简易精神状态量表（MMSE）的使用办法
的相关介绍
简易精神状态量表（the Mini－Mental StateExamin ation，MMSE）可以说是认知检查最常用的一个量表了，其量表很容易得到，但在使用中不同的人偏差较大
使用注意事项：
MMSE使用很广泛，但使用的方法和不同中译文有不规范之处。
（1）定向力：日期和星期差一天可计正常。
（2）即刻记忆：也称最初或一级记忆，要求患者记忆3个性质不同的样物件。告知时需连续给出，应清晰、慢、一秒钟一个。第一次记忆的结果确定即刻记忆的分数[3分]，且为以后“回忆”检查作准备。重复学习最多6次，若仍不能记忆，则后面（4）项的回忆检查则无意义。 （3）注意和计算[5分]：
有两种方法：①要求患者从100连续减7，每错一次扣一分。或②要求患者倒背述“瑞雪兆丰年”，如倒背错为“年丰雪兆瑞”则为3分，以此类推。
（4）语言[9分]：
①命名[2分]：给患者出示表和圆珠笔，能正确命名各记一分。
②语言复述：是检查语言复述能力，要求患者复述一中等难度的成语，如“说话不要拐弯抹角”或“好读书不求甚解”等。因为不是检查患者语言流利
程度，更不是测验患者口齿灵巧和熟练性，故禁用绕口令。Folste in原文为“n o，ifs ands or buts”是一句成语，其意义是“说话不要拐弯抹角”，即“说话时不要总是假若、以及或但是等虚词，而不直明瞭的说出”之意，不是绕口令。
③三级命令：准备一张白纸，要求病人把纸用右手拿起来，把它对摺起来，然后放到地上。三个动作各得一分。
④阅读理解：准备一白纸用粗体大字写“请闭上眼睛”，请患者先朗读一遍，然后要求患者按纸写命令去做。患者能闭上双眼给一分。
⑤书写：给患者纸和笔，请患者在纸上主动随意写一个句子。检查者不能
用口述句子代替患者自发书写。但可给患者一较大书写范围，以节省患者搜寻和筛选时间，如“请写一
有关天气或文艺方面的句子”等。句子应有主语和谓语，必须有意义，能被人理解。文法和标点符号不强作要求。
⑥临摹：要求患者临摹一重叠的两个五角形，五角形的各边长应在一英寸[2．5cm]左右。两图形必须交叉，必须有10个角，交叉后的图需成四边形。但角不锐和边不直可忽略不计。
九章律MMSE的缺点亦不容忽视：
强迫状态
（1）项目内容容易受到受试者受教育程度影响，对文化程度较高的老人有可能出现假阴性，即忽视了轻度认知损害（如Strai n报道，MMSE识别轻度认知失调的敏感性仅为0．52），而对低教育及操方言者有可能出现假阳性； （2）注意（心算）、记忆、结构模仿等项目得分并不足以反映相应的认知领域表现，不能有效地绘制个体认知廓图；
（3）强调语言功能，非言语项目偏少，对右半球功能失调和额叶功能障碍不够敏感；
（4）记忆检查缺乏再认项目，命名项目过于简单；
（5）没有时间限制；
（6）对皮质性功能紊乱比对皮质下功能紊乱更敏感；
（7）不能用于痴呆的鉴别诊断，作为认知功能减退的随访工具亦不够敏感（如Clark对82例A D患者随访4年，16%的患者MMSE得分没有显著下降）。故深入研究认知损害往往采用多个更特异的测验工具搭配使用。
MMSE评估的定义、使用指南
Defini tion
The Mini Mental StateExamin ation（MMSE）is a simple and standa rdiz e d test elabor atedby Folste in in 1975 to evalua te the cognitive performance in oldersubjec ts and to eventu allyquanti fy cognitive defici ts．
This test is compos ed of 30 questi ons or tasks（also called items）that explor e possib l e disord ers/defici ts of：
Orient ation in time and place
Attention
Memory
Languag e：word，compre hensi on，readin g，writin g（aphasi a ＝speech diffic ultie s）
tronatic motionMotorskills althou gh motorfuncti on is intact（also called apraxi a）
Prelim inary remark s
Remark1
This test does not include itemsthat may detect a distur bance of executiv e functi ons：deteri orati on of the capaci ty to thinkin an abstra ctedway，to p lan，to organi ze．．．
翡翠赌石传奇Remark2
It usuall y takesabout 10 minute s to admini ster，a little more in patien ts with modera telysevere defici ts．双机备份
The patien t needs a pencil，threesheets of paper，a text with largecha rac tersf or item 28，a drawin g for item 30．
When the patien t has diffic ultywritin g，questi ons are askedorally．If h e has diffic ultyhearin g or unders tandi ng，the examin er must repeat the questi ons．
The system of scorin g is simple sinceit only involv es adding correc t ans wer s givento the differ ent items．A maximal scorei s 30．The overal l score classi fiesthe variou s levels of dementi a：
Severe form of dementia ＝from 0 to 9 points
Modera te form of dementia ＝from 10 to 19 points
Mild form of dementi a ＝from 20 to 24 points
A scorehigher than 27 is consid eredas normal．A mild cognitive impair ment or dementi a is suspec ted if the scoreis equal or lowerthan 24 points．Limita tions of the test
This test aloneis not suffic i entto detect a dementia because several para me ters（social and educati onal levels，the last professional occupation，the presen ce of psychol ogic al disord ers and，to a lesser extent，age）can bias t
he result s．Indeed，verbal respon se，readin g and writin g are import ant aspe ct s of MMSE．It i
s thus diffic ult to interp ret if the subjec t has poor languag e skills or is hearin g or visual ly impair ed．Thus，the scorecan be overes tima t ed in a cognitive impair ed subject with a high educati on and a high mental a ctivi ty．On the otherh and，the scorecan be undere stima ted in a poorly edu cat ed subjec t and/or a subject with depres sivesympto m s or deliri um．Lastly，this test is used to evalua te the progre ssion of the cognitive disor d ers and therapeutic effica cy of a drug by comparing the result s over a givenperiod．
Here are 30 itemsthat have to be performed：
The examin er begins the test whilesaying：“I will ask you questi ons to evaluate the functi oning of your memory．Some of them are very simple，others less so．Y ou must answer as best you can．"
Test of orient ation in time
Examin er："what is the comple te date today?"
Correct answer＝ 5 points．If the answer is incorr ect or incomplete，t he examin er asks the questi ons remain ing unansw ered，in the following order：Item 1．"What is the year?"
Item 2．"What is the season?"
Item 3．"What is the month?"
Item 4．"What is the date?"
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Item 5．"What is the day of week?"
Allow10 second s for each questi on and give a pointf or each correc t ans wer（maximu m 5 points）．
Test of orient ation to place
Examin er："I am goingto ask you some questi ons about the placewhere w e are"．
Item 6．"Whereare we? （name of the hospit al，clinic．．．）?"
Item 7．"Whichcountr y?"
Item 8．"Whichprovin ce （state）?"
Item 9．"Whichcity?"
Item 10．"Whichfloor（of the hospit al，clinic．．．）?"
Allow10 second s for each questi on and give a pointf or each correc t ans wer（maximu m 5 points）．
Test of learni ng
Item 11 to 13．The examin er："Repeat afterm e the following threewor ds：lemon，key，balloon（or cigar，flower，door）"．If the subjec t do es not repeat all three，the examin er repeat s them until the subject learns all three（he counts trials and record s them）．
The examin er asks him to memori ze them in orderto repeat them later．
1 pointf or each word correc tly said （maximum 3 points）．
Test of attention and calcul ation
Items14 to 18．The examin er："Beginwith 100 and count backwa rds i n groups of 7．Stop after 5 subtra ction s"．
10 seconds for each subtra ction， 1 pointf or each correct answer（maxi mu m：5 points）．
The examin er cannot help the subjec t （if for exampl e he asks how to su btra ct）．
Tasksdescri bed in the items14 to 18 involv e both calcul ation，workin g memory and attention，and theseare diffic ult to carryout for certai n indivi du als．If the subject cannot perform this task，the examin er asks him to spellthe 'WORLD' backwa rds．Give 1 pointf or each correc tly ordere d letter（for exampl e：3 points for DLWOR；5 points for DLROW）．However，this te st is not includ ed in the finalscore．The aim of this test is to calm down th e subject who HAS failed the test of subtra ction．
Test of memory（recall）
Items19 to 21．The examin er：“What were the threewordsy ou have repeat ed afterm e?”
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