MMSE-2

(1)

Mini-Mental State

Examination

-

2

nd

Edition

(2)

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 sc

settings, including screening

reening

individual patients, tr

individual patients, tracking progr

acking progress

ess

over time, screening for large

populations, and clinical trials

(3)

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 sc

settings, including screening

reening

individual patients, tr

individual patients, tracking progr

acking progress

ess

over time, screening for large

populations, and clinical trials

(4)

Goals for the Revision

1.

1. evise somevise some of the of the origie original itnal items to bems to betteretter

standardi!e its administrations, particularly for

translations

".

". #r#rovide an eovide an even briefven briefer version ter version that couhat could be usedld be used

for rapid assessment

$.

$. #r#rovide a sovide a slightly lightly longer vlonger version thersion that would at would bebe

more sensitive to subcortical dementia and that

would not have a ceiling e%ect

&.

&. 'evelop e(u'evelop e(uivalenivalent altert alternate fonate forms to derms to decreacreasese

practice e%ects in serial administration

(5)

Goal #1: Revise Original

Items

•

)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

(6)

- :

Version

as! "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 8o longer can use O9' spelled

backwards as alternate task

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

(7)

E/)ivalen0 etween the

MMSE and MMSE-2:SV

•

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

(8)

Goal #2: "evelo$ riefer

Version

• /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

(9)

(10)

Goal #: "evelo$ Ex$anded

Version

•

/onsists of all of the items on the

MMSE*"-S+ plus two new

tasks- –

Story Memory- 0n immediate recall of a

brief story

–

#rocessing Speed- 0 symbol*digit coding

(11)

MMSE-2: Ex$anded Version

•

3mproves the clinical utility of the MMSE

by- –

E:tending the testCs ceiling

–

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

–

3ncreasing the sensitivity for individuals with

less severe cognitive impairment subcortical

dementia, M/3

(12)

(13)

(14)

Goal #3: "evelo$ E/)ivalent

'lternate 4orms

•

)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

(15)

E/)ating: MMSE %

MMSE-2:SV

(16)

'dministration Iss)es

•

1 years and older

•

elatively easy to administer, typically one

training session is su2cient

•

)est

Materials- – =serCs Manual

– #ocket 8orms Fuide

– Scoring )emplates for #rocessing Speed – 0dministration Gorms

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

(17)

Overview of

'dministration 4orms

as! MMSE

MMSE-2:V MMSE-2:SV MMSE-2: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

(18)

"etermining .hih Version is

'$$ro$riate

•

MMSE-2:V

– 0de(uate for screening large populations screening

individuals in practice who have not been referred because of cognitive complaints

•

MMSE-2:SV

– =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

(19)

Soring

•

Mean raw total scores are presented by

age and education level

• T

scores are also presented by age and

education level

•

#ocket Fuide

(20)

Relia6le (hange Sores

• 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

(21)

Inter$retation

•

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

(22)

(23)

"evelo$ment

•

)ask 'evelopment J K additional tasks were

tested

•

Dias #anel J assessed potential bias and

o%ensiveness to protected groups

•

E:pert

eview- – " neuropsychologist, 1 geriatric psychologist, 1

geriatric psychiatrist

– 0ided in selection of tasks, provided feedback on

content, and assisted with reAning items and

(24)

(25)

Standardi8ation Sam$le

(26)

(ognitivel0 Im$aired

Sam$les

(27)

E7ets of 'ge and

Ed)ation

(28)

"evelo$ment of the

orms

•

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

provided-1. Means and standard deviations of total raw

scores by age and education groups

". 0ge* and education*adLusted

T

scores

continuous norming method

(29)

Relia6ilit0: Internal

(onsisten0

(30)

(31)

(32)

Validit0

• (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