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====== Mini Mental State Examination (MMSE) ======

The Mini International Neuropsychiatric Interview (MINI) ([[sections|section]]: [[mental health]]) was measured in all elderly [[start|Lifelines]] participants during:
  * [[1A Visit 1]] (65+, n = ~13.000) 
  * [[3A Visit 1]] (65+)

===== Background =====
The Mini Mental State Examination ([[https://en.wikipedia.org/wiki/Mini%E2%80%93Mental_State_Examination|MMSE]]) is a brief cognition test used to assess cognitive impairments ([[sections|section]]: [[mental health]]). It is commonly used in medicine and allied health to screen for dementia.\\
The MMSE was performed in ca. 12.000 [[elderly]] (65+) participants during [[1A Visit 1]]. ~12% scored below 24 points (NB: in case of an MMSE score <26 at [[1A visit 1]], the [[Proxy]] interview was performed on location).\\ The MMSE is implemented again in [[3A Visit 1]]\\
The MMSE is used in conjunction with other cognition tests in [[start|Lifelines]], i.e. the [[Ruff Figural Fluency Test|RFFT]] (also during [[1A Visit 1]] and [[3A Visit 1]]) and the [[CogState]] (during [[2A visit 1]] and [[3A Visit 1]]), and with several [[cognition (general)|cognition-related questions]]. 
The MMSE should not be confused with the [[Mini Neuropsychiatric Interview]], which is also used in Lifelines but assesses anxiety and depression.\\ 

De MMSE includes simple questions and tasks in a number of areas: 
  * orientation (V1a-e, V2a-e, max. 10 points); 
  * registration (V3, max. 3 points);
  * attention and calculation (V4, max. 5 points);
  * recall (V5, max. 3 points);
  * language (V6-10, max. 8 points);
  * basic motor skills (V11, max. 1 point, copy a drawing of two pentagons as shown in figure). 

{{:mmse.png?400|}}

===== Scoring =====
A total of 30 points can be scored in the MMSE (see English protocol for details on scoring). The final score will give a first indication of the presence and level of cognitive impairment (but note that the MMSE is __not__ a diagnostic instrument). 
  * 24-30 points: No cognitive impairment
  * 18-23 points: Mild to moderate cognitive impairment
  * 0-17 points: Severe cognitive impairment
Note that in Lifelines, the computer programme gave the following raw data scores:
  * 12 out of 30 items were scored as 1 for correct and 0 for incorrect
  * 18 out of 30 items were scored as 2 for correct and 1 for incorrect
The programme therefore subtracted 1 from each score in these 18 items to get the final score.\\
When raw MMSE data are used for calculations, the same subtraction should be made.\\ 
The Lifelines protocol of the MMSE (in Dutch) can be downloaded here: {{ :mmse_in_dutch.pdf |}}\\
The English equivalent can be downloaded here: {{ :mmse_in_english.pdf |}}

===== Variables =====

| **English**                                                                                                                             | **Dutch**                                                                                                              | **Code**                   | **Variable**  | **Assessment**                       | **Age**  |
| What year is it? (Correct?)                                                                                                             | Welk jaar is het? (Correct?)                                                                                           | mmse_time_adu_m_01_a       | V1A           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| What season is it? (Correct?)                                                                                                           | Welk seizoen is het? (Correct?)                                                                                        | mmse_time_adu_m_01_b       | V1B           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Which month of the year is it? (Correct?)                                                                                               | Welke maand van het jaar is het? (Correct?)                                                                            | mmse_time_adu_m_01_c       | V1C           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| What is today's date? (Correct?)                                                                                                        | Wat is de datum van vandaag? (Correct?)                                                                                | mmse_time_adu_m_01_d       | V1D           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| What day of the week is it today? (Correct?)                                                                                            | Welke dag van de week is het? (Correct)                                                                                | mmse_time_adu_m_01_e       | V1E           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| In which province are we now? (Correct?)                                                                                                | In welke provincie zijn we nu? (Correct?)                                                                              | mmse_place_adu_m_02_a      | V2A           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| In what city or town are we now? (Correct?)                                                                                             | In welke plaats zijn we nu? (Correct?)                                                                                 | mmse_place_adu_m_02_b      | V2B           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| In what street are we now? (Correct?)                                                                                                   | In welke straat zijn we nu? (Correct?)                                                                                 | mmse_place_adu_m_02_c      | V2C           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| What is this building called? (Correct?)                                                                                                | Hoe heet dit gebouw? (Correct?)                                                                                        | mmse_place_adu_m_02_d      | V2D           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| On what floor are we now? (Correct?)                                                                                                    | Op welke verdieping zijn we nu? (Correct?)                                                                             | mmse_place_adu_m_02_e      | V2E           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| I will name three objects now. Could you repeat them after I've said all three? Apple. (Correct?)                                       | Ik noem nu drie voorwerpen. Wilt u die herhalen nadat ik ze alle drie gezegd heb? Appel. (Correct?)                    | mmse_object_adu_m_03_a     | V3A           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Key. (Correct?)                                                                                                                         | Sleutel. (Correct?)                                                                                                    | mmse_object_adu_m_03_b     | V3B           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Table. (Correct?)                                                                                                                       | Tafel. (Correct?)                                                                                                      | mmse_object_adu_m_03_c     | V3C           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Could you subtract seven from 100 and subtract seven again from that number and keep going like that? (score: 0-5 points)               | Wilt u van de 100 zeven aftrekken en van wat overblijft weer zeven aftrekken en zo doorgaan? (score: 0-5 punten)       | mmse_calculation_adu_m_04  | V4            | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Could you mention again the three objects I just named? Apple. (Correct?)                                                               | Noemt u nogmaals de drie voorwerpen van zojuist. Appel. (Correct?)                                                     | mmse_recall_adu_m_05_a     | V5A           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Key. (Correct?)                                                                                                                         | Sleutel. (Correct?)                                                                                                    | mmse_recall_adu_m_05_b     | V5B           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Table. (Correct?)                                                                                                                       | Tafel. (Correct?)                                                                                                      | mmse_recall_adu_m_05_c     | V5C           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| What is this? Pen. (Correct?)                                                                                                           | Wat is dit? Pen. (Correct?)                                                                                            | mmse_object_adu_m_06_a     | V6A           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| And what is that? Watch. (Correct?)                                                                                                     | En wat is dat? Horloge. (Correct?)                                                                                     | mmse_object_adu_m_06_b     | V6B           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Could you repeat the following sentence: Now this, and then that again. (Correct?)                                                      | Wilt u de volgende zin herhalen: Nu eens dit en dan weer dat. (Correct?)                                               | mmse_language_adu_m_07     | V7            | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Could you please read these words and then do what they say? (Paper on which is written in large letters: Close your eyes.) (Correct?)  | Wilt u deze woorden lezen en dan doen wat er staat?(Papier met daarop in grote letters: Sluit uw ogen.) (Correct?)     | mmse_language_adu_m_08     | V8            | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Could you pick up this paper with your right hand, fold it in two and then put it on your lap? (Right hand, correct?)                   | Wilt u dit papiertje pakken met uw rechterhand, het dubbelvouwen en het op uw schoot leggen? (Rechter hand, correct?)  | mmse_motor_adu_m_09_a      | V9A           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Is the paper folded?                                                                                                                    | Is het papiertje dubbelgevouwen?                                                                                       | mmse_motor_adu_m_09_b      | V9B           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Was the paper placed on the lap?                                                                                                        | Is het papiertje op de schoot gelegd?                                                                                  | mmse_motor_adu_m_09_c      | V9C           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Could you write a complete sentence on this piece of paper? (Correct?)                                                                  | Wilt u voor mij een volledige zin opschrijven op dit stuk papier? (Correct?)                                           | mmse_write_adu_m_10        | V10           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| Could you copy this figure? (Correct?)                                                                                                  | Wilt u deze figuur natekenen? (Correct?)                                                                               | mmse_draw_adu_m_11         | V11           | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |
| MMSE total score                                                                                                                        | MMSE totaal score                                                                                                      | mmse_score_adu_m_01        | SCORE         | [[1A Visit 1|1A]] [[3A Visit 1|3A]]  | 65+      |