Equivalence of Items on the Mini-Mental State

Procedural variations affecting the reliability of the Mini-Mental State (MMS) were investigated in three studies using three different populations. Consistent results were obtained from studies of neurologically normal, at-risk, and im-paired individuals which show that the test item involving serial subtractions is significantly more difficult than the alternative item involving backward spelling. MMS users are cautioned against assuming the comparability of scores across individuals, and should specify which attention and concentration task they employ in their evaluations. The mental status examination (MSE) is frequently used to detect organical-ly based cognitive dysfunction in psychiatric, neurological, and extended care settings and MSE results are often important for initial case formula-tions (Berg, Franzen, & Wedding, 1987; Fields & Starratt, 1985). The use of MSEs is appropriate in evaluating patients with known or suspected CNS dysfunction, cases who have shown abrupt changes in emotional or behav-ioral functioning, as well as with the general psychiatric population. Among the variety of brief, objective, MSEs, the Mini-Mental State (MMS; Folstein, Folstein, & McHugh, 1975) has attracted a good deal o