The Modified Mini-Mental State (MMMS) test extends the scope of the Mini-Mental State Examination (MMSE). The 3MS was intended to improve discrimination among different levels of dementia. It offers a brief assessment of attention, concentration, orientation to time and place, long- and short-term memory, language ability, constructional praxis, and abstract thinking. It may be used as a screening test for cognitive loss or as a brief bedside cognitive assessment.
Teng and Chui intended the 3MS to improve sensitivity and specificity of the MMSE by adding items and extending the scoring precision; these changes were also intended to reduce floor and ceiling effects in the MMSE scores.
The 3MS includes the same items as the MMSE from which it was derived, but includes four additional items, and extends the scoring range from a 30-point range for the MMSE to a 100- point range (see Exhibit 8.9). The four new items cover long-term memory (recall of date and place of birth), verbal fluency (naming animals), abstract thinking, and the recall of the three words an additional time (1). The 3MS is administered during an interview, and a correlation of 0.82 has been reported between telephone and in-person administrations (2, p34). Compared with the MMSE, Teng and Chui also provided more detailed instructions for applying and scoring the 3MS, addressing, for example, the surprisingly complex question of how to score the ‘World’ item, which has frequently been scored inconsistently. A considerable debate arose over this issue in a series of letters to the Canadian Journal of Psychiatry and it appears that there is no easy solution (3–5). Teng and Chui’s approach offers a clear, but conservative approach, based on relative order of the letters (6). Gallo offered a guide to scoring based on the idea of “what is the minimum number of moves or changes required to make the reverse spelling accurate?” (4). Teng developed detailed interviewer training materials that even included review questions for testing the interviewers’ understanding of the scale (E. Teng, personal communication, 1993).