Mini-Mental State Examination (MMSE 1975)

The MMSE is a clinical screening tool. A score is not a diagnosis: diagnosis needs a full mental status examination, history, physical examination and other tests.³ This page covers the test's history. It is not a self-test, and no items are reproduced.

Why "mini"

A full psychiatric mental state examination covers much more than cognition. The Folsteins and McHugh kept only the cognitive part and left the rest out.⁷

KEPT: COGNITIVE AREAS SAMPLED

Orientation in timeOrientation in placeImmediate memoryAttention and calculationRecallNaming objectsRepeating a sentenceFollowing commandsWritingCopying a design

Eleven questions or tasks, scored as the number of correct items out of 30.¹

LEFT OUT

MoodAbnormal mental experiencesThought patterns

Its original ward saw depression, dementia, delirium and occasional late-life schizophrenia, so telling cognitive loss apart from other conditions mattered.¹²

EXPLORE · ONE SCORE, SEVERAL RULERS

The same number reads differently

Pick a hypothetical score and a level of schooling. Each row applies one published rule to that score. The rules don't always agree, which is the point.

Hypothetical score23 / 30

Single cutoff: 23 or belowThe generally accepted cutoff for cognitive impairment.¹

Below cutoff

Severity bandsNone 24–30, mild 18–23, severe 0–17.¹

Mild band

Schooling-adjusted cutoff: 23 or below (secondary)From a large Southern Brazilian sample. At this cutoff, sensitivity was 86% and specificity 87%.⁷

Below cutoff

Education-group cutoff: 24 or belowSuggested thresholds for a possible case of dementia needing further investigation: 20 with no formal education, 22 with primary, 24 with secondary or tertiary.⁴

Below cutoff

Population median for this schooling: 29Crum et al. (1993) medians: 29 with 9+ years of schooling, 26 with 5–8 years, 22 with 0–4 years. Here, secondary and higher both map to 9+ years.¹

6 below median

The median rows compare the score with Crum et al.'s 1993 population medians by schooling, which fall with age from 29 at ages 18–24 to 25 at 80 and over.¹ Nothing here is a diagnosis.

Who the cutoff catches, and who it misses

The usual break point for cognitive impairment worth investigating is 23/24, and some clinicians use 24/25 to pick up more mild dementia. A single cutoff can miss cases among highly educated people and flag too many people with little schooling.³

Community and primary care24 or below · dementia⁴

Sensitivity

.87

Specificity

.82

Highly educated older adults23 or below · dementia²

Sensitivity

.66

Specificity

.99

Southern Brazil, whole sample23 · optimal cutoff⁷

Sensitivity

.86

Specificity

.83

Southern Brazil, no schooling21 · optimal cutoff⁷

Sensitivity

.93

Specificity

.82

Weak on mild changesLess sensitive to mild cognitive impairment. A meta-analysis found 27 or below balanced sensitivity and specificity best for that purpose.⁴

Ceiling and floorA low ceiling limits it in able adults. Below about 10 points, a floor effect makes further decline hard to track.³

Little on executive functionIts items lean towards memory and language, so it picks up executive problems less well.⁵

Free for 26 years, then licensed

For decades the MMSE appeared in textbooks, pocket guides and websites, and residents learned it by heart. Commentators credit much of its spread to that free circulation. It is also why this page shows no items.^11,10

1975

PublishedFolstein, Folstein and McHugh publish "a practical method for grading the cognitive state of patients for the clinician".²

1993

Norms by age and educationCrum and colleagues publish population norms, and the MMSE starts to appear with a table for patient-specific norms.¹

2001

Exclusive licencePsychological Assessment Resources acquires an exclusive copyright licence from the authors and begins controlling copying and distribution. Each administration now needs a purchased form.⁹

March 2011

The Sweet 16 disappearsAn open-access 16-item screen, developed at Harvard, with orientation and three-object recall items similar to the MMSE's, is removed from the internet at PAR's request.¹¹

Dec 2011

The NEJM warningNewman and Feldman argue the copyright moves leave clinicians at risk of infringement claims and made a new tool unavailable.⁸

Later

Legal and clinical follow-upA law review article questions whether the copyright should be upheld after decades of free use. A 2015 commentary makes the case for alternatives to the MMSE.¹³

References

[1]Mini-Mental State Examination (MMSE). StrokEngine, McGill University.strokengine.ca

[2]O'Bryant, S. E., et al. (2008). Detecting dementia with the Mini-Mental State Examination in highly educated individuals. Archives of Neurology. ResearchGate.researchgate.net

[3]Mini-Mental State Examination: an overview. ScienceDirect Topics (Medicine and Dentistry).sciencedirect.com

[4]Mini-Mental State Examination score: an overview. ScienceDirect Topics.sciencedirect.com

[5]Mini-Mental Status Exam (MMSE). PsychDB.psychdb.com

[6]45 years of the Mini-Mental State Examination (MMSE): a perspective from Ibero-America. PubMed Central.ncbi.nlm.nih.gov

[7]The Mini Mental State Examination: review of cutoff points adjusted for schooling in a large Southern Brazilian sample. PubMed Central.ncbi.nlm.nih.gov

[8]Newman, J. C., & Feldman, R. (2011). Copyright and open access at the bedside. New England Journal of Medicine 365, 2447–2449.nejm.org

[9]Newman, J. C. (2015). Copyright and bedside cognitive testing: why we need alternatives to the Mini-Mental State Examination. JAMA Internal Medicine. Semantic Scholar.semanticscholar.org

[10]Why the Mini-Mental State Examination copyright has no legal standing. GeriPal.geripal.org

[11]Doctors discover copyright law: cognitive screening test killed over infringement claims. Techdirt (30 Dec 2011).techdirt.com

[12]MMSE and copyrights part II: is the MMSE derivative of some other work? GeriPal.geripal.org

[13]Feldman, R., & Newman, J. Copyright at the bedside: should we stop the spread? PubMed.pubmed.ncbi.nlm.nih.gov

HOW TO CITE THIS PAGE

What's Your IQ. (2026). Mini-Mental State Examination (MMSE), 1975. In Historical IQ Tests Archive. Retrieved October 1, 2026, from /en/historical-iq-tests/mmse-1975

EDITORIAL RECORD

First published2026

Last reviewed1 October 2026

Sources13: clinical references, peer-reviewed validation studies and legal commentary

Not includedAny MMSE item, form or wording (under copyright)

Canonical URLwhats-your-iq.com/en/historical-iq-tests/mmse-1975

Related historical tests

The long-form memory exam1945

Wechsler Memory Scale

Where the MMSE spends a few items on recall, Wechsler's memory scale gives memory a full clinical battery. A low MMSE score is often the reason a patient is referred for that longer assessment.

ReferenceRead more →

A screen inside a battery2009

WMS-IV

The fourth Wechsler Memory Scale added its own Brief Cognitive Status Exam, a short screen for serious cognitive difficulties. It does the MMSE's job inside a larger memory assessment.

ReferenceRead more →

What the MMSE misses1944

Trail Making Test

The MMSE is weak on executive function, which is exactly what Part B of the Trail Making Test targets. Clinicians often pair a global screen with a task like this.

InteractiveTake it →

Naming, in depth1983

Boston Naming Test

The MMSE asks a patient to name a couple of everyday objects. The Boston Naming Test expands that into 60 drawings of increasing difficulty to detect word-finding problems.

ReferenceRead more →

The half it left out1960

Hamilton Depression Rating Scale

The MMSE deliberately excludes mood. On a ward treating depression alongside dementia, a clinician rating scale like the Hamilton covered that other half of the picture.

ReferenceRead more →

Part of the Historical IQ Tests Archive. Editorial content under CC BY-SA 4.0. The MMSE is licensed by its copyright holders to Psychological Assessment Resources; no test items are reproduced.

BibTeX RIS

Thirty points, ten minutes.

Why "mini"

The same number reads differently

Who the cutoff catches, and who it misses

Free for 26 years, then licensed

References

Related historical tests

A screen asks "is something wrong?" An IQ test asks "how strong?"