What should I be aware of if I want to use the Mini Mental State Exam (MMSE) to determine competency to provide consent?

Researchers commonly use the Mini Mental State Exam (MMSE) to screen participants over the age of 65 in order to determine competency to provide consent. For the average healthy 65 year old, this has the potential to be an insulting experience if not administered sensitively. Likewise, learning that you have unexpectedly scored below the cut-off on the MMSE can be frightening. In order to provide some guidance to researchers administering the test, and to make researchers aware of how participants may feel, the REB is suggesting the following as sample wording which could be used prior to administration, and after administration if the participant’s score is below the cut-off.

"The next series of questions is referred to by psychologists and others as the Mini Mental State Exam. It is widely used to determine the ability of the individual being questioned to make decisions regarding their own treatment, for example. This test is administered routinely to anyone taking part in a research project who may be at risk (i.e. may not be able to make decisions for themselves) or individuals who are over the arbitrarily established age of 65. Administration of this test does not mean that we think you are incapable of making your own decisions - it is simply a requirement to protect people who are more vulnerable from being taken advantage of, so please bear with me if you find these questions a bit silly or insulting.”

“Thank you for taking the Mini Mental State Exam. There were several responses you made which did not meet the standard criterion for responses to this test. This means that you will not be able to participate in this research project. I must stress that the MMSE is not a diagnostic tool. Thus your results do not necessarily have any implications regarding your mental or physical health. If you have any questions about the MMSE, or your response, I would advise you to contact your physician to discuss your concerns, since a physician would be more qualified and better able to speak with you about this. I want to thank you for volunteering your time."

For more information about Decision-Making Capacity to Provide Consent see the TCPS2(2018), Chapter 3, Part C.

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