The validity of using the mini mental state examination in NICE dementia guidelines

The mini mental state examination (MMSE) is widely used as a rapid means of quantifying cognitive function.1 The National Institute for Clinical Excellence (NICE) guidelines concerning the use of cholinesterase inhibitors (CI) in Alzheimer’s disease recommend using the MMSE as quantifiable measure to inform decisions regarding initiation and continuation of drug treatment.2 Our study questions whether poor interrater reliability of the MMSE makes it an inappropriate tool for monitoring drug response. A postal survey evaluating the MMSE section termed “attention and calculation” was conducted among all consultant neurologists in the UK. The original instructions regarding this section involve asking the patient to count backwards in sevens from 100 for five subtractions, or, if the patient “cannot or will not perform this task” to spell “WORLD” backwards, scoring the number of letters in the correct order.1 Of the 407 questionnaires sent, there were 234 (58%) …