Development of a digital version of the Mini-Mental State Examination for children: a multidisciplinary study
Abstract
Introduction: Cognitive assessment of children is essential to identify deficits and plan appropriate interventions. Objective: This paper presents the development of a digital version of the Mini-Mental State Examination for Children (MMC), aiming to make it more accessible to children with motor impairments, such as those with cerebral palsy. Methodology or Steps: Using a simple lifecycle model (discovering requirements, designing alternatives, prototyping, and evaluating), a high-fidelity prototype was created. Results: Testing showed strong acceptance among healthcare professionals, with 100% considering the content appropriate and an average System Usability Scale (SUS) score of 85, indicating good usability. The digital version improves accessibility, reduces motor barriers, and enhances result standardization.
Keywords:
Mini-Mental State Examination, Children, Accessibility, Usability, Cognitive Tests
References
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Balestrino, M., Brugnolo, A., Girtler, N., Pardini, M., Rizzetto, C., Alì, P., Cocito, L., e Schiavetti, I. (2024). Cognitive impairment assessment through handwriting (cogitat) score: a novel tool that predicts cognitive state from handwriting for forensic and clinical applications. Frontiers in Psychology, 28(15):1275315.
Brooke, J. et al. (1996). Sus-a quick and dirty usability scale. Usability evaluation in industry, 189(194):4–7.
Cainelli, E., Giacomo, D. L. D., Mantegazza, G., Vedovelli, L., Favaro, J., e Boniver, C. (2020). Prognostic role of Mini-Mental State Pediatric Examination (MMSPE) on neuropsychological functioning. Neurological Sciences, 41(3):619–623.
Chen, L., Zhang, M., Yu, W., et al. (2024). A fully automated mini-mental state examination assessment model using computer algorithms for cognitive screening. Journal of Alzheimer’s Disease, 97(4):1661–1672.
Ciemins, E. L., Holloway, B., Coon, P. J., McClosky-Armstrong, T., e Min, S.-J. (2009). Telemedicine and the mini-mental state examination: assessment from a distance. Telemedicine and e-Health, 15(5):476–478.
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Folstein, M. F., Folstein, S. E., e McHugh, P. R. (1975). “Mini-mental state": A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3):189–198.
Ibrahim, B. A., Hussein, S. A., e Abdullah, W. H. (2023). Cognitive functions in children with type i diabetes. Wiadomości Lekarskie (Medical Advances), 76(5):944–950. Original Article.
Jain, M. e Passi, G. R. (2005). Assessment of a modifed mini-mental scale for cognitive functions in children. Indian Pediatrics, 42(9):907–912. Clinical Trial; Validation Study.
Lazar, J., Feng, J. H., e Hochheiser, H. (2017). Research Methods in Human-Computer Interaction. Morgan Kaufmann, Cambridge, MA, 2 edition.
Luciana, M. e Nelson, C. A. (2002). Assessment of neuropsychological function through use of the cambridge neuropsychological testing automated battery: Performance in 4- to 12-year-old children. Developmental Neuropsychology, 22(3):595–624. PMID: 12661972.
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Nielsen, J. (1994a). Enhancing the explanatory power of usability heuristics. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’94, page 152–158, New York, NY, USA. Association for Computing Machinery.
Nielsen, J. (1994b). Heuristic Evaluation, page 25–62. John Wiley & Sons, Inc., USA.
Nielsen, J. e Molich, R. (1990). Heuristic evaluation of user interfaces. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’90, page 249–256, New York, NY, USA. Association for Computing Machinery.
Preece, J., Rogers, Y., e Sharp, H. (2002). Interaction Design: Beyond Human-Computer Interaction. John Wiley & Sons, New York, NY, 1 edition.
Preece, J., Sharp, H., e Rogers, Y. (2023). Interaction Design: Beyond Human-Computer Interaction. John Wiley & Sons, Hoboken, NJ, 6 edition.
Ricardo, M., Oliveira, A. P. M., Bueno, F. P. L., Oliveira, F. F., de Souza, S. L., Santos, C. M. R., e Geraldi, H. V. (2017). Mini-mental state exam for children (MMC) in children with hemiplegic cerebral palsy. Dementia & Neuropsychologia, 11:287–296.
Rubin, J. e Chisnell, D. (2008). Handbook of Usability Testing: How to Plan, Design, and Conduct Effective Tests. Wiley Publishing, Inc., Indianapolis, IN, 2 edition.
Sauro, J. e Lewis, J. R. (2016). Quantifying the User Experience: Practical Statistics for User Research. Morgan Kaufmann, Waltham, MA, 2 edition.
Scarpa, P., Toraldo, A., Peviani, V., e Bottini, G. (2017). Let’s cut it short: Italian standardization of the MMSPE (Mini-Mental State Pediatric Examination), a brief cognitive screening tool for school-age children. Neurological Sciences, 38(1):157–162.
Soppa Geremias, M., Cerigueli Dutra, T., Maschio, E., e Gasparini, I. (2024). Computational thinking development in children both neurotypical and with intellectual disabilities by the game “pensar e vestir”. In Proceedings of the XXII Brazilian Symposium on Human Factors in Computing Systems, IHC ’23, New York, NY, USA. Association for Computing Machinery.
Tombaugh, T. N. e McIntyre, N. J. (1992). The mini-mental state examination: A comprehensive review. Journal of the American Geriatrics Society, 40(9):922–935.
Yin, R. K. (2015). Estudo de Caso: Planejamento e Métodos. Bookman Editora, Porto Alegre, RS, 5 edition. Tradução da 5ª edição norte-americana.
Zelazo, P. D., Anderson, J. E., Richler, J., Wallner-Allen, K., Beaumont, J. L., e Weintraub, S. (2013). II. NIH Toolbox Cognition Battery (CB): Measuring executive function and attention. Monographs of the society for research in child development, 78(4):16–33.
Andrade, P., Oliveira Ferreira, F., Vasconcelos, A., Lima, P., e Haase, V. (2011). Cognitive profle, motor deficits and infuence of facilitators for rehabilitation of children with neurological dysfunction. Revista Paulista de Pediatria, 29(3):320–327.
Arevalo-Rodriguez, I., Smailagic, N., Roqué i Figuls, M., Ciapponi, A., Sanchez-Perez, E., Giannakou, A., e Cullum, S. (2015). Mini-Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database of Systematic Reviews, 2015(3):CD010783.
Balestrino, M., Brugnolo, A., Girtler, N., Pardini, M., Rizzetto, C., Alì, P., Cocito, L., e Schiavetti, I. (2024). Cognitive impairment assessment through handwriting (cogitat) score: a novel tool that predicts cognitive state from handwriting for forensic and clinical applications. Frontiers in Psychology, 28(15):1275315.
Brooke, J. et al. (1996). Sus-a quick and dirty usability scale. Usability evaluation in industry, 189(194):4–7.
Cainelli, E., Giacomo, D. L. D., Mantegazza, G., Vedovelli, L., Favaro, J., e Boniver, C. (2020). Prognostic role of Mini-Mental State Pediatric Examination (MMSPE) on neuropsychological functioning. Neurological Sciences, 41(3):619–623.
Chen, L., Zhang, M., Yu, W., et al. (2024). A fully automated mini-mental state examination assessment model using computer algorithms for cognitive screening. Journal of Alzheimer’s Disease, 97(4):1661–1672.
Ciemins, E. L., Holloway, B., Coon, P. J., McClosky-Armstrong, T., e Min, S.-J. (2009). Telemedicine and the mini-mental state examination: assessment from a distance. Telemedicine and e-Health, 15(5):476–478.
de Oliveira, L. C., Amaral, M. A. a., Bim, S. A., Valença, G., Almeida, L. D. A., Salgado, L. C. d. C., Gasparini, I., e da Silva, C. B. R. (2024). GranDIHC-BR 2025-2035 - GC3: Plurality and Decoloniality in HCI. In Proceedings of the XXIII Brazilian Symposium on Human Factors in Computing Systems, IHC ’24, New York, NY, USA. Association for Computing Machinery.
de Souza, R. L. M., de Freitas, C. R. S., Freire, A. P., e Delabrida, S. (2021). Enabling the use of photography equipment by people with upper limb disabilities: a participatory design case study of a wearable assistive technology prototype. In Proceedings of the XX Brazilian Symposium on Human Factors in Computing Systems, IHC ’21, New York, NY, USA. Association for Computing Machinery.
Folstein, M. F., Folstein, S. E., e McHugh, P. R. (1975). “Mini-mental state": A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3):189–198.
Ibrahim, B. A., Hussein, S. A., e Abdullah, W. H. (2023). Cognitive functions in children with type i diabetes. Wiadomości Lekarskie (Medical Advances), 76(5):944–950. Original Article.
Jain, M. e Passi, G. R. (2005). Assessment of a modifed mini-mental scale for cognitive functions in children. Indian Pediatrics, 42(9):907–912. Clinical Trial; Validation Study.
Lazar, J., Feng, J. H., e Hochheiser, H. (2017). Research Methods in Human-Computer Interaction. Morgan Kaufmann, Cambridge, MA, 2 edition.
Luciana, M. e Nelson, C. A. (2002). Assessment of neuropsychological function through use of the cambridge neuropsychological testing automated battery: Performance in 4- to 12-year-old children. Developmental Neuropsychology, 22(3):595–624. PMID: 12661972.
Mitchell, A. J. (2009). A meta-analysis of the accuracy of the mmse in the detection of dementia and mci. International Psychogeriatrics, 21(4):689–702.
MoCA Test Inc. (2024). Montreal Cognitive Assessment (MoCA). [link]. Acessado em: 8 de maio de 2025.
Nielsen, J. (1992). Finding usability problems through heuristic evaluation. CHI ’92, page 373–380, New York, NY, USA. Association for Computing Machinery.
Nielsen, J. (1993). Usability Engineering. Morgan Kaufmann, San Francisco, CA. 1st edition.
Nielsen, J. (1994a). Enhancing the explanatory power of usability heuristics. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’94, page 152–158, New York, NY, USA. Association for Computing Machinery.
Nielsen, J. (1994b). Heuristic Evaluation, page 25–62. John Wiley & Sons, Inc., USA.
Nielsen, J. e Molich, R. (1990). Heuristic evaluation of user interfaces. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’90, page 249–256, New York, NY, USA. Association for Computing Machinery.
Preece, J., Rogers, Y., e Sharp, H. (2002). Interaction Design: Beyond Human-Computer Interaction. John Wiley & Sons, New York, NY, 1 edition.
Preece, J., Sharp, H., e Rogers, Y. (2023). Interaction Design: Beyond Human-Computer Interaction. John Wiley & Sons, Hoboken, NJ, 6 edition.
Ricardo, M., Oliveira, A. P. M., Bueno, F. P. L., Oliveira, F. F., de Souza, S. L., Santos, C. M. R., e Geraldi, H. V. (2017). Mini-mental state exam for children (MMC) in children with hemiplegic cerebral palsy. Dementia & Neuropsychologia, 11:287–296.
Rubin, J. e Chisnell, D. (2008). Handbook of Usability Testing: How to Plan, Design, and Conduct Effective Tests. Wiley Publishing, Inc., Indianapolis, IN, 2 edition.
Sauro, J. e Lewis, J. R. (2016). Quantifying the User Experience: Practical Statistics for User Research. Morgan Kaufmann, Waltham, MA, 2 edition.
Scarpa, P., Toraldo, A., Peviani, V., e Bottini, G. (2017). Let’s cut it short: Italian standardization of the MMSPE (Mini-Mental State Pediatric Examination), a brief cognitive screening tool for school-age children. Neurological Sciences, 38(1):157–162.
Soppa Geremias, M., Cerigueli Dutra, T., Maschio, E., e Gasparini, I. (2024). Computational thinking development in children both neurotypical and with intellectual disabilities by the game “pensar e vestir”. In Proceedings of the XXII Brazilian Symposium on Human Factors in Computing Systems, IHC ’23, New York, NY, USA. Association for Computing Machinery.
Tombaugh, T. N. e McIntyre, N. J. (1992). The mini-mental state examination: A comprehensive review. Journal of the American Geriatrics Society, 40(9):922–935.
Yin, R. K. (2015). Estudo de Caso: Planejamento e Métodos. Bookman Editora, Porto Alegre, RS, 5 edition. Tradução da 5ª edição norte-americana.
Zelazo, P. D., Anderson, J. E., Richler, J., Wallner-Allen, K., Beaumont, J. L., e Weintraub, S. (2013). II. NIH Toolbox Cognition Battery (CB): Measuring executive function and attention. Monographs of the society for research in child development, 78(4):16–33.
Published
2025-09-08
How to Cite
AWAWDEH, Letícia Cardoso Mendonça Mustafá; RODRIGUES, Sandra Souza; SANTOS, Juliana Nunes; MORAIS, Rosane Luzia de Souza; FERREIRA, Fernanda de Oliveira; CORRÊA, Evelyn Daynnara Miranda; PEREIRA, Ana Alice Aparecida Sales; FERNANDES, Amanda Cristina.
Development of a digital version of the Mini-Mental State Examination for children: a multidisciplinary study. In: BRAZILIAN SYMPOSIUM ON HUMAN FACTORS IN COMPUTATIONAL SYSTEMS (IHC), 24. , 2025, Belo Horizonte/MG.
Anais [...].
Porto Alegre: Sociedade Brasileira de Computação,
2025
.
p. 1629-1650.
DOI: https://doi.org/10.5753/ihc.2025.10967.
