Page 323 - Encyclopedia of Nursing Research

290 n MENTORING

preliminary evidence of cognitive impairment or the Saint Louis Mental Status Examination
and grounds for further evaluation (Cockrell & (Tariq, Tumosa, Chibnall, Perry, & Morley,
M Folstein, 1988). When patients score approxi- 2006), be used.
mately 27 on the MMSE, scores of items test- In the research arena, the MMSE is
ing long-term memory should be checked used both as an enrollment criterion (cut
because failing only those items could be the score) and to characterize subjects’ cogni-
first signal of MCI (Pasqualetti et al., 2002). tive capacity. Because the MMSE is used in
MMSE scores should be considered with so many studies, it is almost incumbent on
other assessment data and neuropsycho- researchers to include the MMSE to provide
logical test to inform diagnoses and make consumers of research with a benchmark
treatment decisions, for example, a test for of cognitive capacity for comparing results
executive function (Kennedy & Smyth, 2008), across studies. For instance, the Cochrane
because that is not measured by the MMSE. Group conducted systematic reviews of sta-
There are specific clinical instances tins and dementia. In prevention trials, cog-
when the MMSE is not recommended for nition was measured at different times and
use at all, should be used as an adjunct with different scales, precluding their com-
with other assessments, or substituted bination in a meta-analysis (McGuinness,
with an assessment that is not copyrighted. Craig, Bullock, & Passmore, 2009). Treatment
The MMSE is not appropriate for assessing studies provided MMSE change scores from
delirium, and the Confusion Assessment baseline, thus allowing comparisons across
Method is recommended (Inouye et al., 1990). studies (McGuinness et al., 2010).
The MMSE has a “bottom” effect, meaning The MMSE remains a reasonable screen-
that once “0” is scored, the MMSE does not ing instrument for assessing and communi-
have the capacity to further quantify cogni- cating mild-moderate cognitive impairment
tive differences that exist between patients and for characterizing research subjects.
who score “0.” Another scale, as the Bedford Reliability checks need to be in place and
Alzheimer Nursing Subscale (BANS; Volicer, testers should periodically be observed for
Hurley, Lathi, & Kowall, 1994), allows addi- accuracy. Testing needs of special popula-
tional discrimination for persons who “bot- tions should be addressed and validated
tom” on the MMSE. The National Institutes test norms should be used. We agree with
of Health Stroke Scale and the MMSE both Holsinger et al. (2010) that clinicians should
detected severe cognitive impairment after consider one primary tool that is population
a stroke (Cumming, Blomstrand, Bernhardt, appropriate and add others for special situa-
& Linden, 2010). The Montreal Cognitive tions as needed.
Assessment (Nasreddine et al., 2005) is sug-
gested to detect MCI or dementia in persons Ann C. Hurley
with Parkinson disease, with the caveat that Ladislov Volicer
a positive screen using either the MMSE or Ellen K. Mahoney

the Montreal Cognitive Assessment requires
additional assessment because of suboptimal

specificity at the recommended screening
cutoff point (Hoops et al., 2009). Overcoming Mentoring

the copyright (and thus cost) issue of the
MMSE has been addressed (Smith, 2010) with
suggestions that no-cost scales, for example, Mentor relationships are being recognized as
the Modified Mini-Mental State Examination an essential component in the career devel-
(3MS) (Teng & Chui, 1987) that has been found opment of every professional nurse. The
to detect dementia (Bland & Newman, 2001) value of these developmental and support