Mini-Mental State Examination Scores in Dementia and Capacity Assessment: A Narrative Review

Background The Mini-Mental State Examination (MMSE) is widely used in older adults, but its numerical score is sometimes overinterpreted in dementia diagnosis and capacity assessment. This review examined the hypothesis that the MMSE provides screening information but cannot diagnose dementia or determine decision-specific capacity. Methods This narrative review synthesized PubMed-indexed evidence concerning diagnostic accuracy, dementia criteria, alternative screens, and cultural, literacy, sensory, and capacity-related influences. Results MMSE performance modifies diagnostic probability but does not establish a diagnosis of dementia. Accuracy varies with threshold, setting, education, language, culture, clinical stage, sensory status, and prevalence. Alternative screens sample cognition differently but require contextual interpretation. Patient agreement, voluntary participation, and standardized administration are necessary; sensory barriers or incomplete testing may render a score uninterpretable. Capacity assessment requires evaluation of understanding, appreciation, reasoning, choice, consequences, and context. Conclusions MMSE findings should be integrated with clinical, functional, sensory, collateral, and decision-specific evidence, not used alone.