CLINICAL INTERPRETATION OF THE MINI-MENTAL STATE

The Mini-Mental Status Examination (MMSE) is a brief, structured test of cognitive function. The test is often used as a screening or case-f inding instrument for the detection of organic mental disorders or cog nitive impairment. However, many clinicians incorporate the MMSE into their clinical mental status examination. In both contexts, cutoff sco res are often utilized to interpret the results, with scores below the cutoff being interpreted as evidence of cognitive dysfunction, and sc ores above the cutoff being interpreted as evidence against such dysfu nction. However, when the test is done as part of a mental status exam ination, the application of a cutoff score fails to take account of pr ior clinical information, which is critical to the interpretation of a ll diagnostic tests. In this paper, an alternative approach to interpr etation is proposed. In the proposed method, guidelines for interpreta tion are based on the probability of being free of organic disease at each potential score. Scores are interpreted in terms of their consist ency or inconsistency with a prior diagnostic impression. This takes p rior clinical information and clinical judgment into account. Although different from the traditional way of interpreting the MMSE, the prop osed method can be implemented on an intuitive level and does not requ ire mathematical calculations, which are inconvenient at the bedside.