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Cognitive Assessment

Mini Mental State Examination

The most commonly used test to screen cognition is the Mini Mental State Examination (MMSE).  The MMSE looks at various cognitive domains such as learning, language and short term memory. 

The MMSE is a valid and reliable screening instrument.   The sensitivity of MMSE for dementia ranges from 71 to 92%, and the specificity ranges from 56 to 96% [2].  A literature review from 1990 to 1999 showed that the MMSE provides a global score of cognitive ability that correlates with daily function [3].  Hence, the results of the MMSE in conjunction with a history and physical assessment can assist in differential diagnosis of cognitive impairment resulting from various dementia sub-types [3].   However, limitations of the MMSE include it is not reliable when administered through an interpreter to non-English speaking patients; and it lacks sensitivity in picking up very mild cognitive changes [3].  Full instructions and test questions in PDF form can be accessed online through the Regional Geriatric Assessment Programme of Ottawa-Carleton.

Montreal Cognitive Assessment

The Montreal Cognitive Assessment (MoCA) is another test that was designed as a rapid screening instrument for mild cognitive dysfunction [7].  It assesses different cognitive domains including attention and concentration, executive functioning, memory and orientation.  It takes about 10 minutes to administer making it a practical tool to use in a clinical setting.  It is available in a number of languages. Sensitivity and specificity studies have also been performed on the MoCA [7].  To access the results of these studies and the instructions on administration of the test, click on the MoCA website.

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2. Heun R, Papassotiropoulos A, Jennssen F. The validity of psychometric instruments for detection of dementia in the elderly general population. Int J Geriatr Psychiatry 1998;13(6):368-80.

3. Vertesi A, Lever JA, Molloy DW, Sanderson B, Tuttle I, Pokoradi L et al. Standardized mini-mental state examination. Canadian Family Physician 2001; 47:2018-2023.

7. Montreal Cognitive Assessment Tool http://www.mocatest.org/ accessed October 5, 2006

All references for this section