Mini–mental state examination
The mini–mental state examination (MMSE) or Folstein test is a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment.[1][2] It is commonly used in medicine and allied health to screen for dementia. It is also used to estimate the severity and progression of cognitive impairment and to follow the course of cognitive changes in an individual over time; thus making it an effective way to document an individual's response to treatment. The MMSE's purpose has been not, on its own, to provide a diagnosis for any particular nosological entity.[3]
Not to be confused with Mental status examination or Mini-international neuropsychiatric interview.Mini–mental state examination
Folstein test
measure cognitive impairment
Administration of the test takes between 5 and 10 minutes and examines functions including registration (repeating named prompts), attention and calculation, recall, language, ability to follow simple commands and orientation.[4] It was originally introduced by Folstein et al. in 1975, in order to differentiate organic from functional psychiatric patients[5][6] but is very similar to, or even directly incorporates, tests which were in use previous to its publication.[7][8][9] This test is not a mental status examination. The standard MMSE form which is currently published by Psychological Assessment Resources is based on its original 1975 conceptualization, with minor subsequent modifications by the authors.
Advantages to the MMSE include requiring no specialized equipment or training for administration, and has both validity and reliability for the diagnosis and longitudinal assessment of Alzheimer's disease. Due to its short administration period and ease of use, it is useful for cognitive assessment in the clinician's office space or at the bedside.[10] Disadvantages to the utilization of the MMSE is that it is affected by demographic factors; age and education exert the greatest effect. The most frequently noted disadvantage of the MMSE relates to its lack of sensitivity to mild cognitive impairment and its failure to adequately discriminate patients with mild Alzheimer's disease from normal patients. The MMSE has also received criticism regarding its insensitivity to progressive changes occurring with severe Alzheimer's disease. The content of the MMSE is highly verbal, lacking sufficient items to adequately measure visuospatial and/or constructional praxis. Hence, its utility in detecting impairment caused by focal lesions is uncertain.[11]
Other tests are also used, such as the Hodkinson[12] abbreviated mental test score (1972), Geriatric Mental State Examination (GMS),[13] or the General Practitioner Assessment of Cognition, bedside tests such as the 4AT (which also assesses for delirium), and computerised tests such as CoPs[14] and Mental Attributes Profiling System,[15] as well as longer formal tests for deeper analysis of specific deficits.
Copyright issues[edit]
The MMSE was first published in 1975 as an appendix to an article written by Marshal F. Folstein, Susan Folstein, and Paul R. McHugh.[5] It was published in Volume 12 of the Journal of Psychiatric Research, published by Pergamon Press. While the MMSE was attached as an appendix to the article, the copyright ownership of the MMSE (to the extent that it contains copyrightable content[28]) remained with the three authors. Pergamon Press was subsequently taken over by Elsevier, who also took over copyright of the Journal of Psychiatric Research.[29]
The authors later transferred all their intellectual property rights, including the copyright of the MMSE, to MiniMental registering the transfer with the U.S. Copyright Office on June 8, 2000.[30] In March 2001, MiniMental entered into an exclusive agreement with Psychological Assessment Resources granting PAR the exclusive rights to publish, license, and manage all intellectual property rights to the MMSE in all media and languages in the world.[31] Despite the many free versions of the test that are available on the internet, PAR claims that the official version is copyrighted and must be ordered only through it.[32][33] At least one legal expert has claimed that PAR's copyright claims are weak.[28] The enforcement of copyright on the MMSE has been compared to the phenomenon of "stealth" or "submarine" patents, in which a patent applicant waited until an invention gained widespread popularity before allowing the patent to issue, and only then commenced enforcement. Such applications are no longer possible, given changes in patent law.[32] The enforcement of the copyright has led to researchers looking for alternative strategies in assessing cognition.[34]
PAR have also asserted their copyright against an alternative diagnostic test, "Sweet 16", which was designed to avoid the copyright issues surrounding the MMSE. Sweet 16 was a 16-item assessment developed and validated by Tamara Fong and published in March 2011; like the MMSE it included orientation and three-object recall. Assertion of copyright forced the removal of this test from the Internet.[35]