A Short Test of Mental Status: Description and Preliminary Results

doi:10.1016/S0025-6196(12)61905-3

Mayo Clinic Proceedings

Volume 62, Issue 4, April 1987, Pages 281-288

https://doi.org/10.1016/S0025-6196(12)61905-3 Get rights and content

A short test of mental status (encompassing about 5 minutes) was administered to 93 consecutive neurologic outpatients without dementia, 67 outpatients with Alzheimer-type dementia, and 20 outpatients with dementia of miscellaneous causes. The mean scores for patients with Alzheimer-type dementia were lower than those for the nondemented patients in the total scoring and on all subtests (P<0.001). When a total score of 29 or less (maximal attainable score, 38) was used as a screen for dementia, a sensitivity of 92% and a specificity of 91% were reached. For patients older than 60 years of age, a score of 29 or less resulted in a sensitivity of 95% and a specificity of 88%. Thus, in general, this easily administered test distinguishes demented from nondemented patients, but it should not be used as the sole means of diagnosing dementia.

Section snippets

SELECTION OF PATIENTS

In a period of 10 weeks, during routine consultative neurologic practice, a short test of mental status was administered by one of us (E.K.) to all patients, regardless of the reason for consultation or the diagnosis. Of the 105 patients who underwent evaluation, 12 were excluded from the study for various causes: 7 were rejected from final consideration because their primary language was not English, 2 had severe pain and pain behavior that made the examination impossible, 1 was not testable

PROCEDURES

In each patient, the neurologic history was elicited and review of systems was performed in the customary manner. Immediately after the completion of the history-taking process and before any other part of the neurologic examination was conducted, the short test of mental status was performed. Usually, the test was introduced to the patient with a statement such as, “I would now like to examine your memory and related items. Please relax, pay attention to the questions I am asking, and answer

Orientation.

The patient was asked to give his or her (1) full name, (2) address, current location—that is, (3) building, (4) city, and (5) state—and the current date—(6) either the day of the week or the day of the month, (7) the month, and (8) the year. Each correct response was worth 1 point. The maximal score was 8.

Attention.

The second subtest was forward digit span. The patient was told, “I will give you a series of numbers. Please pay close attention to them, wait until I am finished, and then repeat the

STATISTICAL METHODS

Associations between test scores and age, education, and duration of disease were assessed by use of the linear correlation coefficient and the rank correlation coefficient. Only the linear correlation coefficients are reported because the results were consistent with both techniques. All comparisons of means between patient groups were assessed with two-sample t tests, Wilcoxon rank sum tests, and analysis of covariance, after adjustment for age and education. Sensitivity (true positive/[true

RESULTS

The short test of mental status took approximately 5 minutes to administer. No time limits were imposed for performance of any subtest.

Of the 93 nondemented patients, 9 (10%) had 8 years or less of formal education, 38 (41%) had 9 to 12 years, and 46 (49%) had 13 or more years of education. Among the 67 patients with Alzheimer-type dementia, 11 (17%) had 8 years or less of education, 27 (40%) had 9 to 12 years, and 29 (43%) had 13 or more years. Of the other 20 patients with dementia, 2 (10%)

DISCUSSION

A severe language disturbance or inability to speak or understand English would, of course, preclude use of the short test of mental status. Under such circumstances, the language disturbance should be assessed first, and then alternative methods should be used for evaluating cognition, memory, orientation, intellect, and related functions. We did not encounter severe language disturbances in any of the patients, with or without dementia, who formed the basis of this study. The test could be

CONCLUSION

A single brief test such as this short test of mental status should not be used as the sole basis for the diagnosis of dementia. Some patients with dementia may score high on this test, and some patients without dementia may score poorly. We recommend, however, that all patients who have a total score of 29 or less on this test receive special attention for evaluation of dementia. In many instances, the test profile may provide significant insights into the nature of the dementia and thus may

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A Short Test of Mental Status: Description and Preliminary Results

Section snippets

SELECTION OF PATIENTS

PROCEDURES

Orientation.

Attention.

STATISTICAL METHODS

RESULTS

DISCUSSION

CONCLUSION

J Psychiatr Res

Gen Hosp Psychiatry

The Mental Status Examination in Neurology

Diagnostic & Statistical Manual of Mental Disorders

Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease

Neurology

Limits of the ‘mini-mental state’ as a screening test for dementia and delirium among hospital patients

Psychol Med

The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects

Br J Psychiatry

Population screening and the early detection of dementing disorders in old age: a review

Psychol Med

Mini-mental state examination in neurological patients

J Neurol Neurosurg Psychiatry