Instructor s Guide to Dementia Screening: The Mini-Mental State Exam (M.M.S.E.) September 2005 Page 1 of 6
Instructor s Guide to Dementia Screening: The Mini- Mental State Exam (M.M.S.E.) Description of Module In 1975 Dr. Marshal F. Folstein described the Mini-Mental Status Examination (MMSE), a tool developed to standardize and quantify the evaluation of cognitive state (1). Based on that instrument, our group created the Interactive Mini-Mental State Exam Training Module. This computer based tutorial was created as a reusable learning object, and is available in CD ROM and web-based versions. Learning Objectives From module Describe the use and purpose of the MMSE Effectively administer and score the MMSE Identify limitations of the MMSE Explain the results of the MMSE Recognize the importance of the MMSE as a tool to screen for dementia From Instructor Guide Basic Level To explain how the MMSE can be used in assessing cognitive impairment. Describe the components of the MMSE. Advanced level To administer and score the MMSE. Who Should Use This Training Module? Medical students Internal Medicine and Family Medicine residents Geriatrics fellows Nurses Licensed Clinical Social Workers Module Creation This module was originally created in 2001 and revised and updated in 2004 by Geri-U, the Online Geriatrics University, at the Stein Gerontological Institute. Expertise was provided by faculty members from the University of Miami School of Medicine, and the Miami VA, including Drs. J. Ruiz, M. Mintzer and A. Juan (geriatricians). Page 2 of 6
References 1. Folstein MF, Folstein SE, Fanjiang G. Mini-Mental State Examination: Clinical Guide. PAR Inc, 2001. 2. Folstein MF, Folstein SE, McHugh PR. "Mini-Mental Sate." A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198. 3. Christensen H, Hadzi-Pavlovic D, Jacomb P. The psychometric differentiation of dementia from normal aging: a meta-analysis. Psychological assessment, 3, 147-155. 4. Zalkanis KK, Leach L, Kaplan E. On the nature and pattern of neurocognitive function in major depressive disorder. Neuropsychiatry, Neuropsychology and Behavioral Neurology, 11(3), 111-119. 5. Rockwood K, Goodman J, Flynn M, Stolee P. Cross-validation of the Delirium Rating Scale in older patients. Journal of the American Geriatrics Society, 44(7), 839-842. How This Module Will Help You Learn This learning object delivers the information in an interactive way through written text, narrations and video clips demonstrating how to administer and score each section of the MMSE. It contains a significant amount of practice items, in the form of worked examples (where the student is walked-through a problem), and practice exercises (the student solves a problem and gets feedback) (3) Time for Completion About 60 minutes Instructional Use The MMSE is an instrument used to screen for cognitive impairment. It is composed of several tasks that evaluate different cognitive domains: orientation, memory, attention, language, and visual-spatial abilities. Teaching procedures require attention to instructional design guidelines (2) such as the following: Providing Information: o Display the steps with graphics o Demonstrations with steps Providing Practice o Follow along demonstrations o Perform the procedure Page 3 of 6
This module was primarily developed as a self-instruction tool. It can later be used to reinforce the knowledge or skills or as refresher for information and practice. Educators could also use this module in conjunction with preceptor assisted instructional activities such as lectures, workshops, or small group discussions as part of a blended learning approach. The tutorial can be used as a refresher for learners in the clinical environment immediately before performing this assessment in the clinic or at the bedside. [Trainee Performance Support System TPSS (at the point of care)] Rights of Use All material in this module was produced by the Stein Gerontological Institute. All further reproduction rights are given through written permission only. Referencing this work: Ruiz JG, Katz A, Smith M, McEntire A, Juan A, van Zuilen MH, and Mintzer MJ. Dementia Screening with the MMSE (CD-ROM program). GeriU, the Online Geriatrics University, Stein Gerontological Institute, 2004 System Requirements (CD ROM) Windows PC Intel Pentium processor (Pentium II or higher is recommended) 256-color monitor capable of 800 x 600 resolution Windows 95, 98, 2000, XP, Windows NT 4 (Service Pack 3) or Windows ME 64 MB or more of available RAM or higher is recommended Macintosh Intel Pentium II processor (or higher) 256-color monitor capable of 800 x 600 resolution Mac OS 8.5, 8.6, 9.0 and 9.1 (For OS X, we recommend running as Classic) 64 MB or more of available RAM (with virtual memory on) System Requirements (viewing on web) Windows OS: Internet Explorer 6.0 and above, Netscape Navigator 7.0 and above Macintosh OS: Mozilla 1.0 and above (which uses the same engine as Netscape) Flash 6.0 or higher Page 4 of 6
Accessing the Module (CD-ROM version) Windows PC 1. Place the CD-ROM into the CD drive on your computer. 2. The CD-ROM will automatically start if Autorun is enabled on your computer. 3. If the CD-ROM does not automatically start, go to the taskbar on the bottom of your screen, click on <"Start>," then click <"Run...>". Type in "D: Dementia_Training_PC.exe", where D is the letter of the CD drive on your computer. For more details, see the readme.htm file on the CD-ROM. Macintosh 1. Place the CD-ROM into the CD drive on your computer. 2. The CD-ROM will automatically start if Autorun is enabled on your computer. 3. If the CD-ROM does not automatically start, and double-click on the "DT.exe" file within the CD-ROM folder on your desktop. Page 5 of 6
Going Through the Module Each page in the module shows information on the POMA, and presents controls for going through the module. You can go through the module one page at a time, or you can jump from page to page or section to section. Many pages have multimedia elements such as videos. Click on the appropriate button to view them. Click to go to a different section Click to watch videos Click to go to another page Moving between Pages Viewing Videos Moving between Sections Use the arrow buttons in the lower right corner of the screen to move backwards and forwards through the tutorial. To view the video clip, click on the play button in the lower left corner of the video frame. Click on the menu at the left to go to a different section. Page 6 of 6