When mild impairment is not safe: mini-mental state examination scores of ≤21 are associated with emergency response failure.

Introduction: Unrecognized emergency-response deficits contribute to preventable harm and loss of independence in older adults with cognitive decline. Although the Mini-Mental State Examination (MMSE) is widely used to assess global cognition, clinicians often use MMSE scores to inform judgments about everyday functioning. However, the relationship between MMSE performance and emergency-response ability remains unclear. The Test of Executive Functioning in an Emergency (TEFE) is a brief, performance-based assessment that evaluates a patient's ability to relay critical information and contact emergency services. This study examined whether an MMSE threshold was associated with failure on TEFE 911 tasks. Methods: A retrospective analysis included 905 patients from a university-affiliated memory clinic with Alzheimer's disease, vascular dementia, mixed dementia, mild cognitive impairment, or normal cognition. Associations between MMSE scores and TEFE 911 knowledge and behavioral task failure were examined using correlation, adjacent-score comparisons, receiver operating characteristic (ROC) analyses, Youden's Results: MMSE and TEFE scores were moderately correlated ( Discussion: Patients with MMSE scores ≤21 may warrant further performance-based assessment of emergency-response ability. Prospective studies should determine whether this threshold predicts real-world safety outcomes.