Letters MMSE copyright

A copyright-free alternative to the mini-mental state examination is needed

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8589 (Published 21 December 2012) Cite this as: BMJ 2012;345:e8589
  1. Madhavan Seshadri, specialist trainee year 5 in psychiatry 1,
  2. Nadeem Mazi-Kotwal, consultant in old age psychiatry1
  1. 1South Essex Partnership University NHS Foundation Trust, Weller Wing, Bedford Hospital, Bedford MK42 9DJ, UK
  1. seshmadhavan{at}gmail.com

With elderly people being the fastest increasing subgroup of the population in most developed countries, the prevalence of dementia will increase exponentially. Early diagnosis and support will improve quality of life and reduce financial costs to the state.1 2

Folstein’s mini-mental state examination (MMSE) has been used worldwide as a screening tool for dementia for at least the past three decades. Despite its fallacies, its simplicity and ease of use saw it being adopted widely as a standard test for screening, grading, and monitoring the illness.

Globally more than 28 million of the 36 million people with dementia have not received a diagnosis.3 In England and Wales, only 41% (283 000) of people with dementia have a diagnosis,4 and more than 400 000 are undiagnosed.2 4 MMSE was used extensively as a screening tool and to monitor cognitive function after diagnosis. Because of copyright protection, each use of MMSE now costs about £0.80 (€1.00; $1.30).5 The financial implications of this are huge. Health providers like the NHS must look for alternatives or consider paying thousands of pounds for continued use. In addition, some of the other cognitive tests incorporate components of MMSE, compromising their use.

This enforcement of copyright has been criticised for its direct effect on patient care and its timing—the wait for 33 years until the test was widely used. An alternative scale that will be free of copyright problems in the future needs to be developed or identified.


Cite this as: BMJ 2012;345:e8589


  • Competing interests: None declared.


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