Mini-Mental Status Examination (MMSE)
Folstein‚ 1975
Orientation
What is the (year) (season) (day) (month)?
Where are we: (state) (county) (town) (hospital) (floor)
Registration
Name 3 unrelated objects; allow 1 second to say each. Then ask the patient to repeat all 3 after you have said them. Give 1 point for each correct answer. Repeat them until he learns all 3. Count trials and record. Trials:________
Attention and Calculation
Ask patient to count backwards from 100 by sevens. 1 point for each correct answer. Stop after 5 answers. Alternatively spell “world” backwards.
Recall
Ask patient to recall the 3 objects previously stated. Give 1 point for each correct.
Language
· Show patient a wrist watch; ask patient what it is. Repeat for a pencil. (2 points).
· Ask patient to repeat the following: “No ifs‚ ands or buts” (1 point).
· Follow a 3-stage command: “Take a paper in your right hand‚ fold it in half‚ and put it on the floor” (3 points).
· Ask patient to read and obey the following sentence which you have written on a piece of paper. “Close your eyes” (1 point).
· Ask patient to write a sentence (1 point).
· Ask patient to copy a design (1 point).
Instructions for Administration of Mini-Mental State Examination
Orientation
1. Ask for the date. Then ask specifically for parts omitted‚ e.g.‚ “Can you also tell me what season it is?” One point for each correct.
2. Ask in turn “Can you tell me the name of this hospital?” (town‚ county‚ etc.). One point for each correct.
Registration
Ask the patient if you may test his memory. Then say the names of 3 unrelated objects‚ clearly and slowly‚ about one second for each. After you have said all 3‚ ask him to repeat them. This first repetition determines his score (0-3) but keep saying them until he can repeat all 3‚ up to 6 trials. If he does not eventually learn all 3‚ recall cannot be meaningfully tested.
Attention and Calculation
Ask the patient to begin with 100 and count backwards by 7. Stop after 5 subtractions (93‚ 86‚ 79‚ 72‚ 65). Score the total number of correct answers.
If the patient cannot or will not perform this task‚ ask him to spell the word “world” backwards. The score is the number of letters in correct order‚ e.g.‚ dlrow = 5‚ dlorw = 3.
Recall
Ask the patient if he can recall the 3 words you previously asked him to remember. Score 0-3.
Language
Naming: Show the patient a wrist watch and ask him what it is. Repeat for pencil. Score 0-2.
Repetition: Ask the patient to repeat the sentence after you. Allow only one trial. Score 0 or 1.
3-Stage command: Give the patient a piece of plain blank paper and repeat the command. Score 1 point for each part correctly executed.
Reading: On a blank piece of paper print the sentence “Close your eyes”‚ in letters large enough for the patient to see clearly. Ask him to read it and do what it says. Score 1 point only if he actually closes his eyes.
Writing: Give the patient a blank piece of paper and ask him to write a sentence. Do not dictate a sentence‚ it is to be written spontaneously. It must contain a subject and verb and be sensible. Correct grammar and punctuation are not necessary.
Copying: On a clean piece of paper‚ draw intersecting pentagons‚ each side about 1 in.‚ and ask him to copy it exactly as it is. All 10 angles must be present and 2 must intersect to score 1 point. Tremor and rotation are ignored.
Estimate the patient’s level of sensorium along a continuum‚ from alert on the left to coma on the right.
Folstein‚ M.F.‚ Folstein‚ S.E.‚ McHugh‚ P.R. (1975). “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res‚ 12:189–198.
Folstein. M.‚ Anthony‚ J.C.‚ Parhad‚ I.‚ et al. (1985). The meaning of cognitive impairment in the elderly. J Am Geriatr Soc‚ 33:228–235.
Crum‚ R.M.‚ Anthony‚ J.C.‚ Bassett‚ S.S.‚ Folstein‚ M.F . (1993). Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA‚ 269:2386–2391.
Folstein‚ M. (1998). Mini-Mental and son. Int J Geriatr Psychiatry‚ 13:290–294.
McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS