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From 1975 to Today: How did the MMSE become the gold standard for detecting dementia?
Since the Mini-Mental State Examination (MMSE) was first proposed in 1975, this scale has been widely used around the world to screen for dementia and other cognitive disorders. As a 30-point questionnaire, the MMSE not only assesses cognitive function, but also evolves a more nuanced understanding to help doctors distinguish symptoms and severity among various types of dementia patients.
The main advantage of MMSE is its simplicity and efficiency. It usually only takes 5 to 10 minutes to perform and requires no special equipment or training for both doctors and patients.
This test includes items that assess cognitive functions such as registration (repeating nouns), attention and calculation, recall, language skills, and basic motor skills. Tests conducted through these projects can effectively assess an individual's cognitive status and track its change process.
However, the MMSE is not equivalent to a full-scale mental status examination. It was developed mainly to distinguish organic from functional psychopaths. Although many tests exist, such as the Hawkinson Abbreviated Psychological Test (GMS) or the Columbia Psychological Assessment Scale (Cognitive Assessment Scale), the MMSE stands out for its simplicity of design and broad applicability.
Despite these advantages, the use of the MMSE has limitations, such as sensitivity to age and education, and the inability to sensitively detect mild cognitive impairment.
MMSE test features
The MMSE test contains some relatively simple questions, such as asking about the time and place of the test, performing simple arithmetic calculations (such as consecutive subtraction of 7), language comprehension, and testing basic motor skills. These questions are designed to quickly and effectively assess a person's cognitive functioning. While assessing several key areas, the MMSE also takes into account the patient's specific needs and can even make adjustments for visual or motor impairments.
Grade understanding
According to the MMSE scoring standard, a score of 24 or above indicates normal cognition, while a score below this may indicate different degrees of cognitive impairment: severe (≤9), moderate (10-18) or mild (19-23). However, it should be noted that even the highest score of 30 cannot completely rule out the possibility of dementia. Moreover, the existence of focal issues also calls into question the promotion of PSME.
Very low scores are often associated with dementia, but this does not mean that all low scores are indicative of dementia, as other mental illnesses can also cause abnormal results on the MMSE test.
After continuous practice, previous work has shown that MMSE is best used as a screening tool or auxiliary diagnostic tool for cognitive impairment. This means that while the test scores used indicate cognitive problems, further evaluation is needed to obtain more accurate diagnostic information.
Future challenges
With the gradual application of MMSE, many researchers have begun to explore how to improve this test, especially for patients with poor language comprehension or individuals with low education levels. The impact of education deserves further in-depth exploration by researchers to avoid possible misdiagnosis.
MMSE shows mixed performance in detecting dementia and the differences between its different types. For example, people with Alzheimer's disease tend to score lower on tests of time and place discrimination and recall, which are relatively stable in other types of dementia.
During its use and marketing process, MMSE also faces copyright issues. Initially, the copyright of the test belonged to the founding author, but was later transferred to relevant institutions, which virtually made it more difficult to popularize the test. In many countries, the official version of MMSE is considered to be protected by copyright, so although there are many free versions online, users still need to be cautious when using it.
Conclusion
MMSE has become the "gold standard" for dementia screening since its inception because of its flexible design concept, easy execution, and good reliability. Still, as our understanding of dementia and its effects grows, newer, more flexible tests may be needed in the future to allow for deeper data analysis to improve the ability to identify cognitive impairment. In future development, how to balance the conversion between traditional testing and emerging testing will become a topic worthy of attention?
