Meet the MMSE & MMSE-2 Authors: Marshal F. Folstein, MD & Susan E. Folstein, MD

What made you decide initially to develop the Mini-Mental® State Examination (MMSE)?

We developed the MMSE to solve a clinical problem on a geriatric psychiatric inpatient service. The diagnoses of patients on our unit included depression, dementia, delirium, and occasional late-life schizophrenia. We needed a practical quantitative cognitive exam in order to aide clinicians in determining the severity of cognitive impairment ranging from mild to severe and to document improvement or decline.

At the time, Susan was a psychiatry resident rotating on the geriatric psychiatric unit where I (Marshal) was a junior attending. Always a perfectionist, she was not happy when I repeatedly asked for cognitive information that she had not asked about. So she asked me to write down all the items that I wanted her to include.

What made you decide to update it and create the Mini-Mental® State Examination, Second Edition™ (MMSE®-2™)?

Over the years, students and other users made many suggestions about how to improve the MMSE. There was a need to clarify the instructions so that certain tasks were administered; there was a need for phrases that were more easily translated into other languages; and users requested multiple forms in order to minimize practice effects with serial administration. In addition, we had long wanted to develop a shorter version that could be given very quickly in busy clinical settings, and also a longer version that would eliminate ceiling effects. We wanted this longer version to be more sensitive than the original MMSE to disorders of executive function and to the kinds of memory impairment found in mild cognitive impairment.

What would you like to tell people about the MMSE-2 that they may not know?

The MMSE-2 Standard Version scores are equivalent to the original MMSE scores. We took care that subjects tested during development scored the same, regardless of whether they were given the original MMSE or the MMSE-2 Standard Version. Longitudinal studies currently underway can switch to the new version without any adjustment to scores. The original, unrevised MMSE is still available if users do not want to change to the revised versions.

How do you spend your free time?

Marshal takes flute lessons and is trying to improve his photography. Susan enjoys gardening and reading spy novels, biographies, Jane Austen, and Patrick O’Brian. She has a new job at the University of Miami School of Medicine with a joint appointment in psychiatry and in the Hussman Institute for Human Genomics. We both like to write and watch old movies.

Screen for cognitive impairment with a revised version of the most widely used cognitive status exam...

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28 Responses

  1. Hi,

    The MMSE 2 Manual does not provide an interpretation for scores. Is there a specific reasdon why?

    For example if I scored 27 how would I interpret it?

    Thanks,
    Lav

  2. The MMSE 2 Manual does not provide an interpretation for scores. Is there a specific reason why?

    For example if I scored 27 how would I interpret it?

    Thanks,
    Lav

  3. I have the same question. How do you interpret the scores and what are the cutoffs for clinical signficance?

    • Thank you for your post. The details of scoring have been emailed to your personal email address.

      Genevieve Hughes CS Specialist II

      • I posted a request a while ago but I do not see it on here. I need the same thing that you sent out to the others please… MMSE cutoffs and categories of impairment associated with each range of scores.
        Thanks

      • May I have the same information?

  4. Could you also provide me with information on scoring the MMSE and interpretation of MMSE scores?

    • Information on the scoring and interpretation of the MMSE and MMSE-2 can be found in the MMSE Clinical Guide or the MMSE-2 User’s Manual.

      Teri Lyon Technical Support Specialist II

    • I have the same question as Christina. I also understand how to score and convert that to a t-score but I am not sure how to interpret that t score appropriately. My whole department (Psychology) has the same question… My work email is provided in the “details” box. Please send any and all information as you have sent to the others. I agree with Christina, “We have all read it and that is why we are asking the question.” Thank you for your assistance.

      • I have not had any contact regarding my post/question. I am very disappointed.

  5. Hi, do you know if the MMSE2 will replace the original MMSE within clinics, also will the original MMSE still be within the ACE-R or will this change to the updated MMSE? Also if a clinic were to use the MMSE2 would they have to pay $32 per 25 they administer as in the pricing or would this be changed within hospital settings? thank you

  6. Dear Sarah,

    I have sent you an e-mail with some information about your question.

  7. Dear Sarah,

    I have resent you the information. Please let me know if you need any additional information.

  8. I have the same question. I have downloaded the ap from PAR but it is the same as in the manual. I understand how to score and convert that to a t-score but I do not know how to interpret that t score appropriately and write up the results in my reports. It is quite frustrating because with the original MMSE there were cutoffs and categories of impairment associated with each range of scores. My email is christinatorti@hotmail.com, please send any and all information as you (Genevieve) have sent above. Teri, your response of “Information on the scoring and interpretation of the MMSE and MMSE-2 can be found in the MMSE Clinical Guide or the MMSE-2 User’s Manual.” was not helpful. We have all read it and that is why we are asking the question. Thank you for any and all help that you can provide.

  9. madam can i assess dementia through this tool.

  10. Respected madam,
    am anish m. doing msc in psychiatry.am conducting a research on assessing the level of dementia of oldage people.. i wish to use mmse for assessing the level of dementia. can u plz give me the permission to use the tool..if you are giving permission means am very much thankfull to you.
    Faithfully,
    anish.m.mamachan

  11. Hello. I am also looking for interpretation notes.

  12. How can i use MMSE in post stroke patients? For example, if the patient has aphasia, how can i access?

  13. Hello,
    I want to have more information about copyrights.
    I work in a university hospital and also VA system. I am a geriatrician, and we have fellows, residents, students who rotate with us. Can we still use the MMSE to evaluate cognition in this setting or we have to pay for the administration of it??
    Thanks for the info….

  14. high point high school is trying to find Marshall. email john fennel at mandjfen1@msn.com

  15. Good PM, i would like to ask if how can I borrow the tool of MMSE?

    I am Ion Gregorio, currently taking up masters of arts in Nursing at University of Santo Tomas in the Philippines

  16. How do I interpret my T score for the MMSE2? I can’t seem to find cutoff scores in the pocket norms guide or in the manual.

  17. How do I interpret my T score for the MMSE2? I can’t seem to find cutoff scores in the pocket norms guide or in the manual.

  18. Dear Doctors
    I am a Psychiatrist from India interested in research in neuropsychiatric disorders like Parkinson’s Disease. Do we need any permission for using the freely downloadable MMSE. If so please permit me to use it for research
    Thanking you
    Alakananda Dutt
    Consultant Psychiatrist
    Institute of Neurosciences Kokata

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