The use of the mini-mental status examination in the ED evaluation of the elderly

This study was done to examine the impact of the mini-mental status examination (MMSE) in the emergency department (ED) evaluation of the elderly patient. The study was a prospective study of the MMSE applied by the investigators with a comparison to the findings of the treating physician, in a university hospital ED with annual volume of 60,000. Participants were a convenience sample of patients older than 65 years of age without apparent mental status abnormality presenting to the ED. Seventy-four patients were entered in the study with 43 exclusions (23 with low educational level, 5 with Glasgow Coma Scale score of <15, and 15 other) leaving 31 cases for analysis. Of the 31 patients, 20 patients had an MMSE score of <24. The MMSE findings agreed with the treating physicians' assessments in 21 (67%) cases. Disagreement occurred in 10 (32%) cases in which the treating physician believed that both the patient's mental status and results of the investigator's MMSE were normal; these 10 cases all involved low MMSE scores as performed by the investigator. When informed of the abnormal MMSE, both the physician's estimate of the patient's mental status and the patient's ED course were altered in all cases. These results show that the MMSE is a valuable screening tool to assess the mental status of the elderly in the ED setting. Unexpected abnormality was noted in a significant minority of patients in this study, altering the patient's course in all instances. The MMSE should be considered in evaluation of all geriatric patients encountered in the ED.