Mini-Mental State Examination (MMSE)

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the MMSE.

Floor/Ceiling Effects

Folstein, Folstein, and McHugh (1998) reported that the MMSE demonstrates marked ceiling effects in younger intact individuals and marked floor effects in individuals with moderate to severe impairment.

Reliability

Internal consistency:
Tombaugh and McIntyre (1992) reviewed studies published on the psychometric properties of the MMSE over the last 26 years. The internal consistency of the MMSE was reported to range from poor  to excellent (alpha = 0.54 to 0.96).

McDowell, Kristjansson, Hill, and Hebert (1997) examined the internal consistency of the MMSE used as a screening test for cognitive impairment and dementia. The internal consistency was adequate (alpha = 0.78).

Holzer, Tischler, Leaf, and Myers (1984) examined the prevalence of dementia in a community sample (n = 4,917). In this study, the internal consistency of the MMSE was found to be adequate (alpha = 0.77). Reliability of individual items ranged from poor (alpha = 0.43 for Orientation) to excellent (alpha = 0.82 for Registration). Calculation/attention items were omitted from this study.

Kay, Henderson, Scott, Wilson, Rickwood, and Grayson (1985) conducted a community survey in 274 individuals over 70 years of age. Rates of dementia were measured by interviewing participants with the MMSE. In this study, the internal consistency of the MMSE was poor (alpha = 0.68).

Foreman (1987) examined the reliability of the MMSE in 66 hospitalized medical-surgical patients (normal, dementia, or delirium) over 65 years of age. The MMSE was found to have an excellent internal consistency (alpha = 0.96).

Jorm, Scott, Henderson, and Kay (1988) examined whether there was a bias in the MMSE such that individuals with less education (less than or equal to 8th grade) would perform worse on the measure than individuals with more education (more than 8th grade). The MMSE was administered 269 elderly participants. The internal consistency was found to be poor in both the more educated group (alpha = 0.54) and the less educated group (alpha = 0.65).

Albert and Cohen (1992) administered the MMSE to 40 elderly residents with severe cognitive impairment. The internal consistency of the MMSE was poor in patients with an MMSE score ≤ 10 (alpha = 0.56). However, when subjects representing the full range of MMSE scores were included, the internal consistency was excellent (alpha = 0.90).

Tombaugh, McDowell, Kristjansson, and Hubley (1996) compared the psychometric properties of the MMSE to the 3MS in community-dwelling participants between the ages of 65-89. Participants were divided into two groups, one with no cognitive impairment (n = 406) and one with Alzheimer’s disease (n = 119). The internal consistency of the MMSE was poor in the group without cognitive impairment (alpha = 0.62) and was found to be excellent in patients with Alzheimer’s disease (alpha = 0.81).

Hopp, Dixon, Grut, and Backman (1997) administered the MMSE to 44 adults without dementia, who were over the age of 75 years. In this sample, the internal consistency of the MMSE was poor (alpha ranged from 0.31 to 0.52).

Test-retest:
Tombaugh and McIntyre (1992) reviewed studies published on the psychometric properties of the MMSE over the last 26 years. They reported that in studies having a re-test interval of < 2 months, the MMSE has poor to excellent test-retest reliability with correlations ranging from 0.38 to 0.99. Twenty-four out of 30 studies reported excellent test-retest reliability (r > 0.75).

Folstein et al. (1975) administered the MMSE to 206 patients with dementia syndromes, affective disorder, affective disorder with cognitive impairment, mania, schizophrenia, personality disorders, and to 63 healthy controls. The test-retest reliability of the MMSE when administered twice within 24 hours was excellent, with a Pearson correlation coefficient of r = 0.89. When the MMSE was given to patients with depression and dementia twice, 28 days apart, the correlation was excellent, with a Pearson correlation of r = 0.99.
Note: Pearson correlation coefficients are likely to over-estimate reliability and the Pearson is no longer used for test-retest reliability.

Schmand, Lindeboom, Launer, Dinkgreve, Hooijer, and Jonker (1995) examined the test-retest reliability of the MMSE in healthy older subjects who were examined twice with an interval of 1 year between evaluations. Test-retest reliability was adequate (Spearman’s correlation = 0.58). The results of this study are similar to those found in O’Connor et al. (1989). These results suggest that the MMSE is not an appropriate measure for detecting subtle cognitive impairment.

Hopp et al. (1997) administered the MMSE to 44 adults without dementia, who were over the age of 75 years. The test-retest reliability for 6- 12- and 18-month intervals, using Pearson’s correlations, ranged from adequate to excellent (r = 0.56 to r = 0.80).

Olin and Zelinski (1991) examined the 12-month reliability of the MMSE in 57 elderly participants without dementia. Poor 12-month test-retest correlations were found for the total MMSE score (r = 0.34 when administering the alternate Attention item, r =0.23 when administering the same Attention item).

Uhlmann, Larson, and Buchner (1987) also examined the 12-month test-retest reliability of the MMSE in outpatients with dementia. In this study, the test-retest reliability was found to be excellent (r = 0.86).

Mitrushina and Satz (1991) examined the test-retest reliability of the MMSE in 122 healthy community-residing elderly volunteers between the ages of 57-85. The test-retest reliability of the MMSE was adequate (ranging from r = 0.45 to r = 0.50) over a 1-year interval, and poor over a 2-year period (r = 0.38).

Intra-rater reliability / Inter-rater reliability:
Molloy and Standish (1997) examined the intra-rater reliability of the MMSE in comparison to the SMMSE in 48 older adults. University students, who were trained to administer either the MMSE or the SMMSE, tested participants on three different occasions to assess their inter-rater and intra-rater reliability. An adequate ICC of 0.69 was reported for the traditional MMSE.

Inter-rater reliability:
Dick et al. (1984) examined the inter-rater reliability of the MMSE in patients with neurological disorders and reported a kappa of 0.63, demonstrating the adequate inter-rater reliability of the MMSE.

Fabrigoule, Lechevallier, Crasborn, Dartigues, and Orgogozo (2003) examined the reliability of the MMSE in patients who were likely to develop dementia. Fifty trained general practitioners and psychologists examined patients. There was a significant difference in scores between the general practitioners and the psychologists for the MMSE. The concordance correlation coefficient was 0.87 between evaluations performed by general practitioners and those performed by psychologists.

In a study by O’Connor et al. (1989), 5 coders rated taped interviews with 54 general practice patients aged 75 and over. In this study, the inter-rater reliability was excellent, with a mean kappa value of 0.97.

Validity

Construct:
Although the MMSE is generally considered unidimensional, Jones and Gallo (2000) identified five factors (concentration, language and praxis, orientation, memory, and attention) to support the construct validity of the MMSE as a measure of cognitive mental state among community dwelling older adults.

Concurrent: 
Friedl, Schmidt, Stronegger, Fazekas, and Reinhart (1996) examined the concurrent validity of the MMSE and the Mattis Dementia Rating Scale (MDRS) (Mattis, 1976), two measures commonly used to screen for dementia. Concurrent validity between the MMSE and the MDRS was found to be poor (Pearson’s r = 0.29), as were correlations between the MMSE and MDRS subtests (attention r = 0.18; initiation and perseveration r = 0.04; construction r = 0.10; conceptualization r = 0.17; verbal and non-verbal short-term memory r = 0.27).

Folstein et al. (1975) administered the MMSE to 206 patients with dementia syndromes, affective disorder, affective disorder with cognitive impairment, mania, schizophrenia, personality disorders, and to 63 healthy controls. The concurrent validity of the MMSE was examined by correlating the measure with the Wechsler Adult Intelligence Scale (WAIS – Wechsler, 1955). The concurrent validity between the MMSE and the WAIS verbal IQ (r = 0.78) and the WAIS performance IQ (r = 0.66) were both excellent.

Hopp, Dixon, Grut, and Backman (1997) administered the MMSE and the Wechsler Adult Intelligence Scale-Revised (WAIS-R, Wechsler, 1981) to 44 adults without dementia, who were over the age of 75 years. Correlations between the MMSE and the WAIS-R Verbal IQ were adequate, ranging from r = 0.36 to r = 0.52. Correlations between the MMSE and WAIS-R Performance IQ were also adequate, ranging from r = 0.37 to r = 0.57. Correlations between the MMSE and the WAIS-R subtests ranged from poor to excellent (r = 0.20 to r = 0.60). Correlations between the MMSE subscales and the WAIS-R were generally lower than r = 0.41. The Language subscale of the MMSE showed the lowest correlations with both WAIS-R Verbal and WAIS-R Performance. Correlations between MMSE subscales and WAIS-R subtests showed that the MMSE subscale, Orientation, had the lowest correlations with all WAIS-R subtests (r = 0.001 to r = 0.40).

Similar to the results by Hopp et al. (1997), Dick et al. (1984) examined the utility of the MMSE for bedside screening, and serial assessment of cognitive function in 126 neurological patients and found adequate correlations between the MMSE and the Weschler Adult Intelligence Scale (WAIS) (r = 0.55 for WAIS-Verbal; r = 0.56 for WAIS-Performance).

Agrell and Dehlin (2000) reported significant correlations between MMSE scores and the Barthel Index (Mahoney & Barthel, 1965), the Montgomery Asberg Depression Rating Scale (MADRS – Montgomery & Asberg, 1979) and the Zung Depression Scale (Zung, 1965).

Diamond, Felsenthal, Macciocci, Butler, and Lally-Cassady (1996) examined the relationship between cognition and ability to benefit from inpatient rehabilitation in 52 patients admitted to geriatric rehabilitation. Functional gain was assessed using the change in Functional Independence Measure (FIM – Keith, Granger, Hamilton, & Sherwin, 1987) score from admission to discharge. The MMSE was not found to be associated with change in FIM score (r = 0.10). However, the MMSE alone and in combination with age correlated adequately with functional status on admission (r = 0.58) and discharge (r = 0.49).

Convergent:
Snowden at al. (1999) examined 140 patients who were part of the Alzheimer’s Disease Patient Registry to evaluate the psychometric properties of a new measure, the Minimum Data Set (MDS). The cognitive performance scores from the MDS were correlated with the MMSE. The MMSE correlated adequately with the MDS (Spearman’s r = -0.45) (this correlation is negative because a low score on the MMSE indicates cognitive impairment, whereas a high score on the MDS indicates impairment). Consistent with previous studies, the MMSE had excellent correlations with the Weschler Adult Intelligence Scale (WAIS) Verbal and Performance IQ scores (r = 0.78 and r = 0.66, respectively).

Discriminant:
Winograd et al. (1994) developed the Physical Performance and Mobility Examination, a measure used to assess 6 domains of physical functioning and mobility for hospitalized elderly. The construct validity of this measure was examined by comparing it to the MMSE, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) (Lawton & Brody, 1969), Geriatric Depression Scale (Yesavage et al., 1983), and modified Medical Outcomes Study Measure of Physical Functioning (MOS-PFR). The MMSE correlated poorly with the Physical Performance and Mobility Examination (r = 0.36), suggesting that these two measures assess different constructs.

Macnight and Rockwood (1995) examined discriminant validity of the MMSE by comparing it to a new measure, the Hierarchical Assessment of Balance and Mobility (HABAM) in patients 65 and older. The discriminant validity was demonstrated, as the two measures correlated poorly (r = 0.15).

Known groups:
Wetherell, Darby, Emerson, and Miller (1997) found that the MMSE was able to discriminate between patients with Alzheimer’s Disease and frontotemporal dementia.

Kase, Wolf, Kelly-Hayes, Kannel, Beiser, and D’Agostino (1998) found that baseline pre-stroke MMSE scores were significantly lower for patients with stroke than were the scores for matched controls. This difference became more pronounced when the post-stroke scores were compared. The MMSE could discriminate between patients with left- and right-hemispheric stroke. In patients with right-hemispheric stroke, cognitive impairment was characterized by a significant decline in scores from pre-stroke to post-stroke specifically in the areas of orientation and language. For patients with left hemisphere strokes, a significant decline in scores from pre-stroke to post-stroke were found in all five domains of the MMSE except memory.

Predictive:
Ozdemir et al. (2001) examined the predictive validity of the MMSE in 43 patients with stroke. Baseline total MMSE scores were correlated with discharge Motor Functional Independence Measure (Keith et al., 1987) improvement (r = 0.31). The baseline Orientation subscore of the MMSE correlated significantly with functional ambulation score improvement as measured by the Adapted Patient Evaluation and Conference System functional scale (r = 0.31). These results suggest that baseline total MMSE scores are somewhat predictive of functional improvement in patients with stroke after rehabilitation.

Diamond et al. (1996) examined the relationship between cognition and the ability to benefit from inpatient rehabilitation in 52 patients admitted to geriatric rehabilitation. The MMSE was found to be highly predictive of discharge destination such that low MMSE scores were associated with a greater likelihood of nursing home placement (r = 0.68). While only 8% of the uppermost MMSE quartile was discharged to nursing home placement, 62% of the lowest MMSE quartile was discharged to nursing homes.

Aguero-Torres, Fratiglioni, Guo, Viitanen, von Strauss, and Winblad (1998) examined predictors of dependence in activities of daily living (as measured by the Katz index of Activities of Daily Living (Katz, Downs, Cash, Grotz, 1970)) in the elderly. In patients without dementia, the MMSE was found to be one of the strongest predictors for developing functional dependence at a 3-year follow-up interval. Lower MMSE scores were associated with functional dependence in both adults with dementia (OR = 0.8) and in adults without dementia (OR = 0.8). Initial MMSE performance also predicted future functional dependence and decline among adults without dementia (OR = 0.7). Thus, independent of the presence of other chronic conditions, the MMSE may indicate subsequent functional status in a cognitively intact elderly population.

Matsueda and Ishii (2000) retrospectively examined the relationship between MMSE score and ambulatory level (divided into three groups: dependent, partially dependent, and independent) in 162 elderly patients who experienced a hip fracture. A significant relationship was found between initial MMSE score and ambulatory level such that those in the dependent group had the lowest mean MMSE score of only 6.6, those in the partially dependent group had a mean score of 17.9, and those in the independent group had the highest MMSE score of 24.6.

Huusko, Karppi, Avikainen, Kautiainen, and Sulkava (2000) examined the effect of intensive geriatric rehabilitation (intervention group) versus local hospital treatment (control group) on patients with dementia and a hip fracture. MMSE scores were predictive of length of hospital stay such that for patients with moderate dementia (MMSE score of 12-17), the median length of stay was 47 days in the intervention group and 147 days in control group. Patients with mild dementia (MMSE score of 18-23) had a length of stay of 29 days in intervention group and 46.5 days in the control group. No significant differences in mortality or in the length of hospital stay were observed for patients with severe dementia. In the intervention group, 3 months after surgery 91% of the patients with mild dementia and 63% of the patients with moderate dementia were living independently. In the control group, the corresponding figures were 67% and 17%, respectively. The results of this study suggest that the MMSE is associated with the length of hospital and rehabilitation stay, and that length of stay can be impacted on by intervention for those with cognitive impairment.

Pettigrew, Thomas, Howard, Veltkamp, and Toole (2000) examined whether low MMSE scores predict transient ischemic attack, stroke, myocardial infarction, or death. Patients were randomized to receive a carotid endarterectomy or best medical therapy in as a means to preserve cognition. A significant relationship was found between a low post-randomization MMSE score and an increased risk of death. Furthermore, patients who experienced stroke after randomization had a significant and persistent reduction in MMSE score.

Sensitivity and Specificity

Low reported levels of sensitivity, particularly among individuals with mild cognitive impairment, have been reported for the MMSE (Tombaugh & McIntyre, 1992; de Koning et al. 1998) and may be due to the emphasis placed on language items and a lack of items assessing visual-spatial ability (Grace et al. 1995; de Koning et al. 1998; Suhr & Grace, 1999).

Blake et al. (2002) examined the sensitivity and specificity of the MMSE for detecting cognitive impairment after stroke. When the MMSE was compared with cognitive impairment identified an optimum cutoff of <24, with good specificity (88%) and moderate sensitivity (62%). However, it was not possible to identify suitable cutoff scores to use the MMSE to assess for the presence of either visual or verbal memory deficits.

Nys, van Zandvoort, de Kort, Jansen, Kappelle, and de Haan (2005) administered the MMSE to 34 patients with stroke and 34 healthy controls. In this study, no optimum cut-off scores yielding both sensitivity greater than 80%, and specificity greater than 60%, could be identified.

References
  • Agrell, B., Dehlin, O. (2000). Mini mental state examination in geriatric stroke patients. Validity, differences between subgroups of patients, and relationships to somatic and mental variables. Aging (Milano), 12(6), 439-444.
  • Aguero-Torres, H., Fratiglioni, L., Guo, Z., Viitanen, M., von Strauss, E., Winblad, B. (1998). Dementia is the major cause of functional dependence in the elderly: 3-year follow-up data from population-based
  • study. American Journal of Public Health, 88,1452-1456.
  • Albert, M., Cohen, C. (1992). The test for severe impairment: An instrument for the assessment of patients with severe cognitive dysfunction. J Am Geriatr Soc, 40(5), 449-453.
  • Blake, H., McKinney, M., Treece, K., Lee, E., Lincoln, N. B. (2002). An evaluation of screening measures for cognitive impairment after stroke. Age and Ageing, 31, 451-456.
  • Bleecker, M. L., Bolla-Wilson, K., Kawas, C., Agnew, J. (1988). Age-specific norms for the Mini-Mental State Exam. Neurology, 10, 1565-1568.
  • Crum, R. M., Anthony, J. C., Bassett, S. S., Folstein, M. F. (1993). Population-based norms for the mini-mental state examination by age and educational level. JAMA, 18, 2386-2391.
  • Da Costa, F.A., Bezerra, I.F.D., de Araujo Silva, D.L., de Oliveira, R. & da Rocha, V.M. (2010). Cognitive evolution by MMSE in poststroke patients. International Journal of Rehabilitation Research, 33, 248-253.
  • de Koning, I., van Kooten, F., Dippel, D. W. J., van Harskamp, F., Grobbee, D. E., Kluft, C., Koudstaal, P. J. (1998). The CAMCOG: A useful screening instrument for dementia in stroke patients. Stroke, 29, 2080-2086.
  • Diamond, P. T., Felsenthal, G., Macciocci, S. N., Butler, D. H., Lally-Cassady, D. (1996). Effect of cognitive impairment on rehabilitation outcome. American Journal of Physical Medicine & Rehabilitation, 75(1), 40-43.
  • Dick, J. P., Guiloff, R. J., Stewart, A., Blackstock, J., Bielawska, C., Paul, E. A., Marsden, C. D. (1984). Mini-mental state examination in neurological patients. Journal of Neurology, Neurosurgery, and Psychiatry, 47, 496-499.
  • Fabrigoule, C., Lechevallier, N., Crasborn, L., Dartigues, J. F., Orgogozo, J. M. (2003). Inter-rater reliability of scales used to measure mild cognitive impairment by general practitioners and psychologists. Current Medial Research and Opinion, 19(7), 603-608.
  • Folstein, M. F., Folstein, S. E., McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 12(3), 189-198.
  • Folstein, M. F., Folstein, S. E., McHugh, P. R. (1998). Key papers in geriatric psychiatry. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Int J Geriat Psychiatry, 13(5), 285-294.
  • Folstein, M. F., Folstein, S. E., McHugh, P. R., Fanjiang, G. (2001). Mini-Mental State Examination User’s Guide. Odessa, FL: Psychological Assessment Resources.
  • Folstein, M. F., Robins, L. N., Helzer, J. E. (1983). The Mini-Mental State Examination. Arch Gen Psychiatry, 40(7), 812.
  • Foreman, M. D. (1987). Reliability and validity of mental status questionnaires in elderly hospitalized patients. Nurs Res, 36(4), 216-220.
  • Friedl, W., Schmidt, R., Stronegger, W. J., Fazekas, F., Reinhart, B. (1996). Sociodemographic predictors and concurrent validity of the Mini Mental State Examination and the Mattis Dementia Rating Scale. European Archives of Psychiatry and Clinical Neuroscience, 246(6), 317-319.
  • Grace, J., Nadler, J. D., White, D. A., Guilmette, T. J., Giuliano, A. J., Monsch, A. U., Snow, M. G. (1995). Folstein vs modified Mini-Mental State Examination in geriatric stroke. Stability, validity, and screening utility. Archives of Neurology, 52(5), 477-484.
  • Holzer, C. E., Tischler, G. L., Leaf, P. J., Myers, J. K. (1984). An epidemiologic assessment of cognitive impairment in a community. Research in Community Mental Health, 4, 3-32.
  • Hopp, G. A., Dixon, R. A., Grut, M., Backman, L. (1997). Longitudinal and psychometric profiles of two cognitive status tests in very old adults. J Clin Psychol, 53(7), 673-686.
  • Huusko, T. M., Karppi, P., Avikainen, V., Kautiainen, H., Sulkava, R. (2000). Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: Subgroup analysis of patients with dementia. British Medical Journal, 321,1107-1111.
  • Jones, R. N., Gallo, J. J. (2000). Dimensions of the Mini-Mental State Examination among community dwelling older adults. Psychological Medicine, 30, 605-618.
  • Jorm, A. F., Scott, R., Henderson, A. S., Kay, K. W. (1988). Educational level differences on the Mini-Mental State: The role of test bias. Psychol Med, 18(3), 727-731.
  • Kase, C. S., Wolf, P. A., Kelly-Hayes, M., Kannel, W. B., Beiser, A., D’Agostino, R. B. (1998). Intellectual decline after stroke: The Framingham study. Stroke, 29, 805-812.
  • Katz, S., Downs, T. D., Cash, H. R., Grotz, R. C. (1970). Index of Activities of Daily Living. The Gerontologist, 1, 20-30.
  • Kay, K. W., Henderson, A. S., Scott, R., Wilson, J., Rickwood, D., Grayson, D. A. (1985). Dementia and depression among the elderly living in the Hobart community: The effect of the diagnostic criteria on the prevalence rates. Psychol Med, 15(4), 771-788.
  • Keith, R. A., Granger, C. V., Hamilton, B. B., Sherwin, F. S. (1987). The functional independence measure: A new tool for rehabilitation. Adv Clin Rehabil, 1, 6-18.
  • Lawton, M. P., Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179-186.
  • Lorentz, W. J., Scanlan, J. M., Borson, S. (2002). Brief screening test for dementia. Can J Psychiatry, 47, 723-733.
  • Macnight, C., Rockwood, K. (1995). A hierarchical assessment of balance and mobility. Age and Ageing, 24(2), 126-130.
  • Mahoney, F. I., Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Md State Med J, 14, 61-5.
  • Matsueda, M., Ishii, Y. (2000). The relationship between dementia score and ambulatory level after hip fracture in the elderly. American Journal of Orthopedics, 29,691-693.
  • Mattis, S. (1976). Mental status examination for organic mental syndrome in the elderly patient. In: Bellak L, Karasu TB, editors. Geriatric Psychiatry. New York: Grune and Stratton, 77-101.
  • McDowell, I., Kristjansson, B., Hill, G. B., Hebert, R. (1997). Community screening for dementia: The Mini Mental State Exam (MMSE) and modified Mini-Mental State Exam (3MS) compared. Journal of Clinical Epidemiology, 50(4), 377-383.
  • Mitrushina, M., Satz, P. (1991). Reliability and validity of the Mini-Mental State Exam in neurologically intact elderly. J Clin Psychol, 47(4), 537-543.
  • Molloy, D. W., Standish, T. I. M. (1997). A guide to the Standardized Mini-Mental State Examination. International Psychogeriatrics, 9(1), 87-94.
  • Montgomery, S. A., Asberg, M. (1979). A new depression scale designed to be sensitive to change. Brit J Psychiat, 134, 382-389.
  • Newkirk, L. A., Kim, J. M., Thompson, J. M., Tinklenberg, J. R., Yesavage, J. A., Taylor, J. L. (2004). Validation of a 26-point telephone version of the Mini-Mental State Examination. Journal of Geriatric Psychiatry and Neurology, 17(2), 81-87.
  • Nys, G. M., van Zandvoort, M. J., de Kort, P. L., Jansen, B. P., Kappelle, L. J., de Haan, E. H. (2005). Restrictions of the Mini-Mental State Examination in acute stroke. Arch Clin Neuropsychol, 20(5), 623-629.
  • O’Connor, D. W., Pollitt, P. A., Hyde, J. B., Fellows, J. L., Miller, N. D., Brooke, C. P., Reiss, B. B. (1989). The reliability and validity of the Mini-Mental State in a British community survey. J Psychiatr Res, 23(1), 87-96.
  • Olin, J.T., Zelinski, E.M. (1991). The 12-month reliability of the Mini-Mental State Examination. Psychological Assessment, 3, 427-432.
  • Ozdemir, F., Birtane, M., Tabatabaei, R., Ekuklu, G., Kokino, S. (2001). Cognitive evaluation and functional outcome after stroke. American Journal of Physical Medicine & Rehabilitation. 80(6), 410-415.
  • Pettigrew, L. C., Thomas, N., Howard, V. J., Veltkamp, R., Toole, J. F. (2000). Low mini-mental status predicts mortality in asymptomatic carotid arterial stenosis. Neurology, 55,30-34.
  • Roccaforte, W. H., Burke, W. J., Bayer, B. L., Wengel, S. P. (1992). Validation of a telephone version of the mini-mental state examination. J Am Geriatr Soc, 40(7), 697-702.
  • Ruchinskas, R. A., Curyto, K. J. (2003). Cognitive screening in geriatric rehabilitation. Rehab Psychol, 48, 14-22.
  • Schmand, B., Lindeboom, J., Launer, L., Dinkgreve, M., Hooijer, C., Jonker, C. (1995). What is a significant score change on the Mini-Mental State Examination? International Journal of Geriatric Psychiatry, 10, 411-414.
  • Schwamm, L. H., Van Dyke, C., Kiernan, R. J., Merrin, E. L., Mueller, J. (1987). The Neurobehavioral Cognitive Status Examination: Comparison with the Cognitive Capacity Screening Examination and the Mini-Mental State Examination in a neurosurgical population. Ann Intern Med, 107(4), 486-491.
  • Shadlen, M. F., Larson, E. B., Gibbons, L., McCormick, W. C., Teri, L. (1999). Alzheimer’s disease symptom severity in Blacks and Whites. Journal of the American Geriatrics Society, 47,482-486.
  • Snowden, M., McCormick, W., Russo, J., Srebnik, D., Comtois, K., Bowen, J., Teri, L., Larson, E. B. (1999). Validity and responsiveness of the Minimum Data Set. Journal of the American Geriatrics Society, 47(8), 1000-1004.
  • Suhr, J. A., Grace, J. (1999). Brief cognitive screening of right hemisphere stroke: Relation to functional outcome. Arch Phys Med Rehabil, 80(7), 773-776.
  • Teng, E. L., Chui, H. C. (1987). The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry, 48(8), 314-318.
  • Tombaugh, T. N., McIntyre, N. J. (1992). The mini-mental state examination: A comprehensive review. J Am Geriatr Soc, 40(9), 922-935.
  • Tombaugh, T. N., McDowell, I., Kristjansson, B., Hubley, A. M. (1996). Mini-Mental State Examination (MMSE) and the modified MMSE (3MS): A psychometric comparison and normative data. Psychol Assess, 8(1), 48-59.
  • Uhlmann, R. F., Larson, E. B., Buchner, D. M. (1987). Correlations of Mini-Mental State and modified Dementia Rating Scale to measures of transitional health status in dementia. J Gerontol, 42(1), 33-36.
  • Wechsler, D. (1981). Wechsler Adult Intelligence Scale-Revised: Test. New York: Harcourt Brace
  • Wechsler, D. (1955). Manual for the Wechsler Adult Intelligence Scale. New York: The Psychological Corporation.
  • Wetherell, M., Darby, A., Emerson, K., & Miller, B. L. (1997). Mini- Mental State Examination performance in Alzheimer’s disease and frontotemporal dementia. International Journal of Rehabilitation and Health, 3,253-265.
  • Wind, A. W., Schellevis, F. G., van Staveren, G., Scholten, R. J. P. M., Jonker, C., van Eijk, J. M. (1997). Limitations of the mini-mental state examination in diagnosing dementia in general practice. International Journal of Geriatric Psychiatry, 12(1), 101-108.
  • Winograd, C. H., Lemsky, C. M., Nevitt, M. C., Nordstrom, T. M., Stewart, A. L., Miller, C. J., Bloch, D. A. (1994). Development of a physical performance and mobility examination. J Am Geriatr Soc, 42(7), 743-749.
  • Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M. B., Leirer, V. O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37-49.
  • Zung, W. W. K. (1965). A self-rating depression scale. Arch Gen Psychiatry, 12, 63-70.