Page 321 - Encyclopedia of Nursing Research

288 n MENTAL STATUS MEASUREMENT

the Medical Expenditure Panel Survey data by the mere fact of aging they are at risk
(Petterson, Williams, Hauenstein, Rovnyak, for developing Alzheimer’s disease, could
M & Merwin, 2009). have undetected mild cognitive impair-
An emerging and significant area of ment (MCI), or cognitive deficits secondary
MHSR that nurse researchers have begun to to other disease processes. The Mini-Mental
address is the integrated mental and phys- State Examination (MMSE; Folstein, Folstein,
ical health care for persons with severe co- & McHugh, 1975) is a brief clinical assess-
occurring mental and physical disorders. ment appropriate for use in a variety of set-
Traditionally, research in this area has been tings for cognitive screening of older adults.
conducted by other types of health care Up to 75% of cases of dementia or probable
researchers such as psychiatrists, psycholo- dementia are not identified by primary care
gists, social workers and physicians, and often physicians, most likely because of the brief
not in community health care settings. There time available for an office visit (Holsinger,
are some nursing research programs within Deveau, Boustani, & Williams, 2010). A 5- to
academic centers, such as the University 10-minute baseline assessment of cognitive
of Illinois–Chicago Nursing Integrated status using the MMSE would allow for early
Health Care (IHC) Center that researches diagnosis of neurodegenerative disorders
best practices for systems of integrated care such as Alzheimer’s disease, identification of
(McDevitt, Braun, Noyes, Snyder, & Marion, cognitive impairment secondary to a stroke
2005; University of Illinois–Chicago College or diseases such as Parkinson disease, or
of Nursing, 2010). Internationally, some nurse detection of cognitive impairment caused by
researcher teams have partnered with com- medication side effects.
munity health centers to study the impact of The MMSE was constructed more than
integrated care (Smith & Ross, 2007). These 35 years ago to conduct serial cognitive test-
nursing community collaborative initiatives ing of patients on a neurogeriatric ward. The
show promise for improving health care ser- MMSE has been translated into more than
vices for people with severe co-occurring 50 languages (Dean, Feldman, & Morton,
mental and physical disorders and are a pri- 2009), is the most widely used cognitive
ority for continued nursing research. assessment scale (Holsinger et al., 2010),
and was cited by 7000 articles in the OVID
Celia E. Wills Medline database from 1986 to August 2010.
Anna L.D. Villena The MMSE was developed to be a brief and
easy to administer clinical evaluation tool.
Scores range from all correct (30) to no cor-
rect (0) responses. Scores of 26–29 indicate
Mental status questionable dementia, 21–25 mild demen-
MeasureMent: Mini-Mental tia, 11–20 moderate, and 0–10 severe demen-
tia (Perneczky et al., 2006).
state exaMination Six categories of cognitive tasks com-
prise the MMSE: (1) orientation determined
by responses to five questions each about
Recognizing cognitive impairment is impor- time and place (10 points); (2) registration
tant for establishing patients’ capacity to assessed by ability to learn the names of
make (or not) independent health care deci- three unrelated objects (3 points); (3) atten-
sions to be active participants in their care tion and calculation tested by either per-
and for providing individualized qual- forming serial sevens or spelling the word
ity care. It is especially important to know “world” backwards (5 points); (4) recall
the cognitive status of older adults because evaluated by naming the three objects