Diagnosing Dementia: Is the Folstein Test Reliable?

Anyone who has a parent or other family member suspected of having dementia has probably heard of the mini-mental status examination (MMSE) or Folstein test, because this 30-point questionnaire is often used to screen for dementia.

The test is often given to people older than 60 years of age that are suspected of mental decline or are manifesting some signs of dementia.

But the mini-mental test should never be used as the sole test for dementia, because it ignores factors only a neurological examination and more thorough neurocognitive testing can accurately evaluate.

What is the mini-mental test?

The MMSE is the most widely used standardized cognitive screening test. Folstein first described it in 1975 as a “practical method for grading the cognitive state. In about 10 minutes, it samples various functions, including: orientation, short- term memory, ability to follow instructions and object recognition.

It is called “mini” because of its brief nature and its easily administered initial screening of a patients cognitive status. The test does not assess mood or thought disorders. Originally, it was intended to assist psychiatric residents in the cognitive part of the mental status test.

Limitations of the mini-mental test

The MMSE is a useful screening test for cognitive impairment. But it should never be used as the only criterion for making a diagnosis of dementia. No one should ever be told they have Alzheimer’s or any other dementia based solely upon the MMSE findings.

The test is a useful tool in initial screening and assessment as well as the ongoing follow-up of patients with a dementia, but only a complete neurological examination, formal patient history, neuropsychological testing, lab tests, CT or MRI of the head can accurately diagnose or rule out various forms of cognitive dysfunction. Further, the MMSE is not a test of personality, mood or behavior, and does not by itself determine competence.

The MMSE is not always sensitive enough to pick up early dementia and can be influenced by the educational background and gender of the person who takes it. It is also less helpful in forms of dementia where there are early and severe language problems.

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