College of medicine IAU

MSE

14
 OSCE PROMPT FOR COGNITION EXAM:
Patient came to you with cognitive problem,
examine cognition (aka Mini MSE)
You can click on the title to see a video of MMSE

Minin Mental Exam (30 Points) ✓

1.Make sure before doing the rest of the test that patient is conscious
2.Degrees of consciousness
a. Normal alertness/wakefulness
b. Delirious → Disoriented to surrounding & Impaired judgement/decision making
Consciousness c. Drowsy → Respond to verbal & touch stimuli
d. Stupor (near unconsciousness) → Respond minimally w/ vigorous stimulation
e. Coma → No response to stimuli
3. GCS (Eye, motor & Verbal response) “depends on the station, so read the question carfully”
Orientation is the ability to understand one’s situation in
space and time )ّ ‫اﻟﺒﻠﺪ؟ اﻟﻤﻨﻄﻘﺔ؟ اﻟﻤﺪﯾﻨﺔ؟ اﻟﻤﺒﻨﻰ؟ اﻟﺪور؟‬ 
A. Place orientation (‫ﻧﻘﺎط‬
 What building are we in? Which floor? What is the ،‫ اﻟﺨﺒﺮ‬،‫ اﻟﻤﻨﻄﻘﺔ اﻟﺸﺮﻗﯿﺔ‬،‫ اﻧﺎ ﺑﺎﻟﺴﻌﻮدﯾﺔ‬:‫ﻣﺜﺎل‬ 
(‫ اﻟﺪور اﻟﺮاﺑﻊ ) ﻧﻘﺎط‬،‫ﻛﻠﯿﺔ اﻟﻄﺐ‬
Orientation name of this country and in which state/province?
(10 points) B. Time orientation
‫ﻣﻮﺳﻢ؟ ﺣﻨﺎ‬/‫ ﯾﻮم؟ ﻓﺼﻞ‬،‫ ﺷﮭﺮ‬،‫ﺣﻨﺎ أي ﺳﻨﺔ‬ 
 What's the day? What’s the season? Are we in the (‫اﻟﺤﯿﻦ ﻟﯿﻞ وﻻ ﻧﮭﺎر او ﻛﻢ اﻟﺴﺎﻋﺔ؟ ) ﻧﻘﺎط‬
morning or evening? What is the date “day, month & ،‫ ﯾﻮم اﻻﺛﻨﯿﻦ‬، ‫ ﺷﮭﺮ‬، ‫ ﺣﻨﺎ ﺑﺴﻨﺔ‬:‫ﻣﺜﺎل‬ 
year” (approximately)? (‫اﻟﻈﮭﺮ ) ﻧﻘﺎط‬ ‫ واﻟﺴﺎﻋﺔ‬،‫ﻓﻲ اﻟﺼﯿﻒ‬
 What’s the time (Am or Pm)?

 Ask the patient to repeat 3 word of your choice and ‫ ﻛﻠﻤﺎت ﻣﻦ اﺧﺘﯿﺎرك‬٣ ‫اطﻠﺐ ﻣﻦ اﻟﻤﺮﯾﺾ ﯾﻌﯿﺪ‬ 
take 1 second after each word you say (apple, ،‫ طﺎوﻟﺔ‬،‫وﺧﺬ ﺛﺎﻧﯿﺔ ﺑﯿﻦ ﻛﻞ ﻛﻠﻤﺔ ﺗﻘﻮﻟﮭﺎ )ﺗﻔﺎﺣﺔ‬
Registration (‫ﻣﻔﺘﺎح( ) ﻧﻘﺎط‬
table, key)
(3 points) ‫ ﺣﺎول ﺗﻌﯿﺪھﻢ ﻟﮫ اﻛﺜﺮ ﻣﻦ ﻣﺮة‬،‫اذا ﻣﺎ ﻋﺮف‬ 
 Repeat the 3 words until the patient gets the right ‫اﻟﯿﻦ ﯾﺠﯿﺐ اﻟﺘﺮﺗﯿﺐ ﺻﺢ واﺣﺴﺐ ﻋﺪد‬
order, then count the attempts (mentioned) (‫اﻟﻤﺤﺎوﻻت )ﺑﺲ اذﻛﺮھﺎ‬

‫اﻟﺤﺴﺎب‬
Attention is the ability to focus ‫ﺧﻤﺲ ﻣﺮات‬ ‫ﺗﻘﻮل ﻟﻠﻤﺮﯾﺾ ﯾﻨﻘﺺ ﻣﻦ‬
 Digital span (attentional task) (‫ ( ) ﻧﻘﺎط‬، ، ، ، ، )
a. Ask patient to repeat increasing lengths of
numbers forward and backward ‫اﻟﺘﺮﻛﯿﺰ‬
Attention &
، ) ‫ ﺗﻌﻄﻲ اﻟﻤﺮﯾﺾ ارﻗﺎم ﻋﺸﻮاﺋﯿﺔ‬
Calculation Calculation is the ability to maintain focus ‫ ( واطﻠﺐ ﯾﺮﺗﺒﮭﺎ ﺑﺎﻟﻌﻜﺲ‬، ، ،
(5 points)  Serial seven (concentration task) (‫ إذا ﻛﺎن ﻣﺎ ﯾﻌﺮف رﯾﺎﺿﯿﺎت ﺗﻘﻮﻟﮫ ) ﻧﻘﺎط‬
a. Ask patient to subtract 7 from a 100 and again
‫ ﺗﮭﺠﺄ ﻛﻠﻤﺔ "اﻟﯿﻮم" ﺑﺎﻟﻌﻜﺲ‬
total of 5 times
‫ او ﯾﻘﻮل أﯾﺎم اﻷﺳﺒﻮع ﺑﺎﻟﻌﻜﺲ‬
**You do only one of them not both
‫**ﺑﺲ ﺗﺴﻮي وﺣﺪه ﻣﻨﮭﻢ‬
 ‫ أﺷﺮ ﻋﻠﻰ ﺷﯿﺌﯿﻦ ﻓﻲ اﻟﺴﺘﯿﺸﻦ وﻗﻞ اﻟﻤﺮﯾﺾ ﻓﻲ‬.1
،‫ ﻗﻠﻢ ورﻗﺔ‬،‫ﻛﻞ ﻣﺮة اﯾﺶ ھﺬا اﻟﻐﺮض )ﺳﺎﻋﺔ‬
1. Naming (‫ ﺳﻜﺮاب‬،‫ﺷﻤﺎغ‬
 Point at a watch and then a pen and ask the patient for (‫ ﻧﻘﻄﺔ‬٢)
each what is this?
2. Repetition :‫ اطﻠﺐ ﻣﻦ اﻟﻤﺮﯾﺾ ﯾﻌﯿﺪ اﻟﻜﻠﻤﺎت ﺣﺮوف اﻟﺠﺮ‬.2
 Ask the patient to repeat the following: ‘No ifs, ands, or "‫ ﻓﻲ‬،‫ ﻋﻠﻰ‬،‫ ﻋﻦ‬،‫ إﻟﻰ‬،‫"ﻣﻦ‬
buts.’ (‫ ﻧﻘﻄﺔ‬١)
3. Three-stage command
Language  Ask the patient to follow these instructions: ‘take this ‫ اطﻠﺐ ﻣﻦ اﻟﻤﺮﯾﺾ ﯾﺴﻮي ﺛﻼث أواﻣﺮ )ﺧﺬ‬.3
(8 points) paper in your left hand, fold it in half, and put it on the (‫ ﺣﻄﮭﺎ ﻓﻲ اﻷرض‬،‫ اطﻮﯾﮭﺎ‬،‫اﻟﻮرﻗﺔ ﺑﯿﺪك اﻟﯿﺴﺎر‬
floor’. Give the patient a piece of paper and score for ‫وﻋﻂ ﻧﻘﻄﺔ ﻟﻜﻞ اﻣﺮ ﯾﺴﻮﯾﮫ ﺻﺢ‬
each stage completed correctly. (‫ ﻧﻘﺎط‬٣)
4. Obey
 Write ‘CLOSE YOUR EYES’ on a piece of paper, ask ‫ اطﻠﺐ ﻣﻦ اﻟﻤﺮﯾﺾ اﻣﺮ واﺣﺪ وﺧﻠﯿﮫ ﯾﻜﺮره‬.4
the patient to read and obey what it says. (‫ ﻧﻘﻄﺔ‬١)
5. Writing
 Ask the patient to write a sentence. ‫ اطﻠﺐ ﻣﻦ اﻟﻤﺮﯾﺾ ﯾﻜﺘﺐ ﺟﻤﻠﺔ )ذھﺐ ﻣﺤﻤﺪ اﻟﻰ‬.5
(‫اﻟﻤﺪرﺳﺔ‬
(‫ ﻧﻘﻄﺔ‬١)
 Short-term memory (last for sec to mins and may or may not
be temporary) ‫اطﻠﺐ ﻣﻦ اﻟﻤﺮﯾﺾ ﺑﻌﺪ د اﻧﮫ ﯾﺬﻛﺮ ال ﻛﻠﻤﺎت‬ 
a. Ask patient to recall the 3 words you mentioned in the (‫ ﻣﻔﺘﺎح‬،‫ طﺎوﻟﺔ‬،‫اﻟﻠﻲ اﺧﺘﺒﺮﺗﮫ ﻓﯿﮭﻢ ﻗﺒﻞ )ﺗﻔﺎﺣﺔ‬
registration after 5 mins delay (you can distract the (‫ ﻧﻘﻄﺔ‬١.٥)
Memory patient by asking general questions or personal
(Assess the
questions for 5 mins) ‫ ﻓﻘﺮة ﻣﻦ ﻗﺼﺔ‬/‫ اطﻠﺐ ﻣﻦ اﻟﻤﺮﯾﺾ ﯾﻘﺮأ ﻗﻄﻌﺔ‬
b. Ask the patient to read a paragraph and then ask them ‫وﯾﻘﻮﻟﻚ ﻗﺪ ﻣﺎ ﯾﻘﺪر اﻟﻤﻌﻠﻮﻣﺎت اﻟﻠﻲ ﻓﯿﮭﺎ ﺑﻌﺪ ﻣﺎ‬
process of
recall as much information from the story as possible in (‫ﯾﻨﺘﮭﻲ ﻣﻦ اﻟﻘﺮاءة )ﻣﻮ ﻣﮭﻢ‬
learning involving
5 min ‫**ﺑﺲ ﺗﺴﻮي وﺣﺪه ﻣﻨﮭﻢ‬
the registering of
**You do only one of them not both
information, the
storage of that  Long-term memory ‫اﺳﺄل اﻟﻤﺮﯾﺾ ﻋﻦ طﺮﯾﻘﺔ أداء ﺑﻌﺾ اﻟﻤﮭﺎرات‬ 
information, and a. Procedural memory ‫ ﺗﻤﺸﯿﻂ اﻟﺸﻌﺮ‬،‫ ﻣﺜﻞ ﺗﻔﺮﯾﺶ اﻻﺳﻨﺎن‬،‫اﻟﯿﻮﻣﯿﺔ‬
the ability to i. Remembering unconscious automated tasks ‫ﯾﺘﺬﻛﺮھﺎ‬ ‫إذا‬ ‫وﺷﻮف‬
retrieve the ii. Ask patient to show you how he brushes his teeth?
information later) b. Declarative memory
‫ اﺳﺄل اﻟﻤﺮﯾﺾ ﻋﻦ ﻣﻌﻠﻮﻣﺎت ﻋﺎﻣﺔ )ﺗﺎرﯾﺨﯿﺔ‬
iii. Retention of data or facts which can be verbal or
(3 points) ‫ اﺷﮭﺮ‬،‫ ﻋﻦ ﻣﻠﻮك اﻟﻤﻤﻠﻜﺔ‬،"‫"ﻛﻞ اﻟﻨﺎس ﺗﻌﺮﻓﮭﺎ‬
non-verbal (sounds or images)
‫( أﺳﺌﻠﺔ ﺷﺨﺼﯿﺔ‬،‫اﺳﻢ ﻓﻲ اﻟﺤﺮب اﻟﻌﺎﻟﻤﯿﺔ اﻟﺜﺎﻧﯿﺔ‬
iv. Ask patient about personal, graduations, past
،‫ ﺗﺎرﯾﺦ ﺗﺨﺮﺟﮫ ﻣﻦ اﻟﺠﺎﻣﻌﺔ‬،‫)ﺗﺎرﯾﺨﮫ اﻟﻤﺮﺿﻲ‬
medical history, historical information, or name of
(‫ ﻧﻘﻄﺔ‬١.٥) (‫ﺗﺎرﯾﺦ زواﺟﮫ‬
current
‫**ﺑﺲ ﺗﺴﻮي وﺣﺪه ﻣﻨﮭﻢ‬
**You do only one of them not both
ability to recognize the relationship of different objects in the
world
Visuospatial/  Patient asked to do constructional tasks that requires vision,
constructional motor, coordination, strength, tactile sensation & praxis
‫اطﻠﺐ ﻣﻦ اﻟﻤﺮﯾﺾ ﯾﺮﺳﻢ ﻣﻀﻠﻊ ﺧﻤﺎﺳﻲ او‬ 
ability  If patient have a deficiency in this ability, then other .‫ﺳﺎﻋﺔ ﻣﻊ ارﻗﺎﻣﮭﺎ‬
Aka “Apraxia” domains should be tested.
(1 points)  Ask a patient to copy a design
(transparent cube or a clock or to
draw an intersecting pentagram
  Ability to understand the meanings of words beyond the
literal interpretation.
 Ask patient to identify similarities between objects ‫اطﻠﺐ ﻣﻦ اﻟﻤﺮﯾﺾ ﯾﻌﻄﯿﻚ وﺟﮫ اﻟﺸﺒﺔ ﺑﯿﻦ‬ 
Abstractions (example: “how are an apple and an orange both alike.” (‫ﺷﯿﺌﯿﻦ )ﺗﻔﺎح وﺑﺮﺗﻘﺎل‬
a. Abstract answer → fruit
b. Concrete answer → both are round

 Number of intellectual functions, including the ability to be
‫اطﻠﺐ ﻣﻦ اﻟﻤﺮﯾﺾ ﯾﻌﻄﯿﻚ ﻣﻌﻨﻰ ﺑﻌﺾ اﻷﻣﺜﺎل‬ 
self-aware: of one’s existence, one’s thoughts, and one’s
(‫)ﻣﻮ اﻟﻤﻌﻨﻰ اﻟﺤﺮﻓﻲ ﻟﻠﻤﺜﻞ‬
behaviors.
"‫"اﻟﻘﺮد ﻓﻲ ﻋﯿﻦ أﻣﮫ ﻏﺰال‬ 
 Ask patient to interpret proverbs
Conceptualization "‫"ﻣﺪ رﺟﻮﻟﻚ ﻋﻠﻰ ﻗﺪ ﻟﺤﺎﻓﻚ‬ 
a. “The grass is greener on the other side”.
"‫"ﺣﺒﻞ اﻟﻜﺬب ﻗﺼﯿﺮ‬ 
b. “Don’t count your chickens before they hatch”.
"‫"ﻣﺶ ﻛﻞ ﻣﺮة ﺗﺴﻠﻢ اﻟﺠﺮة‬ 
c. Harder ones include “People who live in glass houses "‫"اﻟﺼﺒﺮ ﻣﻔﺘﺎح اﻟﻔﺮج‬ 
shouldn’t throw stones”

‫اﻋرﻓوا ﻛل ﺳؤال ﻛم ﻋﻠﯾﮫ ﻧﻘطﺔ ﻣن ھذا اﻟﺟدول‬

Folstein Mini-Mental Status Examination (Mini MSE)