Page 322 - Encyclopedia of Nursing Research

MENTAL STATUS MEASUREMENT n 289

previously learned (3 points); (5) language was supported by convergent and discrimi-
assessed by six items of naming two nant validity comparing hypothesized sim-
objects, repeating a statement, following a ilarities/differences between scores from M
three-stage verbal command, reading and three groups of normal, demented, and
following a written command, and writing depressed subjects with and without cogni-
a sentence spontaneously (8 points); and tive symptoms.
(6) visual–spatial capacity by copying two The MMSE is the most studied of all cog-
intersecting pentagons (1 point). nitive tests (Holsinger et al., 2010). Additional
To administer the MMSE, a one-page cognitive tests have been developed and com-
sheet with items/instructions and space for pared with the MMSE across conditions, and
writing scores is used. The MMSE is not a those empirical data have supported the sensi-
timed test but usually takes 5 to 10 minutes. tivity and specificity of the MMSE as a cogni-
The tester asks the patient to respond to each tive screening scale. Sensitivity, the percentage
item and records individual scores. Item of people who test positive (number of true
scores are summed to provide the final score positives divided by the number of true posi-
and a calculator is not needed. The MMSE is a tives plus the number of false negatives), has
copyrighted scale, and the Mini-Mental LLC ranged from 71% to 92% (Boustani et al., 2003).
of Massachusetts offers forms, guides, and Specificity, the percentage of people who test
software through Psychological Assessment negative (number of true-negatives divided by
Resources of Florida for approximately $1 the number of true-negatives plus the num-
per test (Powsner & Powsner, 2005). ber of false-positives) has ranged from 56%
Before conducting an MMSE assessment, to 96% (Boustani et al., 2003). Therefore, the
the nurse or other tester should make the MMSE is expected to correctly identify per-
patient comfortable and establish rapport. sons with mild to moderate cognitive impair-
During the testing, praising success and not ment approximately 80% of the time and not
pressing on items the patient finds difficult to incorrectly identify persons as having mild
should enhance cooperation. The testing sit- to moderate cognitive impairment when they
uation may be embarrassing for patients who do not approximately 75% of the time.
are aware that they are “missing” some items Variables other than cognitive status,
and the nurse needs to protect the self-esteem most notably age and education, may influ-
of such patients while preserving the integ- ence test scores (Butler, Ashford, & Snowdon,
rity of the testing procedures. As with any 1996). Older persons and those with low
scale, the degree to which the MMSE is reli- education may score slightly lower yet
able and valid is critical. The tester needs to have higher cognitive capacity so there are
follow the administration procedures exactly MMSE test norms based on these variables
and clinicians/researchers need to interpret (Crum, Anthony, Bassett, & Folstein, 1993).
the meaning of scores properly. Modifications have been made for culturally
Psychometric assessment of the MMSE and linguistically appropriate MMSE ver-
has been conducted. Reliability and validity sions (Folstein, 1998). An increased risk of
estimates of the MMSE were satisfactory for false-positives has been found when using
a screening tool (Folstein et al., 1975). Initial the MMSE with the culturally deaf popu-
reliability, accuracy by measuring consis- lation (Dean et al., 2009). Scores need to be
tency in the items and different raters, was interpreted differently for persons with
adequate for interrater agreement and retest visual or auditory deficits that preclude use
stability when two samples of patients and of certain items that require sight or hearing
several test administrators were compared. or impact test performance.
Validity, the degree to which the MMSE mea- After 35 years of use, an MMSE score of
sures the construct of cognitive impairment, 23 points or less is generally considered to be