Mini-Mental State Exam (MMSE) Copyright

Smith: MMSE Copyright – Page 1

Mini-Mental State Exam (MMSE) Copyright

Marianne Smith, PhD, ARNP, BC

Assistant Professor

University of Iowa College of Nursing

Many healthcare providers are unaware that the Mini Mental State Exam (MMSE) isprotected by copyright. The MMSE was first published in 1975 in the Journal of Psychiatric Research,[1] and the copyright was held by that publisher. In the years since, the MMSE became a widely used and accepted test of cognitive status. In fact, the Alzheimer’s Association describes the MMSE in a fact sheet called “How is Dementia Diagnosed.”[2]However, that fact sheet and other sources such as Wikipedia[3] now include “caution” notes related to copyright, and the need to purchase copies for use from Psychological Assessment Resources (PAR), Inc. of Florida, with current costs at about $1 per form.[4]

How did this happen? Perhaps the best, brief view is provided in a letter to the editor of the American Journal of Psychiatry.[5] Seth Powsner, MD and David Powsner, JD report that after the Journal of Psychiatric Research was purchased by Elsevier,a corporation was formed to license commercial rights to the MMSE and the form is now marketed online by PAR. Posner and Posner liken the current situation to “stealth patents” in which a patent is quietly held until there is a market, and then enforced. As these authors note, some may argue that copyright was lost through lack of enforcement over the years, but that question has yet to be answered in a courtroom.

In the meantime, what should clinicians do? Purchasing the MMSE from PAR is one alternative. Using other mental status examinations is another choice. The question becomes“Which one is best?” One choice is the “Modified Mini Mental State Examination (3MS),” published by Teng and Chui in the Journal of Clinical Psychiatry in 1989.[6] The 3MS builds on the MMSE, adding items and using a finer grade to rate individual items. The result is a 100 point scale that is similar to the MMSE, one that detects dementia,[7] and has been recommended by the American Association of Geriatric Psychiatry for detecting mild cognitive impairment.[8]

Other choices, such as the St. Louis Mental Status Examination (SLUMS)[9] have been developed, and are being tested as an alternative to the MMSE. The good news about the SLUMS is that it is freely available on the web.[10]Certainly, other mental status examinations are also widely available. No matter what scale is selected for use, the best outcomes will continue to rely on the skill of the person who administers and scores the tool. In turn, that relies on understanding how the scale is scored, and using it consistently.

[1] Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.

[2]Alzheimer’s Association. Retrieved March 9. 2006 from

[3] Mini Mental State Examination, Wikipedia. Retrieved March 9, 2007 from

[4]Psychological Assessment Resources, Inc. Retrieved March 9, 2007 from

[5]Powsner, S., Powsner, D. (2005). Cognition, copyright, and the classroom. American Journal of Psychiatry, March; 162, 627-628. PMID 15741491. Free Full Text.

[6] Teng, E.L. & Chui, H.C. (1987). The Modified Mini Mental State (3MS) examination. Journal of Clinical Psychiatry, 48, 314-318.

[7] Bland, R.C. & Newman, S.C. (2001). Mild dementia or cognitive impairment: The Modified Mini Mental State Examination (3MS) as a screen for dementia. Canadian Journal of Psychiatry, 46, 506-510.

[8] Lyketsos, C. (2005). Assessment of mild cognitive impairment. Paper presented at: MCI and Other Non-Dementia Cognitive Conditions: Relevance to Clinical Practice, 2005; Chicago, IL.

[9](March, 2007). A new cognitive assessment tool show promise – and it’s free. ASA Connection. Retrieved March 9, 2007 from

[10]Retrieved March 9, 2007 from