The Mini-Mental State Examination as a diagnostic and screening test for delirium: systematic review and meta-analysis

Gen Hosp Psychiatry. Nov-Dec 2014;36(6):627-33. doi: 10.1016/j.genhosppsych.2014.09.003. Epub 2014 Sep 9.


Objective: To analyse the evidence concerning the accuracy of the Mini-Mental State Examination (MMSE) as a diagnostic and screening test for the presence of delirium in adults.

Method: Two authors searched MEDLINE, PsychINFO and EMBASE from inception till March 2014. Articles were included that investigated the diagnostic validity of the MMSE to detect delirium against standardised criteria. A diagnostic validity meta-analysis was conducted.

Results: Thirteen studies were included representing 2017 patients in medical settings of whom 29.4% had delirium. The meta-analysis revealed the MMSE had an overall sensitivity and specificity estimate of 84.1% and 73.0%, but this was 81.1% and 82.8% in a subgroup analysis involving robust high quality studies. Sensitivity was unchanged but specificity was 68.4% (95% CI = 50.9-83.5%) in studies using a predefined cutoff of <24 to signify a case. In high-risk samples where delirium was present in 25% of patients, then the Positive predictive value and Negative predictive value would be 50.9% (48.3-66.2%) and 93.2% (90.0-96.5%).

Conclusion: The MMSE cannot be recommended as a case-finding confirmatory test of delirium, but may be used as an initial screen to rule out high scorers who are unlikely to have delirium with approximately 93% accuracy.

Keywords: Confusion; Delirium; Mini-mental state; Older adults; Screening.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Delirium / diagnosis*
  • Humans
  • Mass Screening
  • Mental Status Schedule*
  • Neuropsychological Tests
  • Reproducibility of Results
  • Sensitivity and Specificity