Name:

Class:

MINI-MENTAL STATE EXAMINATION (MMSE)

I. ORIENTATIO

MAXIMUM SCORE ACTUAL SCORE

What is today's date? 1
What Is today's year? 1
What Is the month? 1
What day is today? 1
What season it is? 1
What is your profession? 1
Where are you working? 1
What city are you in? 1
What state are you in? 1
What county are you in? 1

11. IMMEDIATE RECALL

Name 3 common objects 3

(eg. Apple, Table & Penny):
(Take 1 second to say each.
Then ask the subject to
repeat them after you have
said. Give 1 point for each
correct answer.)

Then repeat them until

he/she learns all 3.
(NUMBER OF TRIALS: _)

Ill. ATTENTION AND CALULATION

A. Counting Backwards Test· 2.5

(Ask the subject to begin with
100 and count backwa rds by 7.
Record each response. Score
'0.5 for each correct response.
The .score Is the number of
correct subtractions. For
example, 93, 86, 80, 72, 65 is
a score of 2; 93, 86, 78 70, 62,
Is 1; 92,87, 78, 70, 65 Is 0.)
./
B. Spelling Backwards Test 2.5
(Ask the subject to spell the
word "WORLD" backwards.
Record each response. Use the
instructions to determine which
are correct responses, and give
0.5 point for each correct
response.)
 iv. RECALL

(Ask the subject la recall the 3

three words you previously
asked him/her to remember.)
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V. LA GUAGE

Naming (Show the subject a 1

wrist watch and a pen. ask
him/her what it is.)

Repetition 1
Ask the subject to repeat

Three -Stage Command 3

Take a paper in hand
Fold paper in half
Put it on the table.

Reading 1
Hold up the card that reads,
"Close your eyes." So the
subject can' see it clearly. Ask
him/her to read it and do what
it says.

Writing 1
Give the subject a sheet of
blank paper and ask him/her to
write a sentence. It is to be
written spontaneously. If the
sentence contains a subject
and a verb, and Is sensible,
give one point.

Copying 2
Show the subject the drawing
of the Copies pentagons
intersecting .pentagons. Ask
him/her to draw the pentagons.
If ten angles are present and
two Intersect, give two points.

TOTAL SCORE (30):

TOTAL SCORE:
24-30 = Normal (No cognitive impairment)
18-23 = Borderline (Mild cognitive impairment)
0-17= Impaired (Severe cognitive impairment)

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