problems, organizational problems, sensory input deficits, and problems with executive functioning. Below, you will see what the test looks like. I do not recommend you give this test to someone whom you believe has memory problems without the primary care physician’s approval.
Mini Mental Status Exam (MMSE)
Name________________________________
Maximum Examinations (1 point per right answer)
ORIENTATION
Ask the patient what (year) (season) (date) (day) (month) it is. 5 Points
Ask the patient where he/she is (province) (country) (town or city) (hospital) (floor). 5 Points
REGISTRATION
Name 3 common objects (e.g., “apple”, “table”, “penny”). Take 1 second to pronounce each word. Then ask the patient to repeat all 3 words. Give one point for each correct answer. Then repeat them until he/she learns all 3. Make a maximum of 6 trials. 3 Points
ATTENTION AND CALCULATION
Ask the patient to subtract 7 from 100 and keep subtracting 7 until you tell him/her to stop. (93, 86, 79, 72, 65)
OR
Ask him/her to spell “WORLD” backwards. The score is the number of letters in correct order (D_L_R_O_W). 5 Points
RECALL
Ask the patient for the 3 objects repeated above. Give 1 point for each correct answer. (Note: Recall cannot be tested if all 3 objects were not remembered during registration.) 3 Points
LANGUAGE
Show the patient a “pencil” and a “watch” and ask him/her to name them. 2 Points
Ask your patient to repeat the following:
« No ifs, ands or buts. » 1 Point
Ask your patient to follow a 3-stage command:
« Take a paper in your right hand, fold it in half, and put it on the floor. » 3 Points
Ask the patient to read and obey the following :
Close your eyes. 1 Point
Write a sentence. 1 Point
Copy the following design. 1 Point
Totals
Initials
