By London Deanery | August 26, 2018
PERFORM A COGNITIVE SCREENING ASSESSMENT
You need to perform a brief but comprehensive cognitive screening test such as the Mini-Mental State Examination (MMSE) or Standardised Mini- Mental State Examination (SMMSE) either to be demonstrated in role-play with your supervisor or in interview with a real patient. There are two parts to the assessment:
- Firstly, you must demonstrate the verbal communication skills to complete task. This means you should be able to make all instructions readily understandable to the patient. It is worth practicing with someone else how you phrase each instruction and seeing how well you are understood.
- Secondly, you must understand the scoring of any screening tool you use and be able to calculate the correct score for the patient. To demonstrate competency, your score should be within 1 point of your trainer’s score.
Don’t forget to introduce yourself and state the purpose of the test you are doing.
An Abbreviated Mental Test (AMT) is not sufficient to demonstrate this competency.
Remember that the SMMSE/MMSE do not diagnose dementia. They are screening tools for cognitive impairment. The scores can be suggestive of the degree of impairment.
Both the MMSE and the SSMSE can be used clinically but the forms may not photocopied without permission. Sample copies only of the MMSE and SMMSE have been provided but cannot be should not be modified or reproduced due to copyright.
To order or obtain additional information on the MMSE contact: Psychological Assessment Resources, Inc. (PAR) 16204 N. Florida Avenue Lutz, Florida 33549
To order or obtain additional information on the SMMSE please call: (905) 628- 0354 or e- mail at: email@example.com
by Dr Roberts Klotins
a MMSE sequence (30 points total)
Further below you have a sequence of the examination; you can do it very simply with just a couple of sheets of paper at hand. To write the instruction and to draw the sample figure it is advisable to carry a broad-ish black marker; often people in need of MMSE may have poor eyesight, and for the purpose of the test it is important that they can see the text and the figure.
Ask: Are you right-handed or left-handed?
1) Orientation (10 points max)
Year - Season - Month - Day - Date
Country - Region - City - Building - Floor
2) Memory & Concentration (11 points max)
Immediate Recall : Apple - Table - Penny (3)
– please memorise them as I will ask you to repeat them to me a bit later.
Concentration: Serial 7 or spelling WORLD forwards and then backwards. Score only backwards. (5)
Short Term Memory: What were the three things I asked you to repeat and remember? (3)
3) Other parts of the brain (9 points max)
- Repetition (1) “No Ands, Ifs or Buts”
- Naming (2) pen, watch
- Writing (1) write a sentence
- Reading (1) “CLOSE YOUR EYES”
Drawing / Parietal lobe (1)
Please look carefully at this design and make a copy of it.
You can simply draw a sample picture of the interlocking penatagons for your patient on a spare piece of paper and ask them to copy that. Do remember that there have to be 5 sides for each pentagon and the intersection has to have 4 sides.
Three Stage Command (3)
Here you will ask the patient to take the sheet of paper with their non-dominant hand.
Please listen carefully to my intructions; I wil tell them only once, you will have to remember and do as I say.
- Take this sheet of paper with your left hand (1)
- Fold it in half, using both hands (1)
- Place the paper on the floor (1)
Then pass the sheet of paper (usually blank) to the patient.
Such grouping of the test items makes remembering them and scoring easier. See the
Handwritten MMSE page below - it allows you to quickly assess MMSE using just a blank sheet of paper. You should perhaps carry a thick, black felt pen as well because ever so often you will need to do MMSE for older patients whose vision also may be impaired.
There are also several a bit more complicated forms of cognitive assessment that you do not need to use for the competency, but which will be handy for your Old Age Psyhciatry rotation and general knowledge. You can look at them all below:
- ACE-R (Addenbrooke’s Cognitive Examination) and scoring guide
- MoCA (Montreal Cognitive Assessment)
- FAB (Frontal Assessment Battery)
- Parietal lobe test
- Article from Journal of Neurology and Psychiatry (doi:10.1136/jnnp.2004.059758)
- Handwritten MMSE assessment example
Form to sign off the Competency
Note: You can either fill this PDF form on a computer (preferably together with your assessor) and print it out for the assessor to sign, or you can just print the page and fill it out by hand together with the assessor. In any case after the form is signed, you will need to scan it to upload to your portfolio, just like you would with any paper-based evidence form. If you fill the form on your computer you need to SAVE it with a different name - so that the text you typed into the form gets preserved. A form filled on a computer probably, will be easier to read.
If the form opens directly in your browser you probably will not be able to type in the form fields - for that you need to open the form with your system PDF viewer - which likely will be Adobe Reader.