Hi Amy

I have just had a letter from my GP asking if I wanted to volunteer for screening for Alzheimer's (Early onset) and I went along. It was very similar to the MMSE test and recall was included as well as drawing a clock and having to state a topical subject in the news today. The test was administered by the practice phlebotomist who had been trained to conduct the test and then report the findings back to the GP. I think anyone who is healthcare related and with some common sense can administer this and report back the findings.

Bob Nelson

Thank you Anthony and Bob for your replies. It is interesting to know what services in other areas do differently. Would you say that the MMSE is the main brief screening tool used? I have used many other tests over the years but the MMSE strikes me as the main one which is used as a brief screening measure.

Very best wishes

Amy

Hi Amy

Apart from the MMSE there is also the ACE-R which is the Addenbrook's Cognitive Examination - revised. This incorporates the MMSE to a certain extent and is used where the MMSE has been used and answered consistently well. It incorporates some of the MMSE but it is more difficult to bluff your way through. It is more likely to identify a patient that is early in their dementia journey.

Bob

MMSE is widely administered by neurologists as a screening tool in patient with clinical evidence of cognitive dysfunction. It is short, easy to administer, and immediately scored which makes it appealing. It is recognized though as just that, a screening tool.

Thank you both Bob and Gabriel, your replies are very informative. Very best wishes, Amy

Emiliano, thank you also for your response. It really is interesting to hear how different areas screen for cognitive problems.

Researchers in my area (psychology and nutrition) use the MMSE to screen volunteers on cognitive studies or studies at the interface between cognition and nutrition. Some researchers in the past have used the MMSE as an outcome measure, although this is not recommended unless it is used to measure gross cognitive changes over time, for instance over a number of years and in patients with neurocognitive disorders, as it is not a sensitive instrument and other tools are preferred.

Hi Anna, thank you for this information, I really do appreciate it.

In our area we use the Montreal cognitive assessment (MOCA). It is a fairly simple and quick screening tool. We stopped using the MMSE due to copyright issues (which someone else has already referred to.

Hi Amy, a screening tool that is commnly used in geriatric medicine to assess level of cognitive impairment. Not a diagnostic tool and interpretation of results needs to accomodate for ethinicity and education levels, as well as for physical handicaps. Repeated use of the test can be problematic if person tested practices the test. Issue of copy right is intesting given it was taken out after it was released and popularised. Main problem is with reproducing the image of the test. Other tests exist , of course,depending on what is needed. The 4A Test is a simple quick dementia/delirium screening tool has been recently validated. Anoter one to consier is the Montreal Cognitive Assessment MoCA.

Cheers Ande

Thank you Claire and Andre. The MOCA is a good alternative to the MMSE, it is a good screening tool. It really is interesting to hear what other tests other people use for basic screening. Thanks all :-)

Hi, Amy! There are obviously national variations here. In Norway the MMSE is widely used in primary and specialist health care to screen cognitive functioning. The tool is used by neurologists, psychiatrists, geriatricians and general practitioners. Additionally a large group of trained nurses and occupational therapists in geriatrics, psychiatry and primary care, incl nursing homes, use MMSE. The Norwegian National Centre for Ageing and Health (www.aldringoghelse.no) has provided educational resources (web-resources, seminars etc) for the health care system for years and, thus, has been able to disseminate the knowledge to a large group of professionals. To my knowledge, most professionals are aware that MMSE is not a diagnostic tool, although I might be wrong. There is a risk that clinicians put too much weight on this single measure, with sloppy diagnostics as a result. Good luck with your work.

Hi Amy. In our geriatric outpatientclinic we use the MMSE mostly in combination with a clock-drawingtest (Schullman) to screen older patients for cognitive decline. In the GP practice nurses often use the same assessment. Practice Nurses are trained in assessing older adults. I agree with Eivind that some collegueas put to much weight on this score. GP's report the MMSE score not always in theire referalletter. This score (and other parameters) are important for the triage in our outpatient clinic. In our clinical setting the MMSE is used by Psychiatrist, geriatrician, Nurse-practitioners to evaluate the patient. As mentioned by others the MMSE is not a diagnostic tool.

In our Neuropsychology Service we use the MMSE in combination with the Mental Deterioration Battery (Carlesimo GA, Caltagirone C, Gainotti G. and the Group for the Standardization of the Mental Deterioration Battery The Mental Deterioration Battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. Eur Neurol. 1996;36(6):378-84.). These tests are administered by a psychologist, but the diagnostic assessment requires the collaboration/supervision of a neurologist with specific neuropsychological experience

we usually use MoCA. It can be administered by nurse, any physician. Needs training, say half an hour. 

In addition to the MMSE or the MOCA, I have also seen the ACE-R used (Addenbrooks Cognitive Examinations - Revised) which is more complex but includes certain aspects of the MMSE. It is harder for people to complete to give a more accurate picture of a person's cognitive function. I feel this is only part of the picture and very clinical especially if done in a clinic. Home assessments in a familair background may present with a different score and there is a need for more assessment od aily living skills focussing on what the person can do. Trained personnel can use this tool but it needs the senior medical staff to analyse the results and perhaps prescribe treatment if the person is suitable.

Thank you Eivind, Ron, Guido, Tomasz and Bob! Your responses are very informative, helpful and thought provking. Very best wishes, Amy

MMSE - is the most useful tool for the evaluation of the cogniotive status. It is in use by many researchers and  easy to administer. IT IS NOT DIAGNOSTIC the same as the  meassure of temperature does not make a diagnosis ! It only indicates that the cognitive function of the examinated person may be impaired  at the time of the test.

People should be aware about some urban legend  ( ? ) regarding - copyright - when using MMSE ?!  MOCA is much  alike  but probably free of copyright.

Thank you Arthur for your comment! The copyright is a pain isn't it. I think the MOCA is ok to use freely though. Thanks again, I really appreciate it.

To my best knowledge, copyright is only applicable for research. 

I wonder if somebody has more info on the " legality "  of the use of MMSE .

If it has been published then it may be used like any other published info.

On the other hand if from some reason it  is protected by a " patent " this  should

expire some day .The question is how long is such a procedure " protected "?

Hi Amy

Our GP practice is using their own version of the MMSE and screening people over the age of 60 years. They are using a Phlebotomist who has received specific training to record the test and then the GP will review the results particularly if their is evidence of memory problems. They have chosen to do this because of the copyright issue. I am not aware of other GP practices that have done this. Good luck in your research.