Mini Mental Status Examination

EARLY DETECTION OF DEMENTIATaking history from care-giverBrief cognition test :MMSEClock Drawing Test (CDT)

Behavior TestGDS (Geriatric Depression Scale)

Functional testADL (Activity of Daily Living)IADL (Instrumental Activity of Daily Living)

MEMORY COMPLAINTDetail of chief complaintOnset , ageProgressivityChange on other cognitive complaint ( orientation, language, logical thinking, visuospatial)Change on personality and behavior Impact on activity daily living, hobbyImpact on social relationshipNeurological associated symptomsMedical and neurological historyPsychiatric historyNutrition , intoxication historyFamily history

Mini-mental state examination (MMSE)Introduced by Folstein et al in 1975

Folstein test Not diagnostic test but a screening tools for cognitive impairment with older, community dwelling, hospitalized and institutionalized adultsBrief 30-point questionnaire test (max score is 30), only takes 5-10 minutesAreas of cognitive function :

OrientationRegistration (immediate memory)Attention & CalculationRecall languageVisual construction

The benefits of the MMSE include its brevity (5-15 minutes to administer), and the fact that it is a global assessment of many domains including: orientation to time and place (10 points), registration of 3 words (3 points), attention and calculation (5 points), recall of 3 words (3 points), language (8 points) and visual construction (1 point). sensitivity 86% and a specificity 92% Score (Perdossi)

24-30: Normal (except for high education person,

Advantages:

Most common usefulGood consistencyGood test-retest reliabilityHigh sensitifity & specificityGood correlation with Clock Drawing Test

Disadvantage :

Influence by age, education, and culture

CLOCK DRAWING TESTTes yang sensitif dalam membedakan lansia normal dari penderita demensia AlzheimerSensitif untuk menilai kemampuan visuospasial dan konstruksional praksisMenilai kemampuan konsep waktu, angka dan hubungan waktu dan angka

INSTRUKSILetakkan sehelai kertas dan sebuah pensil (tanpa penghapus) di hadapan penderitaKatakan Gambarlah sebuah jam dinding bulat berikut angka-angkanya dalam posisi yang benarSetelah selesai digambar, katakan Gambarlah jarum jam yang menunjukkan pukul sebelas lewat sepuluh menit

PENILAIAN (metode 4 point)SKORMenggambar lingkaran tertutup 1Keduabelas angka lengkap1Meletakkan angka-angka secara tepat1Jarum jam dalam posisi yang tepat1

INTERPRETASISkor rendah menunjukkan perlunya evaluasi kognisi lebih lanjut

Geriatric Depression Scale (GDS)

Assessment of Activity Daily Living

Scores range from 25-30 for normals, 21-24 for mild AD, 14-20 for moderate AD, and less than 13 in severe ADMMSE is a useful screening test for cognitive impairment.The MMSE is not a diagnostic test nor is it equivalent to a neurological examination or formal mental status testing. It is not a test of personality, mood, behavior or function and does not by itself determine competence. It is less helpful is forms of dementia where there are early and severe language problems. The MMSE is a useful test for family physicians. Once the limitations of the test are understood, it can be very helpful in both the diagnosis of dementia and in monitoring the response to the new agents being used to treat Alzheimer's Disease.24 30: "normal" range20 23: mild cognitive impairment or possible early stage/mild Alzheimer's disease10 19: middle-stage/moderate Alzheimer's disease0 9: late-stage/severe Alzheimer's disease *