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Pearls


2 quick questions for dementia screening

When a patient cannot accurately state his or her date of birth, usually the MMSE is ≤10, indicating severe dementia

Vol. 8, No. 8 / August 2009

The Mini-Mental State Examination (MMSE) is widely used in psychiatry and throughout the medical community to evaluate a patient’s cognitive status. The MMSE score is the common language for communicating a patient’s cognitive level among psychiatrists, primary care physicians, social workers, nursing staff, psychologists, long-term care and assisted living facility staff, and insurance companies.

Although the MMSE is highly useful and should continue to be used as a cognitive screening instrument, in some clinical situations time is too limited to allow a full assessment, which could take up to 30 minutes. In my clinical experience, I’ve discovered I can estimate the MMSE score range for a patient I suspect has dementia by asking 2 simple questions.

What is your date of birth (DOB)? When a patient cannot accurately state his or her complete DOB, usually the MMSE is ≤10, indicating severe dementia. Often this observation has been confirmed when another clinician later would do a complete MMSE and return a score close to one I predicted. DOB is a highly personal piece of information that an individual should be able to provide quickly and directly. If a patient is unable to give this information, consider the rest of the patient’s history to be inaccurate and check with collateral sources such as family or close friends.

Can you name 10 vegetables? If a patient is unable to list 10 vegetables—for example, if he or she cannot name 10 vegetables within a minute, repeats them, or mixes them up with fruits or other foods—the MMSE range usually is between 10 to 20, indicating moderate dementia. Instead of vegetables, you can ask your patient to name animals, fruits, or familiar items in other categories.

Clinical value. These 2 bedside questions do not take the place of performing a full MMSE or another established cognitive screen, such as the Montreal Cognitive Assessment1 or the Mini-Cog.2 My quick assessment—which has not been validated by research—is merely a tip that in certain situations may help you get a rough estimate of a patient’s cognitive status.

References

1. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695-699.

2. Borson S, Scanlan J, Brush M, et al. The Mini-Cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15:1021-1027.

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