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titleInformation for Reviewers

Text in black is part of the template used to create this document and is not revised under CDISC internal or public review. Please review the blue text; this text represents the changes made to the template that are specific to this QRS instrument.

Page properties
Title

Mini-Mental State Examination (MMSE)

CDISC ReferenceFunctional Test Supplement to the Study Data Tabulation Model Implementation Guide for Human Clinical Trials
QRS Short Name

MMSE

QRS Permission StatusApproved
TeamCDISC Questionnaires, Ratings, and Scales (QRS) Subteam
Supplement Version1.0
StatusDRAFT
Date2023-09-07-19
Notes to ReadersThis supplement is intended to be used with other CDISC user guides for specific therapeutic/disease areas and follows the CDISC Study Data Tabulation Model Implementation Guide for Human Clinical Trials.

...

Revision History

DateVersion
2023-09-07-191.0 Draft

© 2023 Clinical Data Interchange Standards Consortium, Inc. All rights reserved. 

...

 CDISC did not modify this questionnaires, ratings, and scales (QRS) instrument to meet Clinical Data Acquisition Standards Harmonization (CDASH) case report form (CRF) standards. The PAR provided CRF has updated the item names represented on the CRF that were described in the original reference.

The representation of data collected for this instrument is based on the Study Data Tabulation Model Implementation Guide (SDTMIG) Functional Tests (FT) domain model, which can be found at the CDISC website at: https://www.cdisc.org/standards/foundational/sdtmig.

These The specific implementation details for this instrument are meant to be used in conjunction with the SDTMIG. All CDISC QRS documentation packages can be found on the CDISC web site at: https://www.cdisc.org/standards/foundational/qrs.

...

CDISC specifies how to structure the data that has been collected in a database, not what should be collected or how to conduct clinical assessments or implement protocols. CDISC disclaims any liability for your use of this material.

...

CDISC acknowledges R. Bob Smith III, PhD, Chairman and CEO Psychological Assessment Resources, Inc., for the approval to include the MMSE in the CDISC data standards.

References for the MMSE:

  • Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189‒198.
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  • The PAR website reference for the MMSE is: https://www.parinc.com/Products/Pkey/237.

3 The FT Domain Model

3.1 Assumptions for FT Domain Model

...

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     The scale points original scores include a numeric rating (0-1) and a description of what is represented by the rating (e.g., 0 = "INCORRECT", 1 = "CORRECT"). For the Serial 7s and WORLD questions, the numeric rating is 0-5, and subtotal for subscore for either one of the two sets of questions used is represented by FTTESTCD = "MMS104". For the MMSE, FTORRES is populated with the text description of "INCORRECT" or "CORRECT". The numeric rating is represented in FTSTRESC and FTSTRESN. The actual result answers to each question are not represented in the dataset; only whether the answer is "CORRECT" or "INCORRECT" is represented

  2. Items are divided into 11 subcategories represented in FTSCAT: "ORIENTATION TO TIME", "ORIENTATION TO PLACE", "REGISTRATION", "ATTENTION AND CALCULATION", "RECALL", "NAMING", "REPETITION", "COMPREHENSION", "READING", "WRITING", and "DRAWING".
  3. One item on the MMSE may be conditionally branched per the instrument instructions. Alternative As described on the CRF, an alternative item (spell WORLD backward) should only be administered if the examinee refuses to perform the Serial 7s task. A record is created in rs.xpt for all items. When an item is considered a conditionally branched item, it is represented as follows:

    1. QNAM = “QSCBRFL”, QLABEL = “Conditional Branched Item Indicator Flag “, QVAL = “Y” (this is a QS supplemental qualifier variable related to the record).
    2. QSORRES, QSSTRESC, and QSSTRESN are set to null (missing).
    3. QSREASND = "SUBJECT REFUSED TO ANSWER"
  4. Records are created in qs.xpt for every collected item on the instrument

    1. For items with no data, QSORRES, QSSTRESC, and QSSTRESN are all missing and QSSTAT = "NOT DONE". If the reason is known then that reason is represented in QSREASND (e.g., QSREASND = "PREFER NOT TO ANSWER"). If the reason is unknown, then QSSTAT = "NOT DONE" and QSREASND is missing.

    2. Due to the variability of copyright holder and public domain derived subscore and overall score generation processes, records are not included for derived subscores or total and overall scores that are not provided.
  5. The MMSE instrument includes subtotalsubscore

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    and total scores overall score that are considered as captured data on the CRF and is not considered as derived in the example below.   These scores may be submitted in SDTM or derived in the Analysis Data Model (ADaM) per scoring instructions from the CRF.
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    1. Subtotal Subscore and total overall scores are represented in--ORRES, --STRESC, and --STRESN.
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    2. If subscores or overall scores are received by the sponsor, it is recommended that they are submitted to SDTM and SDTM and verified in ADaM.
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      It is the sponsors repsonsibility to do this verificstin verification based on the instrument's user usesr manual or instructiosn instructions from the copyright owner.
  6. Terminology:
    1. FTCAT, FTTESTCD, and FTTEST values are included in CDISC controlled terminology.

    2. A full list of value sets for result field is provided in Section 4, SDTM Mapping Strategy.

...

The table represents the items, subtotalsubscore, and total scores from the MMSE instrument. USUBJID = "2324-P0001" performed the Serial 7s portion of the MMSE. USUBJID = "2324-P0002" refused the Serial 7s portion of the MMSE but performed the WORLD spelled backwards portion instead. USUBJID="2324-P0003" did not perform the MMSE at the scheduled visit.

Dataset wrap
Nameft
Dataset2
RowSTUDYIDDOMAINUSUBJIDFTSEQFTTESTCDFTTESTFTCATFTSCATFTORRESFTSTRESCFTSTRESNFTSTATFTREASNDFTLOBXFLVISITNUMFTDTC
1STUDYXFT2324-P00011MMS101AMMS1-What Is the YearMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
2STUDYXFT2324-P00012MMS101BMMS1-What Is the SeasonMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
3STUDYXFT2324-P00013MMS101CMMS1-What Is the Month of YearMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
4STUDYXFT2324-P00014MMS101DMMS1-What Is the Day of WeekMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
5STUDYXFT2324-P00015MMS101EMMS1-What Is the DateMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
6STUDYXFT2324-P00016MMS102AMMS1-What Is the StateMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
7STUDYXFT2324-P00017MMS102BMMS1-What Is the CountyMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
8STUDYXFT2324-P00018MMS102CMMS1-What Is the City/TownMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
9STUDYXFT2324-P00019MMS102DMMS1-What Is the BuildingMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
10STUDYXFT2324-P000110MMS102EMMS1-What Is the FloorMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
11STUDYXFT2324-P000111MMS103AMMS1-Repeat Word 1MMSEREGISTRATIONCORRECT11

Y12015-05-15
12STUDYXFT2324-P000112MMS103BMMS1-Repeat Word 2MMSEREGISTRATIONCORRECT11

Y12015-05-15
13STUDYXFT2324-P000113MMS103CMMS1-Repeat Word 3MMSEREGISTRATIONCORRECT11

Y12015-05-15
14STUDYXFT2324-P000114MMS104AAMMS1-What is 100 Take Away 7MMSEATTENTION AND CALCULATIONCORRECT11

Y12015-05-15
15STUDYXFT2324-P000115MMS104ABMMS1-Keep Subtracting 7 Step 2
Jira
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MMSEATTENTION AND CALCULATIONCORRECT11

Y12015-05-15
16STUDYXFT2324-P000116MMS104ACMMS1-Keep Subtracting 7 Step 3MMSEATTENTION AND CALCULATIONCORRECT11

Y12015-05-15
17STUDYXFT2324-P000117MMS104ADMMS1-Keep Subtracting 7 Step 4MMSEATTENTION AND CALCULATIONINCORRECT00

Y12015-05-15
18STUDYXFT2324-P000118MMS104AEMMS1-Keep Subtracting 7 Step 5MMSEATTENTION AND CALCULATIONINCORRECT00

Y12015-05-15
19STUDYXFT2324-P000119MMS104BAMMS1-Spell Backward Letter 1MMSEATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMSUBJECT REFUSED TO ANSWERY12015-05-15
20STUDYXFT2324-P000120MMS104BBMMS1-Spell Backward Letter 2MMSEATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMSUBJECT REFUSED TO ANSWERY12015-05-15
21STUDYXFT2324-P000121MMS104BCMMS1-Spell Backward Letter 3MMSEATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMSUBJECT REFUSED TO ANSWERY12015-05-15
22STUDYXFT2324-P000122MMS104BDMMS1-Spell Backward Letter 4MMSEATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMSUBJECT REFUSED TO ANSWERY12015-05-15
23STUDYXFT2324-P000123MMS104BEMMS1-Spell Backward Letter 5MMSEATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMSUBJECT REFUSED TO ANSWERY12015-05-15
24STUDYXFT2324-P000124MMS104
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MMS1-Attention and Calculation SubtotalMMSEATTENTION AND CALCULATION333

Y12015-05-15
25STUDYXFT2324-P000125MMS105AMMS1-Recall Word 1MMSERECALLCORRECT11

Y12015-05-15
26STUDYXFT2324-P000126MMS105BMMS1-Recall Word 2MMSERECALLCORRECT11

Y12015-05-15
27STUDYXFT2324-P000127MMS105CMMS1-Recall Word 3MMSERECALLCORRECT11

Y12015-05-15
28STUDYXFT2324-P000128MMS106AMMS1-Naming Object 1MMSENAMINGCORRECT11

Y12015-05-15
29STUDYXFT2324-P000129MMS106BMMS1-Naming Object 2MMSENAMINGINCORRECT00

Y12015-05-15
30STUDYXFT2324-P000130MMS107MMS1-Repeat What I SayMMSEREPETITIONCORRECT11

Y12015-05-15
31STUDYXFT2324-P000131MMS108AMMS1-Take in Right HandMMSECOMPREHENSIONCORRECT11

Y12015-05-15
32STUDYXFT2324-P000132MMS108BMMS1-Fold in HalfMMSECOMPREHENSIONCORRECT11

Y12015-05-15
33STUDYXFT2324-P000133MMS108CMMS1-Put on Floor (or Table)MMSECOMPREHENSIONCORRECT11

Y12015-05-15
34STUDYXFT2324-P000134MMS109MMS1-Read This and Do What It SaysMMSEREADINGINCORRECT00

Y12015-05-15
35STUDYXFT2324-P000135MMS110MMS1-Write a SentenceMMSEWRITINGCORRECT11

Y12015-05-15
36STUDYXFT2324-P000136MMS111MMS1-Copy This DesignMMSEDRAWINGINCORRECT00

Y12015-05-15
37STUDYXFT2324-P000137MMS112MMS1-Total ScoreMMSE
252525

Y12015-05-15
38STUDYXFT2324-P000138MMS113MMS1-Level of ConsciousnessMMSE
Alert/ResponsiveAlert/Responsive.

Y12015-05-15
39STUDYXFT2324-P00021MMS101AMMS1-What Is the YearMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
40STUDYXFT2324-P00022MMS101BMMS1-What Is the SeasonMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
41STUDYXFT2324-P00023MMS101CMMS1-What Is the Month of YearMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
42STUDYXFT2324-P00024MMS101CMMS1-What Is the Month of YearMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
43STUDYXFT2324-P00025MMS101DMMS1-What Is the Day of WeekMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
44STUDYXFT2324-P00026MMS101EMMS1-What Is the DateMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
45STUDYXFT2324-P00027MMS102AMMS1-What Is the StateMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
46STUDYXFT2324-P00028MMS102BMMS1-What Is the CountyMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
47STUDYXFT2324-P00029MMS102CMMS1-What Is the City/TownMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
48STUDYXFT2324-P000210MMS102DMMS1-What Is the BuildingMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
49STUDYXFT2324-P000211MMS102EMMS1-What Is the FloorMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
50STUDYXFT2324-P000212MMS103AMMS1-Repeat Word 1MMSEREGISTRATIONCORRECT11

Y12015-05-15
51STUDYXFT2324-P000213MMS103BMMS1-Repeat Word 2MMSEREGISTRATIONCORRECT11

Y12015-05-15
52STUDYXFT2324-P000214MMS103CMMS1-Repeat Word 3MMSEREGISTRATIONCORRECT11

Y12015-05-15
53STUDYXFT2324-P000215MMS104AAMMS1-What is 100 Take Away 7MMSEATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEM

SUBJECT REFUSED TO ANSWER

Jira
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serverIssue Tracker (JIRA)
serverId85506ce4-3cb3-3d91-85ee-f633aaaf4a45
keyQRSSUPP-635

Y12015-05-15
54STUDYXFT2324-P000216MMS104ABMMS1-Keep Subtracting 7 Step 2MMSEATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMSUBJECT REFUSED TO ANSWERY12015-05-15
55STUDYXFT2324-P000217MMS104ACMMS1-Keep Subtracting 7 Step 3MMSEATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMSUBJECT REFUSED TO ANSWERY12015-05-15
56STUDYXFT2324-P000218MMS104ADMMS1-Keep Subtracting 7 Step 4MMSEATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMSUBJECT REFUSED TO ANSWERY12015-05-15
57STUDYXFT2324-P000219MMS104AEMMS1-Keep Subtracting 7 Step 5MMSEATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMSUBJECT REFUSED TO ANSWERY12015-05-15
58STUDYXFT2324-P000220MMS104BAMMS1-Spell Backward Backward  Letter 1MMSEATTENTION AND CALCULATIONCORRECT11

Y12015-05-15
59STUDYXFT2324-P000221MMS104BBMMS1-Spell Backward Letter 2MMSEATTENTION AND CALCULATIONCORRECT11

Y12015-05-15
60STUDYXFT2324-P000222MMS104BCMMS1-Spell Backward Letter 3MMSEATTENTION AND CALCULATIONINCORRECT00

Y12015-05-15
61STUDYXFT2324-P000223MMS104BDMMS1-Spell Backward Letter 4MMSEATTENTION AND CALCULATIONINCORRECT00

Y12015-05-15
62STUDYXFT2324-P000224MMS104BEMMS1-Spell Backward Letter 5MMSEATTENTION AND CALCULATIONCORRECT11

Y12015-05-15
63STUDYXFT2324-P000225MMS104MMS1-Attention and Calculation SubtotalMMSEATTENTION AND CALCULATION333

Y

Jira
serverIssue Tracker (JIRA)
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2015-05-15
64STUDYXFT2324-P000226MMS105AMMS1-Recall Word 1MMSERECALLCORRECT11

Y12015-05-15
65STUDYXFT2324-P000227MMS105BMMS1-Recall Word 2MMSERECALLCORRECT11

Y12015-05-15
66STUDYXFT2324-P000228MMS105CMMS1-Recall Word 3MMSERECALLCORRECT11

Y12015-05-15
67STUDYXFT2324-P000229MMS106AMMS1-Naming Object 1MMSENAMINGCORRECT11

Y12015-05-15
68STUDYXFT2324-P000230MMS106BMMS1-Naming Object 2MMSENAMINGINCORRECT00

Y12015-05-15
69STUDYXFT2324-P000231MMS107MMS1-Repeat What I SayMMSEREPETITIONCORRECT11

Y12015-05-15
70STUDYXFT2324-P000232MMS108AMMS1-Take in Right HandMMSECOMPREHENSIONCORRECT11

Y12015-05-15
71STUDYXFT2324-P000233MMS108BMMS1-Fold in HalfMMSECOMPREHENSIONCORRECT11

Y12015-05-15
72STUDYXFT2324-P000234MMS108CMMS1-Put on Floor (or Table)MMSECOMPREHENSIONCORRECT11

Y12015-05-15
73STUDYXFT2324-P000235MMS109MMS1-Read This and Do What It SaysMMSEREADINGINCORRECT00

Y12015-05-15
74STUDYXFT2324-P000236MMS110MMS1-Write a SentenceMMSEWRITINGCORRECT11

Y12015-05-15
75STUDYXFT2324-P000237MMS111MMS1-Copy This DesignMMSEDRAWINGINCORRECT00

Y12015-05-15
76STUDYXFT2324-P000238MMS112MMS1-Total ScoreMMSE
262626

Y12015-05-15
77STUDYXFT2324-P000239MMS113MMS1-Level of ConsciousnessMMSE
DrowsyDrowsy.

Y12015-05-15
78STUDYXFT2324-P00031MMS101AMMS1-What Is the YearMMSEORIENTATION TO TIME


NOT DONE

12015-05-15
79STUDYXFT2324-P00032MMS101BMMS1-What Is the SeasonMMSEORIENTATION TO TIME


NOT DONE

12015-05-15
80STUDYXFT2324-P00033MMS101CMMS1-What Is the Month of YearMMSEORIENTATION TO TIME


NOT DONE

12015-05-15
81STUDYXFT2324-P00034MMS101DMMS1-What Is the Day of WeekMMSEORIENTATION TO TIME


NOT DONE

12015-05-15
82STUDYXFT2324-P00035MMS101EMMS1-What Is the DateMMSEORIENTATION TO TIME


NOT DONE

12015-05-15
83STUDYXFT2324-P00036MMS102AMMS1-What Is the StateMMSEORIENTATION TO PLACE


NOT DONE

12015-05-15
84STUDYXFT2324-P00037MMS102BMMS1-What Is the CountyMMSEORIENTATION TO PLACE


NOT DONE

12015-05-15
85STUDYXFT2324-P00038MMS102CMMS1-What Is the City/TownMMSEORIENTATION TO PLACE


NOT DONE

12015-05-15
86STUDYXFT2324-P00039MMS102DMMS1-What Is the BuildingMMSEORIENTATION TO PLACE


NOT DONE

12015-05-15
87STUDYXFT2324-P000310MMS102EMMS1-What Is the FloorMMSEORIENTATION TO PLACE


NOT DONE

12015-05-15
88STUDYXFT2324-P000311MMS103AMMS1-Repeat Word 1MMSEREGISTRATION


NOT DONE

12015-05-15
89STUDYXFT2324-P000312MMS103BMMS1-Repeat Word 2MMSEREGISTRATION


NOT DONE

12015-05-15
90STUDYXFT2324-P000313MMS103CMMS1-Repeat Word 3MMSEREGISTRATION


NOT DONE

12015-05-15
91STUDYXFT2324-P000314MMS104AAMMS1-What is 100 Take Away 7MMSEATTENTION AND CALCULATION


NOT DONE

12015-05-15
92STUDYXFT2324-P000315MMS104ABMMS1-Keep Subtracting 7 Step 2MMSEATTENTION AND CALCULATION


NOT DONE

12015-05-15
93STUDYXFT2324-P000316MMS104ACMMS1-Keep Subtracting 7 Step 3MMSEATTENTION AND CALCULATION


NOT DONE

12015-05-15
94STUDYXFT2324-P000317MMS104ADMMS1-Keep Subtracting 7 Step 4MMSEATTENTION AND CALCULATION


NOT DONE

12015-05-15
95STUDYXFT2324-P000318MMS104AEMMS1-Keep Subtracting 7 Step 5MMSEATTENTION AND CALCULATION


NOT DONE

12015-05-15
96STUDYXFT2324-P000319MMS104BAMMS1-Spell Backward Letter 1MMSEATTENTION AND CALCULATION


NOT DONE

12015-05-15
97STUDYXFT2324-P000320MMS104BBMMS1-Spell Backward Letter 2MMSEATTENTION AND CALCULATION


NOT DONE

12015-05-15
98STUDYXFT2324-P000321MMS104BCMMS1-Spell Backward Letter 3MMSEATTENTION AND CALCULATION


NOT DONE

12015-05-15
99STUDYXFT2324-P000322MMS104BDMMS1-Spell Backward Letter 4MMSEATTENTION AND CALCULATION


NOT DONE

12015-05-15
100STUDYXFT2324-P000323MMS104BEMMS1-Spell Backward Letter 5MMSEATTENTION AND CALCULATION


NOT DONE

12015-05-15
101STUDYXFT2324-P000324MMS104MMS1-Attention and Calculation SubtotalMMSEATTENTION AND CALCULATION


NOT DONE

12015-05-15
102STUDYXFT2324-P000325MMS105AMMS1-Recall Word 1MMSERECALL


NOT DONE

12015-05-15
103STUDYXFT2324-P000326MMS105BMMS1-Recall Word 2MMSERECALL


NOT DONE

12015-05-15
104STUDYXFT2324-P000327MMS105CMMS1-Recall Word 3MMSERECALL


NOT DONE

12015-05-15
105STUDYXFT2324-P000328MMS106AMMS1-Naming Object 1MMSENAMING


NOT DONE

12015-05-15
106STUDYXFT2324-P000329MMS106BMMS1-Naming Object 2MMSENAMING


NOT DONE

12015-05-15
107STUDYXFT2324-P000330MMS107MMS1-Repeat What I SayMMSEREPETITION


NOT DONE

12015-05-15
108STUDYXFT2324-P000331MMS108AMMS1-Take in Right HandMMSECOMPREHENSION


NOT DONE

12015-05-15
109STUDYXFT2324-P000332MMS108BMMS1-Fold in HalfMMSECOMPREHENSION


NOT DONE

12015-05-15
110STUDYXFT2324-P000333MMS108CMMS1-Put on Floor (or Table)MMSECOMPREHENSION


NOT DONE

12015-05-15
111STUDYXFT2324-P000334MMS109MMS1-Read This and Do What It SaysMMSEREADING


NOT DONE

12015-05-15
112STUDYXFT2324-P000335MMS110MMS1-Write a SentenceMMSEWRITING


NOT DONE

12015-05-15
113STUDYXFT2324-P000336MMS111MMS1-Copy This DesignMMSEDRAWING


NOT DONE

12015-05-15
114STUDYXFT2324-P000337MMS112MMS1-Total ScoreMMSE



NOT DONE

12015-05-15
115STUDYXFT2324-P000338MMS113MMS1-Level of ConsciousnessMMSE



NOT DONE

12015-05-15

...