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Mini-Mental State Examination (MMSE) Questionnaire

MMSE

Apa itu Mini-Mental State Examination ?

Mini-Mental State Examination (MMSE) is a cognitive screening tool commonly used in the medical field, particularly in psychiatry and neurology, to assess the functional level of someone's cognitive abilities, especially individuals with cognitive problems such as memory disorders, dementia, or other neurological disorders. This tool is designed to provide an overview of an individual's cognitive condition.

Content of the MMSE Instrument

The MMSE consists of a series of questions and tasks designed to assess various cognitive aspects, such as orientation, memory, calculation, verbal skills, and visual-spatial abilities. This test typically comprises 11 questions or tasks that examine several key cognitive areas. Points are awarded based on the patient's correct answers, and the total score that can be obtained usually ranges between 0 and 30 points. Here are some examples of exercises that can be included in the MMSE:

  1. Orientation
    • Patients are asked to indicate the date, time, location, and demonstrate location designation (such as the name of the hospital or city).
  1. Memory
    • Patients are asked to repeat a series of words or numbers provided by the examiner or to memorize three objects after a few minutes.
  1. Calculation
    • Patients are asked to perform simple calculations, such as addition and subtraction, or basic arithmetic.
  1. Verbal Skill
    • Patients are asked to name objects pointed out by the examiner.
  1. Visual-Spatial
    • Patients are asked to mimic simple geometric figures or identify images presented.
  1. Language
    • Patients are asked to follow simple commands, write a sentence, or repeat a sentence given by the examiner.

The MMSE Scoring System

The MMSE score is interpreted as follows:

  • Score 24-30: Normal Cognitive Function.
  • Score 18-23: Indicates Mild Cognitive Impairment.
  • Score 0-17: Signs of More Severe Cognitive Decline.

Download the questionnaire here:

The Reliability of MMSE

POPULATIONCRITERIAMARK
Alzheimer dan Profresif DemensiaInternal consistencyCronbach alpha : 0.76
ElderlyInterater/Intrarater reliabilityLansia Tua ITE : ICC = 0.69 Lansia Muda ITA : ICC = 0.75ITE : ICC = 0.75   *ITA : intrarater reliability, ITE : interrater reliability
ParkinsonTest-retest reliabilityp<0.001
StrokeInternal ConsistencyCronbach alpha : 0.60
Mixed populationTest-retest reliabilityICC = 0.995
 Internal consistencyCronbach alpha : 0.54 – 0.96

MMSE Validity

POPULATIONCRITERIAMARK
Alzheimer and Progressive DementiaCriterion validityThe questionnaire indicates poor concurrent validity when compared to the Mattis Dementia Rating Scale (MDRS) (r = 0.29, p = 0.000). The comparison between SMMSE and MMSE shows excellent concurrent validity (r = 0.820; p < 0.001).
 construct validityExcellent convergent validity is observed between MMSE and the Global Deterioration Scale (r = -0.671). There is also excellent convergent validity between MMSE and MOCA (r = 0.86). Adequate discriminant validity is found between MMSE and Katz Activities of Daily Living (r = 0.465).
ElderlyCriterion Validity (Predictive/ConcurentAdequate predictive validity for dementia (area under the ROC curve is 0.85). Adequate predictive validity for cognitive impairment (area under the ROC curve is 0.85). Excellent predictive validity for dementia (area under the ROC curve is 0.96). Excellent predictive validity for cognitive impairment (area under the ROC curve is 0.93). Excellent predictive validity for dementia (area under the ROC curve is 0.95).
 Construct ValidityAdequate convergent validity is observed between MMSE and MOCA (r = 0.43 – 0.84). There is excellent convergent validity between the patient section of MMSE and GPCOG (r = 0.683). Excellent convergent validity is also noted between MMSE and the number of errors on the Six-Item Screener (r = 0.77 – 0.87). Adequate predictive validity is found for Mild Cognitive Impairment (MCI) (area under the ROC curve is 0.88), and adequate predictive validity for dementia (area under the ROC curve is 0.89).
ParkinsonCriterion Validity (Predictive/Concurent"MMSE correlates negatively with age (P <0.001) and Motor Score B of UPDRS (P <0.001). In individuals with MMSE scores <24 at the onset of Parkinson's disease dementia (PD), the prevalence is 74.8% (95% CI, 48.6 to 101.0) per 1000 people. The odds ratio (OR) associated with PD is 5.3 (95% CI, 3.2 to 8.6) after adjusting for age, gender, and education. The coefficient for MMSE scores <26 is 2.21 (OR = 1 (reference), 95% CI, 3.03-27.28, p <0.0001) to predict Parkinson's disease dementia (PDD).MMSE correlates slightly more with UPDRS I item 1 (Spearman correlation coefficient -0.34, P = 0.0013) than MoCA (Spearman correlation coefficient -0.26, P = 0.0153). A clearer ceiling effect is observed in MMSE (27/88 subjects scored 30) compared to MoCA (4.88 scored 30).Receiver Operating Characteristic (ROC) analysis shows an area under the curve of 0.867 for dementia, 0.82 for mild neurocognitive disorder due to PD, and 0.90 for major neurocognitive disorder due to PD."
 Construct ValidityThe Pearson correlation between MMSE and the Dementia Rating Scale is 0.87 (P < 0.001). MoCA is superior to MMSE as a screening instrument. Adequate convergent validity is observed between MMSE and the Frontal Assessment Battery (r = 0.419). There is excellent convergent validity between MMSE and the Addenbrooke's Cognitive Examination (r = 0.717). Poor discriminant validity is found between MMSE and verbal fluency + language/orientation + memory (r = -0.251).
StrokeCriterion Validity (Predictive/Concurent)Adequate predictive validity, with a correlation of 0.84 for cognitive impairment post-stroke, as indicated by the area under the ROC curve.
 Construct ValidityUsing raw scores, MoCA is more frequently impaired (P = 0.0001) compared to MMSE. MoCA demonstrates good sensitivity (sensitivity, 0.94) but moderate specificity (specificity, 0.42; positive predictive value, 0.77; negative predictive value, 0.76), whereas the opposite pattern is observed for MMSE (sensitivity, 0.66; specificity, 0.97; positive predictive value, 0.98; negative predictive value, 0.58). MMSE scores were found to have a significant correlation with the Beck Depression Inventory (BI), MADRS, and Zung scales (p > 0.05).
Mixed PopulationCriterion Validity (Predictive/Concurent)Poor to Adequate Correlation Between MMSE and FIM (Functional Independence Measure) (Ozdemir et al., 2001; average rehabilitation duration = 64.09 (18.27) days).
 Construct Validity"Excellent convergent validity with: WAIS (Wechsler Adult Intelligence Scale) Verbal IQ (r = 0.78) and WAIS Performance IQ (r = 0.66)."    

Also read: Apa Itu ADHD Dan Peran Fisioterapi Pada ADHD

Reference :

  1. Arevalo-Rodriguez I, Smailagic N, Roqué I Figuls M, Ciapponi A, Sanchez-Perez E, Giannakou A, Pedraza OL, Bonfill Cosp X, Cullum S. Mini-Mental State Examination for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev. 2015 Mar 5;2015(3):CD010783. doi: 10.1002/14651858.CD010783.pub2. Update in: Cochrane Database Syst Rev. 2021 Jul 27;7:CD010783. PMID: 25740785; PMCID: PMC6464748.
  2. Shirley Ryan Ability Lab. diakses pada 13 Agustus 2023 pada https://www.sralab.org/rehabilitation-measures/mini-mental-state-examination

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