The MMS is a valid test of cognitive function. It separates patients with cognitive
disturbance from those without such disturbance. Its scores follow the changes in cognitive
state when and if patients recover. Its scores correlate with a standard test of cognition,
the Wechsler Adult Intelligence Scale (WAIS).
Before considering its uses, it is an elementary but important point that as with any
examination of cognitive performance, the MMS cannot be expected to replace a complete
clinical appraisal in reaching a final diagnosis of any individual patient. Cognitive diffi-
culties arise in a number of different clinical conditions. This is demonstrated by the over-
lapping of scores on the MMS in several categories here. Accurate diagnosis, including
appraisal of the significance of cognitive disabilities documented
in the MMS, depends
on evidence developed from the psychiatric history, the full mental status examination,
the physical status and pertinent laboratory data.
But the MMS does have a number of valuable features for clinical practice even though
it cannot carry alone the diagnostic responsibility.
As it is a quantified assessment of
cognitive state of demonstrable
reliability and validity, it makes more objective what is
commonly a vague and subjective impression of cognitive disability during an assessment
of a patient. It can provide this quantification
easily requiring only a few minutes to com-
plete. It can be repeated during an illness and shows little practice effect. Thus it is ideal
for initial and for serial measurements of this important aspect of mental functioning and
can demonstrate worsening or improvement of this feature over time and with treatment.
As with any other quantified assessment of cognitive function such as the WAIS with
which it correlates so well, the MMS permits comparisons to be drawn between intellectual
changes and other aspects of mental functioning. We have found it particularly useful in
documenting the cognitive disability found in some patients with affective disorder (Post’s
pseudodementia)
and the improvement
of this symptom with appropriate therapy for the
mood disorder. Other applications that demand a quantitative
assessment of cognitive
function might be expected.
The MMS as it is extracted from the clinical examination has an advantage in assessment
of patients and clinical problems not so obvious in tests such as the WAIS that are designed
for other purposes such as prediction of school or occupational performance. Thus failures
in the MMS on orientation, memory, reading and writing have much clearer implications
than do failures in digit symbol, picture completion or vocabulary subtests of the WAIS in
terms of a patients capacity to care for himself. These implications from the MMS score are
easily appreciated by other professionals such as lawyers, judges and social workers con-
cerned with such issues as the patient’s competency to manage his daily affairs. It can
therefore aid in bringing to the patient the social supports that he needs.
Finally we have found the MMS useful in teaching psychiatric residents to become skilful
in the evaluation of the cognitive aspects of the mental status. It provides them with a
standard set of questions replacing what is often a bewildering variety of individual ap-
proaches. Those questions that it employs have obvious clinical pertinence and cover most
of the categories of cognitive disability. Since it can be done quickly and gives a score it
draws the resident’s attention to global improvements or declines in cognitive state. It also
though because special attention is focused on memory and language functions will reveal