Normative Data on the MMSE

Tufts University School of Medicine/Tufts-New England Medical Center

Department of Psychiatry

The Mini Mental State Examination

The Mini Mental State Examination (MMSE) is a widely used method for assessing cognitive mental status. The evaluation of cognitive functioning is important in clinical settings because of the recognized high prevalence of cognitive impairment in medical patients. As a clinical instrument, the MMSE has been used to detect impairment, follow the course of an illness, and monitor response to treatment. The MMSE has also been used as a research tool to screen for cognitive disorders in epidemiological studies and follow cognitive changes in clinical trials.

While the MMSE has limited specificity with respect to individual clinical syndromes, it represents a brief, standardized method by which to grade cognitive mental status. It assesses orientation, attention, immediate and short-term recall, language, and the ability to follow simple verbal and written commands. Furthermore, it provides a total score that places the individual on a scale of cognitive function.

The normative data for different ages and educational levels are presented below, as is a list of references on the use of the MMSE. Further information on the MMSE may be obtained at www.minimental.com.

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Normative Data on the MMSE
Cognitive performance as measured by the MMSE varies within the population by age and educational level. There is an inverse relationship between MMSE scores and age, ranging from a median of 29 for those 18 to 24 years of age, to 25 for individuals 80 years of age and older. The median MMSE score is 29 for individuals with at least 9 years of schooling, 26 for those with 5 to 8 years of schooling, and 22 for those with 0 to 4 years of schooling.

The results in the following table (from Crum et al., 1993) can be used to compare your patient's MMSE score with those determined from a population reference group based on age and educational level.

	Age
Education	18-24	25-29	30-34	35-39	40-44	45-49	50-54	55-59	60-64	65-69	70-74	75-79	80-84	>84
4th grade	22	25	25	23	23	23	23	22	23	22	22	21	20	19
8th grade	27	27	26	26	27	26	27	26	26	26	25	25	25	23
High School	29	29	29	28	28	28	28	28	28	28	27	27	25	26
College	29	29	29	29	29	29	29	29	29	29	28	28	27	27

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Selected References on the MMSE

1. Folstein MF, Folstein, SE and McHugh PR (1975) Mini-Mental State: A practical method for grading the state of patients for the clinician, Journal of Psychiatric Research, 12: 189-198.
2. Anthony JC, LeResche L, Niaz U, VonKorff MR and Folstein MF (1982) Limits of the mini-mental state as a screening test for dementia and delirium among hospital patients. Psychological Medicine, 12: 397-408.
3. Cockrell JR and Folstein MF (1988) Mini Mental State Examination (MMSE), Psychopharmacology, 24: 689-692.
4. Crum RM, Anthony JC, Bassett SS and Folstein MF (1993) Population-based norms for the mini-mental state examination by age and educational level, JAMA, 18: 2386-2391.