MMSE-2

Mini-Mental State nd Examination - 2 Edition

Overview •

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Original MMSE is one of the most widely used brief screening instruments for cognitive impairment Has been used in a variety of settings, including screening sc reening individual patients, tracking tr acking progress progress over time, screening for large populations, and clinical trials

Overview •

•

Original MMSE is one of the most widely used brief screening instruments for cognitive impairment Has been used in a variety of settings, including screening sc reening individual patients, tracking tr acking progress progress over time, screening for large populations, and clinical trials

Goals for the Revision 1. evise some some of the the original original items items to better better standardi!e its administrations, particularly for translations ". #rovide #rovide an even even briefer briefer version that that could could be used for rapid assessment $. #rovide #rovide a slightly slightly longer version version that that would be more sensitive to subcortical dementia and that would not have a ceiling e%ect &. 'evelop e(uivalen e(uivalentt alternate alternate forms forms to decrea decrease se practice e%ects in serial administration

Goal #1: Revise Original Items •

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 )he MMSE*" Standard +ersion MMSE*"-S+ maintains the same structure and scoring as the original MMSE /hanges were made to improve problematic items and to better standardi!e administration in other languages e.g., penny, no if, ands, or buts

as! 

- : Version

"esri$tion

Idential tas! on Original MMSE

Revision on MMSE-2:SV

Registration % Reall

0bility to repeat and retain three unrelated words, and then recall after a short intervention task

ords have been made slightly more di2cult and easier to translate

Orientation to ime

3dentify current year, season, month, day of the week, and date

4

Orientation to &lae

3dentify state, county, city5town, building, and 6oor currently in

4

'ttention % (al)lation *Serial +s,

/ount backwards by 7s

4

aming

0sk to identify body parts when pointed to by e:aminer

/hange from ;watch< and ;pencil< to body parts allows for translation and no use of e:ternal materials

Re$etition

e(uired to repeat a sentence that contains words not often said together

evised to include a sentence that is easier to translate and di2culty slightly decreased

(om$rehension

=nderstand and carry out a three* stage verbal command

emoved the reliance on motor responses.

Reading

ead and follow instructions

4

8o longer can use O9' spelled backwards as alternate task

E/)ivalen0 etween the MMSE and MMSE-2:SV •

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9ike the MMSE, the MMSE*"-S+ has a raw score range of >*$>  )he generali!ability coe2cient  n ? &11 between the MMSE and the MMSE*"-S+ total raw score was .@7  )herefore it is possible to switch from MMSE to the MMSE*"-S+ without compromising longitudinal data and without any change in the normal range of scores

Goal #2: "evelo$ riefer Version •

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/an be used for (uick cognitive screener, speciAcally when an individual has not been referred for speciAc cognitive impairment /omposed of egistration5ecall, Orientation to )ime, and Orientation to #lace aw score ranges from >*1B points  )asks were selected based on literature review, use in the MMSE, and their sensitivity and speciAcity to detect dementia

MMSE-2: rief Version

Goal #: "evelo$ Ex$anded Version •

/onsists of all of the items on the MMSE*"-S+ plus two new tasks –

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Story Memory- 0n immediate recall of a brief story #rocessing Speed- 0 symbol*digit coding task

MMSE-2: Ex$anded Version •

3mproves the clinical utility of the MMSE by –

 E:tending the testCs ceiling

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3ncreasing the range of raw scores >*@>

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3ncreasing the sensitivity for individuals with less severe cognitive impairment subcortical dementia, M/3

Goal #3: "evelo$ E/)ivalent 'lternate 4orms •

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 )wo forms Dlue and ed were developed for each of the $ versions of the MMSE*" Dased on the results of the e(uating study, the accuracy of the e(uating process was conArmed

E/)ating: MMSE % MMSE-2:SV

'dministration Iss)es •

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1 years and older elatively easy to administer, typically one training session is su2cient  )est Materials –

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=serCs Manual #ocket 8orms Fuide Scoring )emplates for #rocessing Speed 0dministration Gorms •

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MMSE*"-D+ Dlue and ed Gorm MMSE*"-S+ Dlue and ed Gorm MMSE*"-E+ Dlue and ed Gorm

as!

Overview of 'dministration 4orms MMSE

MMSE2:V

MMSE2:SV

MMSE2:EV

Registration % Reall

5

5

5

5

Orientation to ime

5

5

5

5

Orientation to &lae

5

5

5

5

'ttention % (al)lation *Serial +s,

5

5

5

aming

5

5

5

Re$etition

5

5

5

(om$rehension

5

5

5

Reading

5

5

5

.riting

5

5

5

"rawing

5

5

5

"etermining .hih Version is '$$ro$riate •

MMSE-2:V  –

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MMSE-2:SV  –

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0de(uate for screening large populations screening individuals in practice who have not been referred because of cognitive complaints

=sed Arst if referred because of complaint of cognitive decline or if patient indicates memory is not as good as it use to be depending on results may want to supplement with MMSE*"-E+

MMSE-2:EV  –

Same as above I well educated ceiling e%ect suspected subcortical dementia

Soring •

Mean raw total scores are presented by age and education level

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T  scores

are also presented by age and education level

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#ocket Fuide

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eliable /hange Scores

Relia6le (hange Sores •

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eliable change refers to the e:tent to which the change in test performance shown by an individual falls beyond the range that can be attributed to practice e%ects or to measurement variability that is inherent to the instrument itself   )he approach used here is a method developed by 3verson ">>1

Inter$retation •

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0 cut score of ""5"$ is typically used with the original MMSE Decause the MMSE*"-S+ is e(uivalent to the MMSE, the same cut score is suggested  )he authors have not provided speciAc recommendations for the new forms, however ranges of raw score cut scores are provided for the dementia, 0', and subcortical samples by form

Exam$le of ()to7 a6le

"evelo$ment •

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 )ask 'evelopment J K additional tasks were tested Dias #anel J assessed potential bias and o%ensiveness to protected groups E:pert eview –

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" neuropsychologist, 1 geriatric psychologist, 1 geriatric psychiatrist 0ided in selection of tasks, provided feedback on content, and assisted with reAning items and instructions for the pilot and standardi!ation versions

&ilot esting

Standardi8ation Sam$le

n ?

1,K$1 healthy controls

(ognitivel0 Im$aired Sam$les

E7ets of 'ge and Ed)ation

"evelo$ment of the orms •

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Decause of the importance of age and education on MMSE*" scores norms were developed for several di%erent age and education ranges  )wo resources for age and education adLustments are provided1. Means and standard deviations of total raw scores by age and education groups ". 0ge* and education*adLusted T  scores continuous norming method

Relia6ilit0: Internal (onsisten0

Relia6ilit0: est Retest

Relia6ilit0: Interrater

Validit0 •

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(ontent Validit0 J similar items on other tests e.g., Serial 7s similar to attention and concentration task on MS*333 3ntercorrelations among task and total scores presented for both the normative and clinical samples

"iagnosti Validit0- #rior work on the MMSE using ""5"$ or "$5"&