Mini-Mental State Examination
suggested Mini-mental status exam
- Age
- Time (to 1 hour)
- Address for recall at end of test (patient should repeat to ensure heard correctly)
- Year
- Name of institution
- Recognition 2 persons (e.g. doctor, nurse)
- Date of birth
- Date St. Patrick's day
- Present Taoiseach
- Count backwards 20 - 1
- Orientation for time- year, season, date, day, month (5 points)
- Orientation in place- country, county, town, hospital, ward (5 points)
- Registration of new information- repeat carrot, purple, library (3 points)
- Attention/Concentration- spell WORLD backwards (5 points)
- Short term memory- recall the above three words (3 points)
- Language- (9 points)
- Name 2 objects (2)
- Repeat “no ifs, ands or buts” (1)
- Three stage command “take this piece of paper with your right hand, fold it in half and put it on the floor (3)
- Read and obey (Close your eyes) (1)
- Write a sentence (subject/verb/makes sense) (1)
- Copy this diagram: (1)
Total Score out of 30. 23 is taken as cut off for significant mental impairment in most elderly
Dementia
Is an acquired syndrome of decline in memory and at least one other cognitive domain such as language, visuo-spatial, or executive function sufficient to interfere with social or occupational functioning in an alert person.
- Commonest causes are Alzheimer's disease (70%) and cerebrovascular ischemia (vascular dementia) (20-30%)
- Dementia causes a high burden of suffering for patients and their families.
- Age is the strongest risk factor for dementia:
- 3% - 11% >65yo have dementia, (rising to 25% - 47 % in those >85yo)
- 1st degree relatives have x2 the risk of developing dementia compared with general population
- CVS risk factors (e.g. ↑BP) risk of both Alzheimer's disease and vascular dementia.
Mini-Mental Statue Examination (MMSE)
- The Mini-Mental Status Exam (MMSE) is the best-studied instrument for screening for cognitive impairment
- Similar sensitivity and specificity as using a more detailed Functional Activities Questionnaire (FAQ)
- The accuracy of the MMSE depends upon a person's age and educational level
- Early detection of dementia is important for both the patient and care givers
Potential treatment options
Cholinesterase inhibitors: moderate supporting RCT evidence (they slow progression of symptoms if used early)
Ginkgo biloba, selegeline, vitamin E, and oestrogen: No real evidence in favour of their use.
Management of ↑BP in vascular dementia: No strong evidence supporting pharmacotherapy
Non-pharmacological Interventions: (e.g. behaviour training) Some weak supporting evidence for caregiver burden
Links
U.S. Preventive Services Task Force - Screening For Dementia
