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<div class="editorbox"> '''Original Editor '''- [[User:User Name|Simisola Ajeyalemi]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
<div class="editorbox"> '''Original Editor '''- [[User:User Name|Simisola Ajeyalemi]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
<div class="editorbox"> '''Original Editor '''- [[User:Tolulope Adeniji]]


</div>
== Description ==
== Description ==
The Mini-mental state examination is used to measure [[Cognitive Impairments|cognitive impairment]] in [[Older People Introduction|older adult]]<nowiki/>s. According to Folstein et al, it can be used to screen for cognitive impairment, to estimate the severity of cognitive impairment at a given point in time, to follow the course of cognitive changes in an individual over time, and to document an individual’s response to treatment.<ref>Folstein MF, Folstein SE, McHugh PR "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov; 12(3):189-98.</ref> <ref name=":1">Sleutjes DK, Harmsen IJ, van Bergen FS, Oosterman JM, Dautzenberg PL, Kessels RP. [https://journals.lww.com/alzheimerjournal/fulltext/2020/07000/validity_of_the_mini_mental_state_examination_2_in.16.aspx Validity of the Mini-Mental State Examination-2 in Diagnosing Mild Cognitive Impairment and Dementia in Patients Visiting an Outpatient Clinic in the Netherlands]. Alzheimer disease and associated disorders. 2020 Jul;34(3):278.</ref>


Although Transcutaneous electrical nerve stimulation is known for non-pharmacological pain control, some scholars showed that it might also be used for brain stimulation in person with  dementia<ref name=":0">Cameron MH, Lonergan E, Lee H. [https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004032/abstract?__cf_chl_jschl_tk__=825dbba406e2e362cb19738244ae7e0a475486a5-1581864188-0-AQ8RbL_QUahFu9b2bCRFWIkHcLgzgixv5JQTknus7P-t56OnEYoJstiRFPPBo2_YqT6WKd9PW8jnBarcvCYHvdKo7oGeGNg2jTyVpwRJH Transcutaneous electrical nerve stimulation (TENS) for dementia.] Cochrane Database of Systematic Reviews. 2003(3).</ref><ref>Schabrun SM. [https://www.researchgate.net/publication/50315174_Transcranial_direct_current_stimulation_A_place_in_the_future_of_physiotherapy Transcranial direct current stimulation: a place in the future of physiotherapy?]. Physical Therapy Reviews. 2010 Aug 1;15(4):320-6.</ref>. Application of TENS electrodes to head is called Cranial Electrical Nerve Stimulation (CES) or transcranial stimulation and it is one of the methods used to stimulate the brain of a person with dementia<ref name=":0" />. Despite a recent evidence that CES alone or combine with physical therapy improves some functional activities in person with possible cognitive impairment<ref name=":1">Yotnuengnit P, Bhidayasiri R, Donkhan R, Chaluaysrimuang J, Piravej K. [https://journals.lww.com/ajpmr/FullText/2018/01000/Effects_of_Transcranial_Direct_Current_Stimulation.2.aspx Effects of transcranial direct current stimulation plus physical therapy on gait in patients with Parkinson disease: a randomized controlled trial.] American journal of physical medicine & rehabilitation. 2018 Jan 1;97(1):7-15.</ref>, trans-cranial electrical nerve stimulation is not a common practice among  physiotherapists who are one of the experts in managing person with dementia. This paper will therefore provide information on the CES method of application to stimulate the brain of a person with dementia.<br>
* It assesses different subset of cognitive status including attention, language, [[memory]], orientation, visuospatial proficiency.
* It has also been recommended for the screening of cognition in [[Depression|depressed]] patients<ref>Special Report, Expert Consensus Guideline Series, ''Postgraduate Medicine,'' October 2001.</ref>
* The mini-mental state examination is proprietary and takes about 10-15 minutes to administer.
<br>
When compared to participants with ischemic vascular dementia and [[Parkinson's]] disease, participants with [[Alzheimer's Disease]] demonstrated significant impairment on the Mini-mental state examination index evaluating orientation and memory, according to the findings. On the Assessing working memory and motor/constructional abilities, the  ischemic vascular dementia and Parkinson's disease groups performed significantly worse than the AD patients.<ref>Ala, TA; Hughes, LF; Kyrouac, GA; Ghobrial, MW; Elble, RJ. "The Mini-Mental Status exam may help in the differentiation of dementia with Lewy bodies and Alzheimer's disease". ''International Journal of Geriatric Psychiatry''.  June 2002;'''17''' (6): 503–9. </ref><ref>Jefferson, AL; Cosentino, SA; Ball, SK; Bogdanoff, B; Leopold, N; Kaplan, E; Libon, DJ. "Errors produced on the mini-mental status examination and neuropsychological test performance in Alzheimer's disease, ischemic vascular dementia, and Parkinson's". ''The Journal of Neuropsychiatry and Clinical Neurosciences''. 2002;'''14''' (3): 311–20. </ref><ref>Palmqvist, S; Hansson, O; Minthon, L; Londos, E. "Practical suggestions on how to differentiate dementia with Lewy bodies from Alzheimer's disease with common cognitive tests". ''International Journal of Geriatric Psychiatry''. December 2009;'''24''' (12): 1405–12. </ref> However, it should not be used to exclusively diagnose or differentiate the different types of [[dementia]].<ref>Arevalo-Rodriguez I.; Smailagic N.; Ciapponi A.; Sanchez-Perez E.; Giannakou A.; Figuls M.; Cullum S. "Mini-Mental Status Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI)". 2015. </ref><ref>Creavin ST, Wisniewski S, Noel-Storr AH, et al. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. ''Cochrane Database Syst Rev''. 2016;(1):CD011145.</ref>


== Dementia(Major Neurocognitive disorder)  ==
The [[Mini-Cog]] and revised '''Addenbrooke's Cognitive Examination''' are preferred alternatives to the Mini-Mental State Examination for dementia screening, and the [[Montreal Cognitive Assessment (MoCA)|Montreal Cognitive Assessment]] is a preferred alternative to detect mild cognitive impairment.<ref name=":0">Tsoi KK, Chan JY, Hirai HW, Wong SY, Kwok TC. Cognitive tests to detect dementia: a systematic review and meta-analysis. ''JAMA Intern Med''. 2015;175(9):1450–1458.</ref>
DSM-5 detailed  on the definition and diagnosis of  neurocognitive disorders<ref name=":2">American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013 May 22.</ref>. Dementia now addressed as a major neurocognitive disorder according to DSM-5 on neurocognitive disorder, is an impairment in one or more cognitive domain with functional status impairment<ref name=":2" />, which is of concern to both patient and patient relative. A cognitive impairment without significant impact on the functional activities of the person with dementia is termed mild neurocognitive impairment. Neuropsychological and behavioural characteristics such as anxiety, depression…and sleeping disturbances are prominent feature of dementia<ref>Burke AD, Goldfarb D, Bollam P, Khokher S. [https://link.springer.com/article/10.1007/s40120-019-00148-5 Diagnosing and Treating Depression in Patients with Alzheimer’s Disease.] Neurology and therapy. 2019 Aug 1:1-26.</ref><ref>Müller-Spahn F. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181717/ Behavioral disturbances in dementia. Dialogues in clinical neuroscience]. 2003 Mar;5(1):49.</ref>. This characteristics including neurocognitive impairment might improve with trans cranial electrical nerve stimulation<ref name=":0" /><ref>Das N, Spence JS, Aslan S, Vanneste S, Mudar R, Rackley A, Quiceno M, Chapman SB. [https://www.frontiersin.org/articles/10.3389/fnins.2019.00307/full Cognitive training and transcranial direct current stimulation in mild cognitive impairment: A randomized pilot trial]. Frontiers in Neuroscience. 2019;13:307.</ref><ref name=":3">Moreno-Duarte I, Gebodh N, Schestatsky P, Guleyupoglu B, Reato D, Bikson M, Fregni F. [https://www.sciencedirect.com/science/article/pii/B9780124047044000028 Transcranial electrical stimulation: transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial pulsed current stimulation (tPCS), and transcranial random noise stimulation (tRNS).] InThe stimulated brain 2014 Jan 1 (pp. 35-59). Academic Press.</ref>. Scholars affirmed that TENS might stimulate brain and improve both the cognitive impairment and the neuropsychological characteristics of the dementia<ref name=":0" />


== '''Cognitive Impairment Assessment''' ==
{{#ev:youtube|y39BDAljIbg}}
Evaluating the person with dementia requires standardised neuropsychological assessment tools. Among this tools, the most common one universally use is Mini Mental Status Examination<ref>Folstein MF, Folstein SE, McHugh PR. “[https://www.ncbi.nlm.nih.gov/pubmed/1202204 Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician.] Journal of psychiatric research. 1975 Nov 1;12(3):189-98.</ref>  and for functional status, Functional Activities Questionnaire (FAQ) for older adults might be used<ref>Mayo AM. [https://consultgeri.org/try-this/dementia/issue-d13 Use of the Functional Activities Questionnaire in older adults with dementia.] Try This: Best Practices in Nursing Care to Older Adults with Dementia D. 2012;13.</ref>. More so, this tools can be used to monitor the person with major neurocognitive impairment  progress on the intervention.
== Mini Mental State Examination(MMSE) ==
Mini Mental State Examination is used to screen cognitive status of the older adults by screening of the cognitive domains like language, memory, attention and soon<ref>Folstein MF, Folstein SE, McHugh PR "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov; 12(3):189-98.</ref>. This tool is easy to administer and it takes about 10-20 minutes to administer it. Person with neurocognitive impairment perform differently  on the different domains of the tool items. The person with  [[Alzheimer's Disease|Alzheimer's disease]]  perform lesser in test of orientation to time and place and the recall part of the memory test when compared with those with Lewy bodies, vascular and Parkinson type of neurocognitive impairment.<ref>Ala, TA; Hughes, LF; Kyrouac, GA; Ghobrial, MW; Elble, RJ. "The Mini-Mental Status exam may help in the differentiation of dementia with Lewy bodies and Alzheimer's disease". ''International Journal of Geriatric Psychiatry''.  June 2002;'''17''' (6): 503–9. </ref><ref>Jefferson, AL; Cosentino, SA; Ball, SK; Bogdanoff, B; Leopold, N; Kaplan, E; Libon, DJ. "Errors produced on the mini-mental status examination and neuropsychological test performance in Alzheimer's disease, ischemic vascular dementia, and Parkinson's". ''The Journal of Neuropsychiatry and Clinical Neurosciences''. 2002;'''14''' (3): 311–20. </ref><ref>Palmqvist, S; Hansson, O; Minthon, L; Londos, E. "Practical suggestions on how to differentiate dementia with Lewy bodies from Alzheimer's disease with common cognitive tests". ''International Journal of Geriatric Psychiatry''. December 2009;'''24''' (12): 1405–12. </ref>  Although, MMSE  has a good diagnostic ability<ref>Arevalo-Rodriguez I.; Smailagic N.; Ciapponi A.; Sanchez-Perez E.; Giannakou A.; Figuls M.; Cullum S. "Mini-Mental Status Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI)". 2015. </ref><ref name=":4">Creavin ST, Wisniewski S, Noel-Storr AH, et al. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. ''Cochrane Database Syst Rev''. 2016;(1):CD011145.</ref>, Mini-Cog and revised Addenbrooke's Cognitive Examination  are better for cognitive screening.{{#ev:youtube|y39BDAljIbg}}


== Scoring and Interpretation of Scores ==
== Scoring and Interpretation of Scores ==
Folstein and associates (1975) MMSE has 11 questions with total possible 30 points on the following cognitive domains- orientation, registration, attention and calculation, recall and language. The authors described the test in relations to patient responses, which are verbal responses to orientation, memory and attention questions and the second requires naming, reading and writing and the ability to follow verbal and written commands, write a sentence and copy, The MMSE score is basically the lower the score the poorer the cognitive outcome. A test taker that score more than 25 is considered cognitively intact while below 25 is suggesting possible cognitive impairement.  
The Mini-mental state examination is scored on a scale of 0-30 with scores > 25 interpreted as normal cognitive status.
* Severe cognitive impairment:  0-17
* Mild cognitive impairment: 18-23
* No cognitive impairment:  24-30
<br>
Interpretation of the mental status examination must take into account the patient's native language, education level<ref>Galea M, Woodward M. Mini-mental state examination (MMSE). Australian Journal of Physiotherapy. 2005 Jan 1;51(3):198.</ref>, and culture as these factors can affect performance.<ref>Faber RA. The neuropsychiatric mental status examination. ''Semin Neurol''. 2009;29(3):185–193. Level of evidence C</ref>
 
== Validity ==
== Validity ==
Creavin and associates<ref name=":4" /> conducted a review of studies and found that 14 articles supported evidence that MMSE had a good sensitivity  sensitivity of of an average of 88.3% (95% confidence interval [CI], 81.3% to 92.9%) and a specificity of 86.2% (95% CI, 81.8% to 89.7%) to evaluate cognitive status in person with dementia, The authors showed that the optimal cut-off for cognitive impairment was within the range of 23-25<ref name=":4" />. In another study, Lin and associates<ref name=":5" /> findings is in tandem with Creavin et al.<ref name=":4" />, that MMSE  has a good sensitivity. The authors showed that MMSE exhibited sensitivity of 81% (95% CI, 78% to 84%) and specificity of 89% (95% CI, 87% to 91%) for dementia patient<ref name=":5">Lin JS, O'Connor E, Rossom RC, Perdue LA, Eckstrom E. Screening for cognitive impairment in older adults: a systematic review for the U.S. Preventive Services Task Force [published correction appears in Ann Intern Med. 2014;160(1):72]. ''Ann Intern Med''. 2013;159(9):601–612.</ref>
In 14 studies, the MMSE had a sensitivity of 88.3% (95% confidence interval [CI], 81.3% to 92.9%) and a specificity of 86.2% (95% CI, 81.8% to 89.7%) for dementia, with a score cutoff of 23 to 25 indicating significant impairment.<ref name=":0" /> A more recent meta-analysis of 108 cohort studies found a sensitivity of 81% (95% CI, 78% to 84%) and specificity of 89% (95% CI, 87% to 91%)<ref>Lin JS, O'Connor E, Rossom RC, Perdue LA, Eckstrom E. Screening for cognitive impairment in older adults: a systematic review for the U.S. Preventive Services Task Force [published correction appears in Ann Intern Med. 2014;160(1):72]. ''Ann Intern Med''. 2013;159(9):601–612.</ref><ref name=":1" />
== '''Cranial Electrical Nerve Stimulation (CES) intervention''' ==
Using electrotherapy modalities like TENS requires assessment like skin sensation test to determine if the intervention will be appropriate. CES application requires several parameter based on the objectives to achieve in the person with dementia<ref name=":3" /> <ref>Peterchev AV, Wagner TA, Miranda PC, Nitsche MA, Paulus W, Lisanby SH, Pascual-Leone A, Bikson M. [https://www.ncbi.nlm.nih.gov/pubmed/22305345 Fundamentals of transcranial electric and magnetic stimulation dose: definition, selection, and reporting practices. Brain stimulation.] 2012 Oct 1;5(4):435-53.</ref> . ''Moreno-Duarte''<ref name=":3" /> affirmed that low level intensity transcranial electrical nerve stimulation is the major documented intensity level of CES application and there are four methods to this: transcranial direct current stimulation (tDCS), transcranial pulsed current stimulation (tPCS), transcranial alternating current stimulation(tACS) and transcranial random noise stimulation (tRNS)(see figure 1 for the summary of the parameters used)<ref name=":3" />. Although, there is still some controversial in the use of CES among person with dementia, yet there are supporting evidence that  using CES either combined with physiotherapy intervention  or not improves cognitive, physical activities and behavioural characteristics<ref name=":1" /><ref>Elsner B, Kugler J, Pohl M, Mehrholz J. [https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009645.pub3/abstract Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke]. Cochrane Database of Systematic Reviews. 2016(3).</ref>
 
Figure 1
 
== CES in Physiotherapy Practice for Brain Stimulation ==
[[File:T dementia.jpg|thumb|<ref>Moreno-Duarte I, Gebodh N, Schestatsky P, Guleyupoglu B, Reato D, Bikson M, Fregni F. Transcranial electrical stimulation: transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial pulsed current stimulation (tPCS), and transcranial random noise stimulation (tRNS). InThe stimulated brain 2014 Jan 1 (pp. 35-59). Academic Press.</ref>]]


== Resources ==
* [https://www.ihacpa.gov.au/sites/default/files/2022-08/smmse-tool-v2.pdf Standardized Mini-Mental State Examination (SMMSE)]
* [https://www.ihpa.gov.au/what-we-do/standardised-mini-mental-state-examination-smmse Standardized Mini-Mental State Examination (SMMSE) Guidelines for administration and scoring instructions]


== References  ==
== References  ==
<references />


<references />
[[Category:Older People/Geriatrics - Outcome Measures]]
[[Category:Older People/Geriatrics - Outcome Measures]]
[[Category:Outcome Measures]]
[[Category:Outcome Measures]]
[[Category:Mental Health]]
[[Category:Mental Health]]
[[Category:Mental Health - Assessment and Examination]]
[[Category:Mental Health - Assessment and Examination]]
== Resources  ==
== References  ==
<references />
[[Category:Electrophysical]]

Latest revision as of 09:12, 12 September 2023

Original Editor - Simisola Ajeyalemi Top Contributors - Simisola Ajeyalemi, Kim Jackson, Lauren Lopez, Safiya Naz, Shaimaa Eldib, Tolulope Adeniji, Vidya Acharya, Lucinda hampton, Areeba Raja and Naomi O'Reilly

Description[edit | edit source]

The Mini-mental state examination is used to measure cognitive impairment in older adults. According to Folstein et al, it can be used to screen for cognitive impairment, to estimate the severity of cognitive impairment at a given point in time, to follow the course of cognitive changes in an individual over time, and to document an individual’s response to treatment.[1] [2]

  • It assesses different subset of cognitive status including attention, language, memory, orientation, visuospatial proficiency.
  • It has also been recommended for the screening of cognition in depressed patients[3]
  • The mini-mental state examination is proprietary and takes about 10-15 minutes to administer.


When compared to participants with ischemic vascular dementia and Parkinson's disease, participants with Alzheimer's Disease demonstrated significant impairment on the Mini-mental state examination index evaluating orientation and memory, according to the findings. On the Assessing working memory and motor/constructional abilities, the  ischemic vascular dementia and Parkinson's disease groups performed significantly worse than the AD patients.[4][5][6] However, it should not be used to exclusively diagnose or differentiate the different types of dementia.[7][8]

The Mini-Cog and revised Addenbrooke's Cognitive Examination are preferred alternatives to the Mini-Mental State Examination for dementia screening, and the Montreal Cognitive Assessment is a preferred alternative to detect mild cognitive impairment.[9]

Scoring and Interpretation of Scores[edit | edit source]

The Mini-mental state examination is scored on a scale of 0-30 with scores > 25 interpreted as normal cognitive status.

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


Interpretation of the mental status examination must take into account the patient's native language, education level[10], and culture as these factors can affect performance.[11]

Validity[edit | edit source]

In 14 studies, the MMSE had a sensitivity of 88.3% (95% confidence interval [CI], 81.3% to 92.9%) and a specificity of 86.2% (95% CI, 81.8% to 89.7%) for dementia, with a score cutoff of 23 to 25 indicating significant impairment.[9] A more recent meta-analysis of 108 cohort studies found a sensitivity of 81% (95% CI, 78% to 84%) and specificity of 89% (95% CI, 87% to 91%)[12][2]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Folstein MF, Folstein SE, McHugh PR "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov; 12(3):189-98.
  2. ↑ 2.0 2.1 Sleutjes DK, Harmsen IJ, van Bergen FS, Oosterman JM, Dautzenberg PL, Kessels RP. Validity of the Mini-Mental State Examination-2 in Diagnosing Mild Cognitive Impairment and Dementia in Patients Visiting an Outpatient Clinic in the Netherlands. Alzheimer disease and associated disorders. 2020 Jul;34(3):278.
  3. ↑ Special Report, Expert Consensus Guideline Series, Postgraduate Medicine, October 2001.
  4. ↑ Ala, TA; Hughes, LF; Kyrouac, GA; Ghobrial, MW; Elble, RJ. "The Mini-Mental Status exam may help in the differentiation of dementia with Lewy bodies and Alzheimer's disease". International Journal of Geriatric Psychiatry.  June 2002;17 (6): 503–9. 
  5. ↑ Jefferson, AL; Cosentino, SA; Ball, SK; Bogdanoff, B; Leopold, N; Kaplan, E; Libon, DJ. "Errors produced on the mini-mental status examination and neuropsychological test performance in Alzheimer's disease, ischemic vascular dementia, and Parkinson's". The Journal of Neuropsychiatry and Clinical Neurosciences. 2002;14 (3): 311–20. 
  6. ↑ Palmqvist, S; Hansson, O; Minthon, L; Londos, E. "Practical suggestions on how to differentiate dementia with Lewy bodies from Alzheimer's disease with common cognitive tests". International Journal of Geriatric Psychiatry. December 2009;24 (12): 1405–12. 
  7. ↑ Arevalo-Rodriguez I.; Smailagic N.; Ciapponi A.; Sanchez-Perez E.; Giannakou A.; Figuls M.; Cullum S. "Mini-Mental Status Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI)". 2015. 
  8. ↑ Creavin ST, Wisniewski S, Noel-Storr AH, et al. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016;(1):CD011145.
  9. ↑ 9.0 9.1 Tsoi KK, Chan JY, Hirai HW, Wong SY, Kwok TC. Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Intern Med. 2015;175(9):1450–1458.
  10. ↑ Galea M, Woodward M. Mini-mental state examination (MMSE). Australian Journal of Physiotherapy. 2005 Jan 1;51(3):198.
  11. ↑ Faber RA. The neuropsychiatric mental status examination. Semin Neurol. 2009;29(3):185–193. Level of evidence C
  12. ↑ Lin JS, O'Connor E, Rossom RC, Perdue LA, Eckstrom E. Screening for cognitive impairment in older adults: a systematic review for the U.S. Preventive Services Task Force [published correction appears in Ann Intern Med. 2014;160(1):72]. Ann Intern Med. 2013;159(9):601–612.
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