We focused on this section of the MMSE alone to ensure brevity of the survey, as we perceived that the scoring method assigned to these questions is particularly dependant on the rater’s interpretation. This interrater error leads to a potential score difference of up to four points for this section alone. This survey of consultant neurologists confirmed substantial variability in the use and scoring of the serial sevens/WORLD backwards section of the MMSE. When scoring “93–85–78–71–64”, 59% assigned a score of four points and 23% a score of one. Other scores included two respondents assigning a score of five. Out of a maximum of five points, 51% assigned a score of three and 25% a score of one.

We did not allocate a “correct” score for this example since we believe the original guidance on how to score errors 1 is imprecise. Raters were asked to score a sample incorrect response “DRLOW”. Only 10% of respondents were aware of schemes describing standardised scoring of mistakes when spelling WORLD backwards. Test choice and method of scoring this section of the MMSE are shown in fig 1. The MMSE was used in clinical practice by 91% of respondents, with 51% of respondents describing their use as “frequent”. Of the 407 questionnaires sent, there were 234 (58%) responses. The original instructions regarding this section involve asking the patient to count backwards in sevens from 100 for five subtractions, or, if the patient “cannot or will not perform this task” to spell “WORLD” backwards, scoring the number of letters in the correct order. 2 Our study questions whether poor interrater reliability of the MMSE makes it an inappropriate tool for monitoring drug response.Ī postal survey evaluating the MMSE section termed “attention and calculation” was conducted among all consultant neurologists in the UK. 1 The National Institute for Clinical Excellence (NICE) guidelines concerning the use of cholinesterase inhibitors (CI) in Alzheimer’s disease recommend using the MMSE as quantifiable measure to inform decisions regarding initiation and continuation of drug treatment. The mini mental state examination (MMSE) is widely used as a rapid means of quantifying cognitive function.

Mmse reliability and validity