Folstein Exam

Institutional affiliation: Susan Folstein 1978 - 2011; Marshal Folstein 1975 - Present

Susan and Marshal Folstein

Of all academic papers published in psychiatry, which one has been cited most by other researchers? It is the 1975 paper written by Hopkins faculty psychiatrists Marshal and Susan Folstein, along with Paul McHugh, that introduced the Mini-Mental State exam. The paper that described this simple bedside test of cognition has been cited in over 25, 000 other published articles, almost twice as much as the next most cited paper in psychiatry and neurology.

What makes the Mini-Mental State so important? The Folsteins developed the test as an efficient method to measure impairments in memory, attention, concentration, verbal and constructive capacities in the course of a brief interview. The “mini-mental” caught on as a tool to screen for signs of dementia and to track its course, and so has become indispensible in the clinic and in research on cognitive illness.

A few more words are in order about Susan Folstein, who came to Johns Hopkins (with her husband Marshal) from a fellowship during which she reported the first evidence of a genetic basis for autism. After further genetics training at Hopkins with the pioneer of medical genetics, Victor McKusick, she went on to establish psychiatric genetics as an active research interest within the department. She midwifed the Huntington Disease clinic, which reached out to patients and families clinically and became a source of volunteers in the hunt for the genetic cause of neurodegenerative movement disorders. In addition, her influence spawned psychiatric genetics research in mood and anxiety disorders at Hopkins. She has the distinction of having been the first woman to be named full professor of psychiatry at Hopkins.

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