[Mini-mental state examination: proposal of protocol to be used]

The Mini-Mental State Examination (MMSE) is currently one of the most widely used tools for the assessment and screening of cognitive impairment despite a number of issues raised regarding the sensitivity of some subtests and the negative impact of advanced age and poor education. The informal use of invalidated and poor quality translations of the MMSE into Spanish language is widespread, and presumably this further increases some of the uncertainties linked to this test. The result may be misleading, not only as it may overestimate the prevalence of dementia but because it decreases interrater consistency with a view to epidemiological projects. A validated translation of the MMSE into Spanish is therefore much needed. Such a version would not only pay attention to educational and age issues but it would also take into account potential cultural and linguistics inter-community difference of some subtests when specifically applied in Spain which may represent another potential source of inconsistency throughout the country. Furthermore, subtle inhomogeneities in the way the test is administered may result in gross intra-rater and inter-rater variability, hence further decreasing reliability. On the basis of experience gained from a large hospital-based experience in administering the traditional MMSE to neurological patients we propose a standardized version to apply MMSE in Spanish with the alm to improve reliability. This is a preliminary step toward developing a reliable and sensitive Spanish version of the MMSE.