How To Perform The Mini-Mental State Examination On Hospice Patients

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Introduction

The Mini-Mental State Examination (MMSE) is a 30-point screening test to quantitatively assess the severity of cognitive impairments and to document cognitive changes that occur over time. It is not intended to serve as the sole criterion for diagnosing dementia or to differentiate between various forms of dementia. However, MMSE scores may be used to classify the severity of cognitive impairment or to document serial change in dementia patients.

 

The MMSE has scores which have been correlated with scores on the Functional Assessment Staging Tool (FAST) developed by Reisburg and used in determining typical time course of Alzheimer’s disease. It is therefore a useful tool to support findings of the FAST scale. The MMSE is also very useful in assessing and documenting cognitive impairment in any patient which may have needs associated with mental status including age or disease-related dementia. Because it is so quick and easy to use, it is an especially helpful tool to document change over time.

 

The MMSE consists of a variety of questions, has a maximum score of 30 points, and ordinarily can be administered in 5-10 minutes.

 

The following three cut-off levels should be employed to classify the severity of cognitive impairment:

 

No cognitive impairment = 24-30
Mild cognitive impairment = 18-23
Severe cognitive impairment = 0-17

When is the MMSE to be completed?

  1. The MMSE should be completed on admission of any patient with dementia/Alzheimer as the primary or secondary diagnosis and documented on the clinical note.
  2. For each dementia/Alzheimer’s patient for each recertification period. The score is documented on the Dementia Clinical Summary.
  3. Anytime a patient’s cognitive function would be considered a prognostic indicator for survival or any time there are significant changes in status. The score is documented in the clinical note.
  4. The MMSE may also be completed for patients who have a coexisting cognitive impairment which may impact quality of life and survival. The score is documented in the clinical note.

How to complete the MMSE Form

  1. Nurses, psychosocial professionals, and physicians may complete the MMSE.
  2. Review MMSE form.
  3. Ask questions in the order listed on the form and score immediately.
  4. If a patient is unable to complete a question, do not ask again.
  5. Document score in the appropriate location.

To view the MMSE Exam, please download the attachment located at the bottom of this article.

 

 

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