If you suspect that a loved one is developing cognitive impairment beyond normal memory issues associated with aging, the next step is to have them evaluated by a psychiatrist or neurologist.

Diagnosing dementia can be difficult because symptoms typically occur gradually and are often associated with many different disorders. Certain tests, including the Mini Mental Status Exam, seek to eliminate ambiguity and concretely define a patient's overall cognitive ability.

When The Test Is Used

There are several different mental status tests that can be implemented to gather information to diagnose a patient with dementia, or monitor the progression of the condition. The Mini Mental Status Exam (MMSE) is one of these tests, and is administered to patients at risk for or suspected of developing dementia. The test was developed around 1975, and has been used to track an individual's mental deterioration over time.

The MMSE aims to determine whether a patient:

  • Has a sense of him/herself, as well as where he/she is and the date and time
  • Is aware of the symptoms he/she is experiencing
  • Is capable of remembering basic lists
  • Is capable of following instructions and performing simple math

Procedure

The MMSE is conducted by a health professional in about ten minutes. The test consists of 30 possible points, which are distributed across memory, orientation and math skills—covering eight sections. While variations of the test do exist, the point allocation and subjects covered generally remain the same.

  • (5 points) “Orientation to time" measures an individual's sense of date and time
  • (5 points) “Orientation to place" measures an individual's sense of location
  • (3 points) “Registration" is a patient's ability to repeat a short list of prompts, usually common objects
  • (5 points) “Attention and calculations" use serial sevens (counting backward from 100 by increments of 7), or similar basic math to determine a patient's arithmetic ability
  • (3 points) “Recall" determines if a patient can remember the list from “Registration"
  • (2 points) “Language" forces a patient to name common objects, usually two
  • (1 point) “Repetition" asks a patient to repeat a given phrase
  • (6 points) “Complex Commands" gives an abstract instruction, such as to draw an object, to test a patient's capacity for complex cognitive function.

What It Means

The MMSE features a clear grading scale:

  • 25 or more points is considered “intact"
  • 21-24 points is considered “mild" cognitive impairment
  • 10-20 points is considered “moderate" cognitive impairment
  • 0-9 points is considered “severe" cognitive impairment

Scores in the bottom two categories strongly indicate the presence of dementia.

The exam, while beneficial in its cognitive assessment, should only serve as a portion of a full clinical assessment to determine whether a patient has developed dementia.

Low scores are highly correlated with instances of dementia, but several other factors can complicate the assessment—including physical injuries, other existing mental conditions and previous difficulty with math and/or language. The test cannot serve as an exclusive diagnosis of dementia, but it can be very useful as a complementary tool and a method to track a patient's progression as the disease develops.