The Min-Mental State Exam (MMSE) is the most common exam for screening and follow-up of cognitive impairment. One of 30 points is allocated to correct orientation to the weekday (“day orientation”).

The purpose of this study is to assess whether day orientation correlates with the weekday in which the exam was conducted, hypothesis being that orientation would be better on the work day immediately following the weekend (in Israel – Sundays).

All digitally recorded MMSE scores from Shalvata MHC’s were collected. The percentage of correct answers to day orientation was compared between weekdays. Differences between in/correct answers were assessed by Chi-square tests, with Cramer's V for the effect size of the correlations. Differences in total score between groups were assessed by independent t- tests with Cohen's d for effect size (p=0.05)

The cohort consisted of 2,049 MMSE taken by 1,376 patients [average age 80.3 (SD 9.3) 56.4% Female] between 2016 and 2022. Due to very few responses (n=7) on Friday and Saturday, these days were excluded from analyses. Overall, 67.8% of exams were correctly oriented to the day. Correct response rate according to the weekday yielded a significant result (X2 = 20.77, p < .001, Cramer's V = 0.104), with the largest effect difference was found on Sundays (53.4%), and then on Mondays (38.9%). The relative odds ratio (OR) for providing a correct response was found for Sunday (OR=1.55, p=.001), while for other days no significant OR was found. Patients who responded correctly showed higher final total scores in comparison with patients who did not respond correctly across all days. Similar analysis was carried out for orientation to the month, comparing between the first 5 days and last 5 days of the month, but no statistically significant difference for correct answers was found.

MMSE delivered on the first working day of the week may entail a better day orientation, and thus a higher total score. This finding may have significant implications for assessments (as in clinical trials) and thus treatment.