I presented the use of Mini-Mental State Exam and Montreal Cognitive Assessment in Psychiatry as part of an academic presentation during my Psychiatry rotation on 22/03/2024 to an audience that consisted of my fellow medical interns, medical students, medical officers, and Psychiatric consultants.

1. The use of MMSE and MoCA in
Psychiatry
Dr. Nghitukuhamba T.E Kalipi
BSChB, MBChB (CUZ)
Medical Intern
Mentor and supervisor: Dr. B.P Bock
MD (UABT)
Senior Resident Medical Officer

2. Outline
1. Introduction
2. What is MMSE?
3. What is MoCA?
4. The use of MMSE and MoCA in Psychiatry
5. Research articles
6. Take home message
7. References
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 2

3. Introduction
• In 1975, Marshal Folstein and colleagues published the Mini-Mental State Exam
(MMSE) as a tool for brief quantitative assessment of cognitive function,
almost 49 years ago.
• The MMSE is now a widely used test for standardized cognitive assessment
especially in the elderly population.
• In 2005, a newer tool, the Montreal Cognitive Assessment (MoCA) was
launched by Dr. Ziad Nasreddine and colleagues for detection of mild
cognitive impairment.
• These two tools, although distinct in their uses share common similarities in
areas they used to assess such as short term memory, executive function,
attention and focus.
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 3

4. The Mini-Mental State Exam (MMSE)
• The Mini-Mental State Exam is used for the brief assessment of cognitive
performance.
• It focuses of cognitive issues, leaving out issues related to psychiatric
disorders or behavior, and it should therefore not be confused with the Mental
State Exam (MSE).
• The test consists of two parts, the first part evaluates issues related to
orientation, memory and attention, while the second part assesses for verbal
and written ability.
• It is commonly used in the elderly patients for the diagnosis and prognosis
of cognitive impairment.
• Its use is better reserved for patients already known with dementia.
• It takes about 7-8 minutes to complete the assessment.
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 4

5. Overview of the MMSE
It consists of various parameters that are assessed, each given a score of 1
First Part
Orientation (10 points)
• What is the (year) (season) (date) (day) (month)?
• Where are we (state) (country) (town) (hospital)
(floor)?
Registration (3 points)
• Name 3 objects (The examiner names 3 objects and
then asks the patient to repeat them
• The total number of attempts is written down.
Attention and Calculation (5 points)
• Serial 7's (stop after 5 answers) or
• Spell the word "world" backwards
Recall (3 points)
• Ask patient to recall objects mention under
registration above
Second Part
Language (9 points)
This part requires a pen and paper for some questions
• Name a pencil and a watch (2)
• Repeat the following "No ifs, ands, or buts" (1)
• Follow a 3-stage command:
• "Take a paper in your hand, fold it in half and put it on
the floor" (3)
• Read and obey the following: "Close your eyes" (1)
• Write a sentence containing a subject and a verb (1)
• Copy the design shown below (1)
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 5

6. Overview of the MMSE cont...
• The total score is out of 30.
• A score of 25 or higher is classed as normal.
• A score of 24 or below is classed as abnormal and is indicative of
possible cognitive impairment.
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 6

7. The Montreal Cognitive Assessment (MoCA)
• The Montreal Cognitive Assessment (MoCA) is used to detect mild cognitive
decline and early signs of dementia in the elderly.
• It is an update from the older Mini-Mental State Exam (MMSE).
• It is better at distinguishing between normal cognition and the mild cognitive
impairment, and its use is mainly in the detection of dementia.
• The test consists of 30 questions with a maximum score of 30.
• It takes about 10-12 minutes to complete the assessment.
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 7

8. Overview of the Montreal Cognitive Assessment
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 8

9. The Montreal Cognitive Assessment (MoCA) cont...
• The total score is out of 30.
• A score of 26 and above is considered normal.
• A score of 25 and below is considered abnormal and indicates mild cognitive
impairment.
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 9

10. Mini-Mental State Exam vs Montreal Cognitive Assessment
MMSE
• It evaluates 5 domains of cognition
(orientation, registration,
attention/calculation, recall and
language).
• Questions are less difficult.
• Has lower sensitivity for cognitive
impairment but is able to monitor
for subtle changes in people with
moderate to severe dementia.
• Better at monitoring people with
known dementia.
MoCA
• It evaluates 7 domains of cognition
(executive/visuospatial function,
naming, attention, language,
abstraction, recall and orientation).
• Questions are more difficult.
• Has higher sensitivity for mild
cognitive impairment but less value
for people with moderate to severe
dementia.
• Better at detecting early dementia.
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 10

11. Research articles
Summary
• The test was given to two groups,
sample A and B. Sample A contained
69 patients with clinical conditions
such as dementia, affective disorders
and depression).
• Sample B contained 137 normal
elderly patients.
• The test indicated that a score of
less than 20 was found
essentially only in patients
with dementia, delirium,
schizophrenia, or affective disorder,
and not in normal elderly people or
in patients with a primary diagnosis
of neurosis and personality disorder.
• The Mini-Mental Status was useful
in quantitatively estimating the
severity of cognitive impairment . Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 11

12. Research articles
Summary
• The study contained 94 patients
meeting the MCI clinical criteria, 93
patients with mild Alzheimer's
disease and 90 healthy elderly
controls.
• Using a cutoff score of 26, MoCA
detected 90% of MCI subjects.
• It showed a sensitivity of 100% and
a specificity of 87%
• In conclusion, the MoCA is a
brief cognitive screening tool with
high sensitivity and specificity for
detecting MCI.
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 12

13. Take home message
• MCI as an entity is ever evolving, and often progresses to dementia. The MMSE
and MoCA assessment tools are designed to assist first-line clinicians in
detecting these cognitive impairments.
 The MMSE is commonly used in the elderly patients for the diagnosis and
prognosis of cognitive impairment. Its use is better reserved for monitoring
patients with dementia.
 The MMSE has a total score of 30, a score of 25 or higher is classed as normal,
while a score of 24 or below is classed as abnormal and indicative
of possible cognitive impairment.
 The MoCA is better at distinguishing between normal cognition and the mild
cognitive impairment, and its use is mainly in the early detection
of dementia.
 The MoCA has a total score of 30. A score of 26 and above is considered
normal, while a score of 25 and below is considered abnormal and
indicates mild cognitive impairment.
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 13

14. References
Folstein, M.F., Folstein, E.S., McHugh, P
.R. (1975). “Mini-mental state”: A practical method for grading
the cognitive state of patients for the clinician. Portland, Oregon, U.S.A: University of Oregon Medical
School. Retrieved
from https://www.sciencedirect.com/science/article/abs/pii/0022395675900266?via%3Dihub
Gallegos, M., Morgan, M.L., Cervigni, M., Martino, P
., Murray, J. (2022). 45 Years of the mini-mental state
examination (MMSE): A perspective from Ibero-America. Ibero, Brazil: Dement Neuropuschol. Retrieved
from https://pubmed.ncbi.nlm.nih.gov/36530763/
Gever, J. (2023). MoCA beats MMSE to Assess Dementia. Retrieved
from https://www.medpagetoday.com/meetingcoverage/ana/42322
Nasreddine, Z.S., Phillips, N.A., Bedirian, V., Charbonneau, S., Whitehead, V. (2005). The Montreal
Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Quebec,
Canada: Neuro Rive-Sud Memory Clinic. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15817019/
Getz, L. (2024). MMSE vs MoCA: What You Should Know. Retrieved
from https://www.todaysgeriatricmedicine.com/news/ex_012511_01.shtml
Rosenzwieg, A. (2023). Montreal Cognitive Assessment (MoCA) Test for Dementia. Retrieved
from https://www.verywellhealth.com/alzheimers-and-montreal-cognitive-assessment-moca-98617
Voss, R, M., Das, J.M. (2022). Mental Status Examination. Retrieved
from https://www.ncbi.nlm.nih.gov/books/NBK546682/
Dr. Nghitukuhamba T.E Kalipi (BSChB, MBChB) 14