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Reliability of the MMSE Administered In-Person and by Telehealth

Published online by Cambridge University Press:  02 December 2014

Wendaline McEachern
College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Andrew Kirk*
Division of Neurology, Aging Research & Memory Clinic, University of Saskatchewan
Debra G. Morgan
Institute of Agriculture Rural & Environmental Health, Aging Research & Memory Clinic, University of Saskatchewan
Margaret Crossley
Department of Medicine, Department of Psychology, Aging Research & Memory Clinic, University of Saskatchewan
Carol Henry
Telehealth Department, Saskatoon Health Region, Saskatoon
Division of Neurology, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada.
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Recent advances in telehealth have improved access to health care for those in rural areas. It is important that examinations conducted via telehealth are comparable to in-person testing. A rural and remote memory clinic in Saskatoon provided an opportunity to compare scores on the Mini-Mental State Examination (MMSE) administered in-person and via telehealth.


After an initial one day assessment in Saskatoon, patients were seen in follow-up at 6 and 12 weeks. Individual patients were randomly assigned to either in-person follow-up assessment in Saskatoon or telehealth assessment in their home community. Patients who initially received in-person assessments were seen by telehealth for their next follow-up visit and vice-versa. The same neurologist administered MMSEs at all visits. The first 71 patients with both 6 and 12 week follow-up assessments were included in this study. The scores of in-person and telehealth MMSE administrations were compared using the methods of Bland and Altman as well as a paired t-test.


MMSE scores did not differ significantly between telehealth (22.34 +/- 6.35) and in-person (22.70 +/- 6.51) assessments.


Telehealth provides an acceptable means of assessing mental status of patients in remote areas.



Les progrès récents de la télésanté ont amélioré l'accès aux soins de santé par les habitants des régions rurales. Il est important que les examens effectués via télésanté soient comparables à ceux effectués en personne. Une clinique de la mémoire dans une région rurale éloignée à Saskatoon a fourni l'occasion de comparer les scores du Mini-Mental State Examination (MMSE) administré en personne et via télésanté.


Suite à une évaluation initiale d'une journée à Saskatoon, les patients ont été réévalués 6 et 12 semaines plus tard. Les patients ont été assignés au hasard soit à une évaluation de suivi en personne à Saskatoon ou à une évaluation via télésanté dans leur lieu de résidence. Les patients qui ont reçu initialement des évaluations en personne ont été vus par télésanté à leur visite de suivi subséquente et vice-versa. Le même neurologue administrait le MMSE à toutes les visites. Les premiers 71 patients qui ont eu une évaluation de suivi après 6 et 12 semaines ont été inclus dans cette étude. Les scores au MMSE obtenus en personne et via télésanté ont été comparés au moyen des méthodes de Bland et Altman ainsi que par test de t apparié.


Les scores du MMSE n'étaient pas significativement différents entre les évaluations via télésanté (22,34 ± 6,35) et en personne (22,70 ± 6,51).


La télésanté est un moyen acceptable d'évaluer l'état mental de patients résidant dans des régions éloignées.

Research Article
Copyright © The Canadian Journal of Neurological 2008


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