Should the mini-mental state examination be retired?

Neurologia. 2014 Oct;29(8):473-81. doi: 10.1016/j.nrl.2013.07.003. Epub 2013 Oct 17.
[Article in English, Spanish]


Introduction: Short cognitive tests are routinely used in clinical practice to detect and screen for cognitive impairment and dementia. These cognitive tests should meet minimum criteria for both applicability and psychometric qualities.

Development: The Mini-Mental State Examination (MMSE) is the most frequently applied short cognitive test, and the article introducing it remains a milestone in the history of medicine. Its main advantages are its widespread use and the extensive empirical evidence that supports it. However, the MMSE has important shortcomings, including lack of standardisation, its lack of suitability for illiterate subjects, the considerable effect of socio-educational variables on results, and its limited effectiveness for detecting cognitive impairment. Lastly, since the test is copyright-protected, using it is necessarily either costly or fraudulent. Newer available instruments do not share these shortcomings and have demonstrated greater diagnostic accuracy for detecting cognitive impairment and dementia, as well as being more cost-effective than the MMSE CONCLUSION: It is time to acknowledge the MMSE's important role in the history of medicine and grant it a deserved and honourable retirement. Its place will be taken by more effective instruments that require less time, are user-friendly and free of charge, can be applied to all individuals, and yield more equitable outcomes.

Keywords: Abbreviated cognitive evaluation; Cognitive impairment; Demencia; Dementia; Deterioro cognitivo; Evaluación cognitiva abreviada; Mini-Mental; Screening test; Short cognitive test; Test cognitivos breves; Test de cribado.

MeSH terms

  • Cognition Disorders / classification
  • Cognition Disorders / diagnosis
  • Dementia / diagnosis
  • Educational Status
  • Female
  • Humans
  • Male
  • Mass Screening / methods
  • Mass Screening / standards
  • Neuropsychological Tests / standards*
  • Psychometrics
  • Socioeconomic Factors