The diagnosis of incipient dementia can prove difficult if the patient refuses to cooperate. Since most people with dementia initially realise that something is wrong, many of them try to avoid unpleasant situations by using a variety of avoidance strategies. In order to be able to make a suspected diagnosis of dementia, the statements of the patient and all other available informants must be included.
Family or friends, who are in the patient’s constant environment, are often a great help. If a visit to the doctor is necessary, the specialist has various options open to him. Diagnostics can be carried out in the laboratory and supported by imaging techniques such as sonography, EEG, CT or MRT. On the other hand, neuropsychological test procedures should be used, as these are less stressful for the patient while the test forms are highly standardized and meaningful. In the context of the rapid detection of cognitive deficits, as they occur in dementia patients, a number of test examinations have been developed, some of which are particularly prominent.
Mini Mental Status Test (MMST)
The MMST was developed to provide a simple screening procedure for the assessment of cognitive deficits in everyday clinical practice. Since its introduction in 1975, the MMST has proven to be a very reliable test procedure. It is the most widely used diagnostic tool in the diagnosis of Alzheimer’s disease and dementia.
The MMST is ideally suited for measuring the severity of the disease and for monitoring the progress of existing therapy. Cognitive deficits are assessed over a large area using a 30-point system and the following skills are examined: orientation, memory, concentration and arithmetic, speech, understanding hearing and following instructions, and tracing. The mini-mental status test takes about 15 minutes and should be carried out by medical assistants or qualified personnel.
The respondent is first asked about his/her temporal orientation. The date and day of the week, as well as the year, month, day and season should be stated. If it becomes apparent that the respondent is time oriented and directly knows the correct date, it is not necessary to ask for more precise information.
The respondent receives one point for each individual fact. The examination of the spatial orientation is similar. Here, reference is made to the respondent’s current localisation by asking him/her about the country and state, the city, the institution and the floor on which he/she is located.
Then the respondent is given three simple words (e.g. car, flower, candle). He should repeat these directly and keep them in his short-term memory for a moment. A simple arithmetical exercise follows in which the respondent is asked to subtract 7 from 100.
From the result 7 must be subtracted again and so on. Up to 65 the calculation is evaluated. If the respondent does not give the correct result, this is given to him/her so that he/she can continue with the task.
If the respondent is not able to complete the calculation successfully, the word “radio” can alternatively be spelled backwards. In both cases the concentration of the respondent is checked. After The Intermediate Task, the memory test is completed.
For this purpose, the respondent is asked to repeat the words he has just memorised (e.g. car, flower, candle). For each term that is remembered, the test person receives a point. Afterwards, the linguistic skills are tested by naming a wristwatch and a pencil and by repeating any sentence.
This is followed by some instructions in oral form, which are formulated by the tester. For example, the patient should take a sheet of paper in his hand and fold it up. The maximum score to be achieved is 30 points.
For each completed subtask the test person receives one point. Depending on the literature, the threshold value for dementia is between 24 and 26 points. In this context, it is advisable to take into account the everyday competence and statements of the patient and the experiences of the relatives in order to make a goal-oriented diagnosis.
If the score is below 23/24 points, dementia is very likely to exist. The threshold value for moderate dementia is given at 20 points and for severe dementia at 10 points. Antidementia drugs, drugs that counteract dementia, are paid for by the health insurance companies from less than 24 points and up to 10 points.
Evaluation and criticism: The test takes only a short time to perform and evaluate and keeps the burden on the patient as low as possible – clear advantages of this screening procedure. The test covers several diagnostic criteria at once and can be carried out even in cases of the slightest suspicion. In addition, the course of the disease can be monitored with the therapy used.
A disadvantage is the low sensitivity of the test procedure for mild dementia. This means that only few patients who are in the early stages of the disease are tested positive. In addition, a good score in some tasks can conceal the failure in others.
The MMST is very susceptible to disturbing influences. The interview should be conducted in a calm and understanding environment. It provides a rough overview of existing deficits, but does not allow for an exact diagnosis.
Further tests must be carried out for this. In the past it has happened that depressed people have had a bad result in the MMST. In the case of severe depression, cognitive impairment can occur, which must be differentiated from dementia.
