Instrument template · CognitionUpdated September 28, 2026

MMSE eCRF template for eligibility and follow-up

The Mini-Mental State Examination is still the most common cognitive entry criterion in dementia trials. Capture the section scores and total in a structured form, with range checks and the attention task used recorded at every visit.

  • 11 section scores
  • Eligibility range checks
  • Attention task recorded

Free sandbox · No credit card · 21 CFR Part 11 aligned

MMSE · Screening
Subject 004-0033 · Protocol range 20 to 26Query open

Orientation to time (0 to 5)

4

Orientation to place (0 to 5)

5

Attention task used

Serial sevensWORLD backwards

Attention and calculation (0 to 5)

3

Total score (0 to 30)

19

Below protocol range 20 to 26

Eligibility range flagged at entry

MMSE at a glance

  • Published by Folstein, Folstein and McHugh in 1975. 30 points across orientation, registration, attention and calculation, recall, language and copying, in about 5 to 10 minutes.
  • Commonly used severity ranges: 24 to 30 no significant impairment, 18 to 23 mild, 0 to 17 severe, though conventions differ and scores are influenced by age and education.
  • Many Alzheimer's disease trials use an MMSE range (for example 20 to 26 for mild disease) as an eligibility criterion.
  • The attention item can use serial sevens or spelling WORLD backwards. Record which one was used and keep it consistent.
  • The MMSE is copyrighted and licensed (the rights are held by PAR). Obtain official forms before use.

The instrument

Why the MMSE is still everywhere

Half a century after publication, the MMSE remains the reference point that clinicians, ethics committees and regulators recognise for overall cognitive severity. Its familiarity is its main advantage in trials: an MMSE range in the inclusion criteria tells everyone roughly which stage of disease the study enrols, and results can be compared with decades of published data.

Its limitations are equally well known. It has ceiling effects in people with high education and mild impairment, it is less sensitive to executive dysfunction than the MoCA, and it changes too slowly to serve as a primary efficacy endpoint in most modern trials. That is why it tends to appear at screening and as a secondary or staging measure, with longer scales such as the ADAS-Cog carrying efficacy.

Scoring

Each section score is added to give a total of 0 to 30; lower means more impairment. Because education, age and language all affect scores, some studies apply adjusted cut-offs. Write the exact eligibility range and any adjustment into the protocol and use the same rule at every site.

Serial sevens or WORLD

The attention and calculation item can be administered as serial subtraction of seven from 100 or as spelling WORLD backwards. The two are not interchangeable in difficulty, so studies should specify which is used and the eCRF should record it at each administration.

MMSE total · Subject 004-0033

Screening total

19 / 30

Mild
0-17 Severe18-23 Mild24-30 No significant impairment
One commonly used convention

Structure

MMSE sections and points

SectionMax pointseCRF field
Orientation to time5Number, 0 to 5
Orientation to place5Number, 0 to 5
Registration (three words)3Number, 0 to 3
Attention and calculation5Number, 0 to 5, plus task used
Recall (three words)3Number, 0 to 3
Naming2Number, 0 to 2
Repetition1Number, 0 to 1
Three-stage command3Number, 0 to 3
Reading1Number, 0 to 1
Writing1Number, 0 to 1
Copying (intersecting pentagons)1Number, 0 to 1
Total30Number, 0 to 30, with eligibility range check

Structure only. Obtain the official MMSE forms and licence from the rights holder.

Eligibility

Screen-fail on the total, not on a typo

Put the protocol range on the total as a range edit check. A total outside the range raises an auto-query straight away, so the site either confirms the participant is ineligible or catches an arithmetic mistake before the screening visit ends. The eligibility form then records the criterion as met or not met.

  • Range checks on every section and on the total.
  • Auto-query with priority when the total falls outside the protocol range.
  • Linked to the eligibility screening form.
Vital signs · Systolic blood pressure

Edit checks / auto-queries

2
Auto-query

Type

Range High

Operator

Greater than

Value

180

Priority: High

Auto-query

Type

Range Low

Operator

Less than

Value

80

Priority: Normal

Query raised automatically

Value 192 violates limit (180). Please verify.

Licensing

Licensed instrument, licence on record

Because the MMSE is licensed, record the licence details on the form in Capture: licence number, holder and expiry. The form carries a staff-only watermark until the licence is recorded, and new data collection stops if it lapses.

PROMIS SF v1.0 · Fatigue 8a · Settings

Copyright & licence

Approval pending
Licence required

Licence number

Not recorded

Expiry date

Not recorded

Watermark shown to staff only. Participants never see it.

Try an MMSE eligibility check in the sandbox

Build the sections, set your protocol range and enter a sample total below it.

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Before go-live

MMSE form checklist

Licence and official forms obtained

Record licence details on the form in Capture.

Attention task specified

Serial sevens or WORLD, the same for everyone, recorded each time.

Eligibility range on the total

Range check matching the inclusion criterion exactly.

Rater training

Standardise administration and scoring across sites before first participant.

Source documents defined

The completed test sheet is the source; the eCRF records scores.

SDV scope

Verify the total and the sections most prone to scoring error.

In dementia trials

How the MMSE is used across a dementia program

In most Alzheimer's disease programs the MMSE does three jobs. At screening it defines the disease stage the trial enrols, usually as a range of total scores in the inclusion criteria. During the study it can describe how the population progresses, as a secondary or supportive measure. And across a program it gives a common language for comparing populations between trials.

Its practice effects are smaller than those of word-list-heavy tests, but repeated administration still produces some learning, particularly in people with mild impairment. Studies that give the MMSE often should keep the interval consistent and record any deviation from standard administration.

Eligibility ranges and rescreening

Participants near the boundary of an eligibility range may score in range on one day and out of range on another. If the protocol allows rescreening, record the first attempt as a screen failure and the rescreen as a new screening, as the eligibility screening template does, so the history is visible.

FAQ

Questions about this template

Something not covered here? Ask us directly.

How is the MMSE scored?

Eleven section scores are summed for a total of 0 to 30. Lower scores mean more cognitive impairment.

What MMSE score indicates dementia?

One commonly used convention is 24 to 30 no significant impairment, 18 to 23 mild and 0 to 17 severe, but cut-offs vary and are affected by age and education. Trials define their own ranges in the protocol.

Is the MMSE free to use?

No. It is copyrighted and licensed. Obtain official forms and permission from the rights holder.

Should I use serial sevens or WORLD?

Either is acceptable, but they are not equivalent in difficulty. Pick one, write it into the protocol and record it on the eCRF.

Can the eCRF flag ineligible scores?

Yes. A range edit check on the total raises an auto-query when the score is outside the protocol range.

MMSE or MoCA?

The MoCA is more sensitive to mild cognitive impairment; the MMSE has a longer history in Alzheimer's disease trials. Many programs use one for eligibility and a longer scale for efficacy.

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