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Invited Commentary
September 2015

Copyright and Bedside Cognitive TestingWhy We Need Alternatives to the Mini-Mental State Examination

Author Affiliations
  • 1Division of Geriatrics, San Francisco Veterans Affairs Medical Center, University of California, San Francisco
JAMA Intern Med. 2015;175(9):1459-1460. doi:10.1001/jamainternmed.2015.2159

“Whan that Aprille, with his shoures soote…”

Geoffrey Chaucer, The Canterbury Tales (in Eliot1[p 11])

Many years ago, a wizened professor forced the distracted students who were fulfilling their freshman English literature requirement to recite from memory the opening lines of Chaucer’s Canterbury Tales in as close to its original pronunciation as we could muster. I remember little else from that class, but even now these lines roll off my tongue. Many readers have a similar relationship with the Mini-Mental State Examination (MMSE). After we memorized it as medical students and recited it as physicians for countless patients, the phrases “Spell WORLD backwards” and “No ifs, ands, or buts” roll off our tongues. The MMSE might be the only cognitive test many ever learned. Why, then, do Tsoi and colleagues2 plaintively ask in this issue of JAMA Internal Medicine whether there is any useful alternative to the MMSE? The question is driven by a copyright controversy that affects practitioners and researchers.

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