Mini Mental Status Assessment

Today, we have the ability to monitor patients with the use of various technologic means pivotal to the daily assessment / monitoring practices. Despite the advancements, the Mini Mental State Examination (MMSE) created by Folstein and Collegues in 1975 remains the mental status assessment of choice; this method is relatively quick and easy. The assessment screens for and monitors cognitive function while testing a person’s overall orientation, short-term memory and attention, calculation ability, language, and construction. The following will discuss the findings of a MMSE administered to a random patient in a skilled nursing facility.
Patient Introduction The MMSE was administered to Ms. L following a recent hospitalization. Ms. L is 71-year-old
high-school educated female; she has a history of multiple co-morbidities including COPD, sleep apnea, acute-on-chronic CHF, diabetes mellitus type II, hypertension, peripheral vascular disease, obesity, depression, severe spinal stenosis, and urinary retention. She had a Foley catheter in place that was changed monthly by home health services. She was on numerous home medications including MS Contin, Lortab, and Lasix to name a few. Ms. L has a substantial medical history including recurrent hospitalizations for Urosepsis.
History of Event
Ms. L was found unresponsive by her family with a Sp02 of 50% on home oxygen at 2L/min via nasal cannula; she was hypotensive, weak and theady pulses, and had an accucheck of 258. The family reports a snoring like sound coming from the patient as well as a clenched jaw. Ms. L was gray in color and diaphoretic.
Hospitalization
Ms. L was admitted with left-sided status-epilepticus and severe septic shock- multi-system organ failure. She was extubated following an eleven-day ventilation period and was later sent to the skilled-nursing unit for rehab following the 4-week hospital stay. The patient’s family reports, “She is just not the same anymore – her behavior is inconsistent, and she doesn’t remember like she used to.”
Mini-Mental Status Examination The MMSE was administered in a quite environment and took approximately 30 minutes to complete.
The results are as follows: Ms. L was alert and oriented to person and place indicating a decrease in orientation regarding time and situation. Registration was assessed with minimal difficulty noted. Attention and calculation was performed correctly; however, took an extensive amount of time. The patient required reassurance to complete the assessment process. Ms. L was unable to recall any of the three test words identified earlier in the exam; however, was able to complete a portion of the language section yet struggled to read and perform the command; she was able to follow the direction yet took a fair amount of time to process the instructions. Additionally, the drawing of the provided design was moderately
completed.
Interpretation
Following the review of the patient’s MMSE, there is a clear impairment recognized with a moderate cognitive function decline. Based on the findings, the temporal lobe was likely impaired during the hypoxic event as evidenced by memory loss and personality changes described by family. Furthermore, the patient completed the assessment yet would periodically become outwardly frustrated with self and staff. Patient was reassured and reoriented as needed.

Recommendation
Recommendations include follow-up with a neurologist and primary care provider. Ms. L would likely benefit from Speech, Occupational, and physical therapy. A psychological examination should not be ruled out. The patient’s family should be provided educational sessions to assist with any adjustments in the care of their loved one in the future. Finally, a case management consult should be ordered to assist patient and family with future planning needs.
Recognizing Delirium and Mental Illness
One may be able to recognize delirium and mental illness in the patient who also demonstrates cognitive impairment from the MMSE in multiple ways.
First, the patient may experience a sudden change in assessment from one examination to the next. Additionally, these patients may demonstrate frequent fluctuations in mood and behavior. The nurse should take into consideration the patient’s history, physical assessment, and data from family in addition to the MMSE.
When asked to determine whether the findings in the MMSE would present differently in patients with delirium or mental illness the answer is possibly; in my opinion, there is no definitive answer as there are numerous variables to consider in these patients including type of mental illness as well as level of delirium to name a few. The overall goal of treatment in the elderly patient with cognitive impairment, delirium, and mental illness is based on returning the patient to the highest level of function while promoting independence in a safe
environment.
Conclusion
The Mini Mental Status Examination is a vital tool in assessing a patient’s overall cognitive function while monitoring for changes. In the above, we reviewed Ms. L’s medical history as well as the results of her MMSE. There was a clear deficit recognized. The patient can potentially benefit from various interventions including therapy and discharge planning. Her family will likely require assistance with future patient care and would benefit from educational and supportive measures. Ms. L has likely suffered a substantial hypoxic brain injury; extensive treatment is expected; projected results are undeterminable at this time.