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November 10, 1993

Norms for the Mini-Mental State Examination

Author Affiliations

Boston (Mass) University College of Liberal Arts
Boston (Mass) University School of Medicine

JAMA. 1993;270(18):2178. doi:10.1001/jama.1993.03510180048021

To the Editor.  —Crum et al1 report age- and education-specific norms on the Mini-Mental State Examination (MMSE)2 based on a large community sample. Similar data are also available from the Framingham Study that provide further insight into the usefulness of the MMSE.Since 1982 the cohort participating in the Framingham Study has been screened for dementia with the MMSE as part of every biennial medical examination. Individuals suspected of being cognitively impaired have been further evaluated by a neurologist and neuropsychologist. A panel of two neurologists and a neuropsychologist made a final determination about the presence and subtype of dementia. We are able to confirm the age and education association with the MMSE and also address two acknowledged limitations of the study by Crum et al. Since a clinical diagnosis of dementia was made, our data allow us to comment on the performance of individuals with dementia and