mini mental state

[clc26]

heys guys,
im doing my psyc rotation and am confused!
ok so the mental state examination (MSE) is the 'physical examination' of the patient, and the cogntive part consists of orientation, memory and calculation (i think).

however what i dont understand is, the mini mental state (MMS) seems to be a more indepth cognitive part of the MSE, so when would you use MMS over MSE? (i know in elderly people you should always do a MMS).

and if you did the MMS, should you also do the MSE?

anyone help (or even understand what i am asking??)

[M Clayton]

If in doubt, do the full 30 point mini mental state exam as part of your MSE. I'm not doing a psych rotation (thank god!) but whenever I've been asked to assess a patient's cognitive function, I've started with the 10 point screening test and gone on to do the full 30 if there's been any clear deficit identified.

As you say, it's practically compulsory to do the MMS on any elderly psych patient...

[clc26]

oh so you do the normal MSE and if you suspect/identify and cognitive impairment do a more thorough screen i.e. MMS?

[M Clayton]

Yep but remember, I'm currently a lazy surgeon and we don't really do an awful lot of medicine...

[clc26]

thanks mark
p.s. i love reading your blog :-)

[yeliab_cram]

it is sillily confusing. the mental state examination (MSE) includes much more than a simple assesment of cognition. you are also looking at the appearance, bahviour, thoughts, speech, mood, insight (etc etc etc). forming your own opinion of the mental state of your patient.

the 10 point abreviated mental state score (AMTS) and the mini mental state exam (MMSE) are basically simple reproducable, standardised screening tests to assess cognition. They dont tell you anything about the patients mood, any wired hallucinations, or the fact that they are sitting naked on the floor, but they give you a fairly standard idea of their cognitive state. in other words are they confused (for whatever reason) or not.

it is worth noting that the AMTS is used far more commonly on general medical and surgical wards than the MMSE, but is actually fairly non specific and misses a lot.

so, as mark says, your MMSE is used to assess cognition, which is a part of your MSE, but by no means the whole thing. when ur not doing psyc, it is about the only psyc style examination you will do.

any clearer??

[sbailey]

Very useful summary, Mr yeliaB! (And having just finished my Psych rotation a few weeks ago, I can confirm it is all correct. ) Would you mind elaborating on what sort of stuff the AMTS misses? I'd like to know more.

[clc26]

thanks marc for your reply.

ok so i think between you and mark i get it now;

the MSE comprises amongst appearance, mood etc an examination of cognition (10 point?? this thing you call AMTS?)

but the MMSE is more comprehensive (30 point) and it would be used when you pick up any abnormality during the MSE, or in older patients.

but if i wanted to play safe, i could use the MMS as a substitute for the cognitive part of MSE?

[yeliab_cram]

the cognitive part of your MSE can be assessed in any way you like. you can either use AMTS or MMSE or use your own set of questions which are less strict but still give you an idea if the patient knows where he is and what is going on!

in my experience of psyc, most of the doctors used MMSE for the cognitive part of the MSE.

on the wards generally, AMTS is the most commonly used screen for cognitive problems, eg post operative confusion. despite the fact that MMSE is actually better at picking these things up.

SB: if you have a look at the AMTS questions and the MMSE questions you can see the overlaps and omissions across both. at the end of the day, 30 questions give you more info than 10 questions. but there are still things in the AMTS that do not feature in the MMSE. that is why experienced psychiatrists also use additional questions of their own.

psychiatry is a minefield, and not my preferred subject, so i will leave it there.