🧠 Mini-Mental State Examination (MMSE)

A brief 30-point cognitive screening tool covering orientation, registration, attention/calculation, recall, language and visuospatial copying. It supports assessment but does not diagnose dementia or delirium.

• RACGP guidance favours opportunistic case-finding rather than population screening; tools named include SMMSE, GPCOG, RUDAS (for culturally and linguistically diverse patients) and KICA (for Aboriginal and Torres Strait Islander people). A positive screen needs clinical assessment, not a diagnosis (1)(2).

Explain purpose and gain consent. Optimise hearing, vision, pain, language and environment. Record education, language, cultural background and factors affecting performance. Use an authorised local version and standard wording/scoring.

• Merck: brief standardised questionnaires can screen orientation, memory and depression/anxiety symptoms as part of the mental state examination (3). MMSE is a copyrighted instrument – licensed forms only.

Acute/fluctuating inattention suggests delirium and requires medical assessment. A normal score does not exclude executive dysfunction or early cognitive disease; a low score may reflect language, education, sensory impairment, depression or acute illness.

• A cut-off of <24 is commonly used but is unreliable across education, language, mood, sensory and health status – low education gives false positives, high education can mask decline (2)(4).

Document domain errors and function rather than relying on the total alone. Compare with prior scores only when testing conditions are similar. MoCA may be more sensitive to mild impairment but also requires standardised administration.

• MoCA is generally more sensitive for mild cognitive impairment, though education correction can reduce sensitivity; GPCOG is brief and includes an informant component; RUDAS minimises language/cultural effects (5)(2).

Obtain collateral history and assess activities of daily living, mood, medications and neurological/medical contributors. Cognitive screening should lead to an appropriate diagnostic work-up, safety review and follow-up.

• See Dementia, Delirium and Mental State Examination pages.