scispace - formally typeset
Search or ask a question
Journal ArticleDOI

“Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician

TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
About: This article is published in Journal of Psychiatric Research.The article was published on 1975-11-01. It has received 76181 citations till now. The article focuses on the topics: Cognitive decline & Cognitive Intervention.
Citations
More filters
Journal ArticleDOI
TL;DR: A group of experts on aging and MCI from around the world in the fields of neurology, psychiatry, geriatrics, neuropsychology, neuroimaging, neuropathology, clinical trials, and ethics was convened to summarize the current state of the field of MCI.
Abstract: The field of aging and dementia is focusing on the characterization of the earliest stages of cognitive impairment. Recent research has identified a transitional state between the cognitive changes of normal aging and Alzheimer's disease (AD), known as mild cognitive impairment (MCI). Mild cognitive impairment refers to the clinical condition between normal aging and AD in which persons experience memory loss to a greater extent than one would expect for age, yet they do not meet currently accepted criteria for clinically probable AD. When these persons are observed longitudinally, they progress to clinically probable AD at a considerably accelerated rate compared with healthy age-matched individuals. Consequently, this condition has been recognized as suitable for possible therapeutic intervention, and several multicenter international treatment trials are under way. Because this is a topic of intense interest, a group of experts on aging and MCI from around the world in the fields of neurology, psychiatry, geriatrics, neuropsychology, neuroimaging, neuropathology, clinical trials, and ethics was convened to summarize the current state of the field of MCI. Participants reviewed the world scientific literature on aging and MCI and summarized the various topics with respect to available evidence on MCI. Diagnostic criteria and clinical outcomes of these subjects are available in the literature. Mild cognitive impairment is believed to be a high-risk condition for the development of clinically probable AD. Heterogeneity in the use of the term was recognized, and subclassifications were suggested. While no treatments are recommended for MCI currently, clinical trials regarding potential therapies are under way. Recommendations concerning ethical issues in the diagnosis and the management of subjects with MCI were made.

4,424 citations


Cites background from "“Mini-mental state”: A practical me..."

  • ...Screening instruments are routinely used to quantify the degree of cognitive impairment in patients with dementia and are likely to be particularly helpful early in a dementing illness, when functional and behavioral disturbances are absent.(29,30) The value of neuropsychological measures in helping to identify early cases of dementia has been documented by cross-sectional and longitudinal studies....

    [...]

Journal ArticleDOI
TL;DR: The CAM is sensitive, specific, reliable, and easy to use for identification of delirium and was shown to have convergent agreement with four other mental status tests, including the Mini-Mental State Examination.
Abstract: Objective To develop and validate a new standardized confusion assessment method (CAM) that enables nonpsychiatric clinicians to detect delirium quickly in high-risk settings. Design Prospective validation study. Setting Conducted in general medicine wards and in an outpatient geriatric assessment center at Yale University (site 1) and in general medicine wards at the University of Chicago (site 2). Patients The study included 56 subjects, ranging in age from 65 to 98 years. At site 1, 10 patients with and 20 without delirium participated; at site 2, 16 patients with and 10 without delirium participated. Measurements and main results An expert panel developed the CAM through a consensus building process. The CAM instrument, which can be completed in less than 5 minutes, consists of nine operationalized criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). An a priori hypothesis was established for the diagnostic value of four criteria: acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness. The CAM algorithm for diagnosis of delirium required the presence of both the first and the second criteria and of either the third or the fourth criterion. At both sites, the diagnoses made by the CAM were concurrently validated against the diagnoses made by psychiatrists. At sites 1 and 2 values for sensitivity were 100% and 94%, respectively; values for specificity were 95% and 90%; values for positive predictive accuracy were 91% and 94%; and values for negative predictive accuracy were 100% and 90%. The CAM algorithm had the highest predictive accuracy for all possible combinations of the nine features of delirium. The CAM was shown to have convergent agreement with four other mental status tests, including the Mini-Mental State Examination. The interobserver reliability of the CAM was high (kappa = 0.81 - 1.0). Conclusions The CAM is sensitive, specific, reliable, and easy to use for identification of delirium.

4,393 citations

Journal ArticleDOI
TL;DR: Progress made during the first half of the Human Connectome Project project in refining the methods for data acquisition and analysis provides grounds for optimism that the HCP datasets and associated methods and software will become increasingly valuable resources for characterizing human brain connectivity and function, their relationship to behavior, and their heritability and genetic underpinnings.

4,388 citations

Journal ArticleDOI
TL;DR: Both linear regressions and multivariate analyses correlating three global neuropsychological tests with a number of structural and neurochemical measurements performed on a prospective series of patients with Alzheimer's disease and 9 neuropathologically normal subjects reveal very powerful correlations with all three psychological assays.
Abstract: We present here both linear regressions and multivariate analyses correlating three global neuropsychological tests with a number of structural and neurochemical measurements performed on a prospective series of 15 patients with Alzheimer's disease and 9 neuropathologically normal subjects. The statistical data show only weak correlations between psychometric indices and plaques and tangles, but the density of neocortical synapses measured by a new immunocytochemical/densitometric technique reveals very powerful correlations with all three psychological assays. Multivariate analysis by stepwise regression produced a model including midfrontal and inferior parietal synapse density, plus inferior parietal plaque counts with a correlation coefficient of 0.96 for Mattis's Dementia Rating Scale. Plaque density contributed only 26% of that strength.

4,020 citations

Journal ArticleDOI
TL;DR: Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate- control strategy, and there are potential advantages, such as a lower risk of adverse drug effects, with the rate -control strategy.
Abstract: Background There are two approaches to the treatment of atrial fibrillation: one is cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm, and the other is the use of rate-controlling drugs, allowing atrial fibrillation to persist. In both approaches, the use of anticoagulant drugs is recommended. Methods We conducted a randomized, multicenter comparison of these two treatment strategies in patients with atrial fibrillation and a high risk of stroke or death. The primary end point was overall mortality. Results A total of 4060 patients (mean [+/-SD] age, 69.7+/-9.0 years) were enrolled in the study; 70.8 percent had a history of hypertension, and 38.2 percent had coronary artery disease. Of the 3311 patients with echocardiograms, the left atrium was enlarged in 64.7 percent and left ventricular function was depressed in 26.0 percent. There were 356 deaths among the patients assigned to rhythm-control therapy and 310 deaths among those assigned to rate-control therapy (mortality at five years, 23.8 percent and 21.3 percent, respectively; hazard ratio, 1.15 [95 percent confidence interval, 0.99 to 1.34]; P=0.08). More patients in the rhythm-control group than in the rate-control group were hospitalized, and there were more adverse drug effects in the rhythm-control group as well. In both groups, the majority of strokes occurred after warfarin had been stopped or when the international normalized ratio was subtherapeutic. Conclusions Management of atrial fibrillation with the rhythm-control strategy offers no survival advantage over the rate-control strategy, and there are potential advantages, such as a lower risk of adverse drug effects, with the rate-control strategy. Anticoagulation should be continued in this group of high-risk patients.

3,988 citations

References
More filters
Book
01 Jan 1965

84 citations

Journal ArticleDOI
TL;DR: Three parallel forms of the clinical tests of the sensorium were devised, tried out and modified on two groups of 24 subjects and correlated moderately well when repeated.
Abstract: Three parallel forms of the clinical tests of the sensorium were devised, tried out and modified on two groups of 24 subjects. The final versions were further assessed by using each form in turn with 108 psychiatric patients. The three forms of tests gave scores with very similar means and standard deviations. They correlated moderately well when repeated.

57 citations

Journal ArticleDOI
TL;DR: The present paper has attempted to attack the problem of differential “memory function” by examining the discriminating power of certain test results as between “functional”, “doubtful” and “organic” groups of elderly patients, showing that the best discrimination between the groups is achieved by a simple perceptual task.
Abstract: 1. The aim of the research is to examine the relationship of certain aspects of mental functioning to the psychiatric illnesses of old age. The present paper has attempted to attack the problem of differential “memory function” by examining the discriminating power of certain test results as between “functional”, “doubtful” and “organic” groups of elderly patients. 2. The design of the present study shows that spuriously positive results may arise from inadequate control over factors contributing to the selection of the criterion groups. 3. The investigation fails to confirm, for the patients tested, the diagnostic usefulness of certain tests in common use. 4. The results fail to confirm the predictions of “Ribot's Law” as applied to memory in these elderly patients. 5. The study shows significant differences between the means of the results of the psychiatric groups on some tasks which appear to involve “memory function”. These differences cannot be accounted for merely in terms of group differences in general intelligence. The nature of the possible underlying “memory function” remains to be further examined. 6. The investigation so far shows that the best discrimination between the groups is achieved by a simple perceptual task (Bender Gestalt). 7. The study fails to show differences between groups on any of the tests which are sufficiently great to enable these tests to be immediately employed as useful diagnostic instruments.

55 citations

Journal ArticleDOI
TL;DR: It is shown that tests for senility should be short, especially those with oral questions, because of straying attention, impaired comprehension, and short retention, andPerseveration is greatly increased in senescence; it can be brought out merely by having a succession of short, varied items.
Abstract: A tentative battery of 25 short tests for the measurement of senescence is described ( cf. Table I). The scale is the result of the application of nearly 80 tests to senile patients in three London hospitals. It was administered in full to 38 patients in all, and the present findings refer to a group of 20 less seriously demented ones, with an age range of 68 to 83. The tests are classified into three groups according to the degree of difficulty experienced by the seniles (Table II). The divisions were made on the basis of a number of criteria which emerged during the working up of the results, and are only pointers to the kind of functions involved. Briefly, the most difficult tests were those in which subjects were required to break away from old mental habits and adapt to unfamiliar situations, tests of recent memory (logical), of judgment, planning, and reasoning, or embodying difficult or lengthy instructions. Less difficulty was found with such tests as rote memory, fluency of associations, simple arithmetic, and vocabulary. Performance seemed to be least affected on tests of visual recognition, old mental habits, and simple motor tasks. It is shown that tests for senility should be short, especially those with oral questions, because of straying attention, impaired comprehension, and short retention. Perseveration is greatly increased in senescence; it can be brought out merely by having a succession of short, varied items. There is a loss of steadiness and speed on the motor side. The disturbing effect of tests with a time element on the slower acting senile is noted. The present mental status of the patients is estimated on eleven tests which are scored on the (outmoded) mental age method (Table I): the average of these is between M.A. 10 and 11. This figure is compared with previous reports on the decline of intelligence. An estimate of the former mental status of each patient is made by means of efficiency quotients on part of the “Bellevue” scale. These relate each score to the average level for the peak age-group of 20 to 24 years (Table III). The use of the vocabulary score as an index of former level is discussed. A comparison of score variation within individuals with variation between individuals shows a ratio of the former to the latter of approximately 85 per cent. Variability of scores within individuals increases with age inside the patient group, also with lower intelligence. A shortened version of the scale, which takes about 40 minutes, is indicated (Table I).

19 citations