Modified Mini-Mental State Test (3MS or MMMS)

Teng‚ 1987

1. WHEN AND WHERE BORN? Date dd/mm/ yyyy Place city/province (5)
dd (1‚0)‚mm (1‚0)‚ yyyy (1‚0)‚ city/town (1‚0)‚ province (1‚0)

2. REGISTRATION (3)

THREE WORDS (Say the 3 words listed below‚ then ask the person to repeat them. Repeat until correct but only score the first attempt)

· Shoes (1 0)

· Blue (1 0)

· Modesty (1 0)

3. MENTAL REVERSAL (7)

COUNTING and WORLD BACKWARDS
COUNTING FORWARDS 5 to 1 (write their answer)

· Accurate (2)

· 1 or 2 errors / misses (0 1)

SPELL “WORLD”
“World” backwards (print letters) D L R O W (0 1 2 3 4 5)

Give one point for each correct answer

4. FIRST RECALL (9)

Ask the person to the 3

· Spontaneous : Shoes (3)

· Cue: Something to wear (2)

· Multiple: Shirt‚ shoes‚ socks (1)

· Missed completely (0)

· Spontaneous : Blue (3)

· Cue: A colour (2)

· Multiple: Black‚ brown‚ blue (1)

· Missed completely (0)

· Spontaneous : Modesty (3)

· Cue: A good personal (2)

· Multiple: Modesty‚ ch‎arity‚ honesty (1)

· Missed completely (0)

5. TEMPORAL ORIENTATION (15)

Today’s date

· Accurate (3)

· Missed by 1 or 2 days (2)

· Missed by 3–5 days (1)

· Missed by more than 5 days (0)

Month

· Accurate or within 5 days (2)

· Missed by 1 month (1)

· Missed by more than a month (0)

Year

1. Accurate (8)

2. Missed by 1 year (4)

3. Missed by 2–5 years (2)

4. Missed by more than 5 years (0)

Day of week

· Accurate (1)

· Missed (0)

Season

· Accurate or within a month (1)

· Missed (0)

6. SPATIAL ORIENTATION (5)

· Province (2 0)

· Country (1 0)

· City or town (1 0)

· Hosp.‚ store‚ home (1 0)

7. NAMING (5)

Ask the person to name the following:

· Forehead (1 0)

· Elbow (1 0)

· Chin (1 0)

· Knuckle (1 0)

· Shoulder (1 0)

8. FOUR-LEGGED ANIMALS (10)

(30 SECONDS) 1 POINT EACH

Ask the person to name as many 4 legged animals as they can in 30 seconds. The maximum score is 10.

9. SIMILARITIES (6)

Ask the person how an Arm and Leg are similar.

Arm-leg

· Limbs‚ extremities (2)

· Body‚ parts‚ bend‚ move‚ joint (1)

· Very weak or no (0)

Laughing-crying

· Feeling‚ (2)

· Expressions‚ sounds‚ relieve (1)

· Very weak or no (0)

Eating-sleeping

· Necessary bodily functions (2)

· Bodily functions‚ relaxing‚ good for you (1)

· Very weak or no (0 )

10. REPETITION (5)

I would like to go home (out)

· Correct (2)

· 1 or 2 missed/wrong words (1)

· More than 2 missed/wrong words (0)

· No ifs (1 0)

· ands (1 0)

· or buts (1 0)

11. READ AND OBEY “CLOSE YOUR EYES” (Use Cue Card) (3)

· Obeys without prompting 3

· Obeys after prompting (2)

· Read aloud only (1)

· None of the above (0)

12. WRITING (5)

(1 minute)

Ask the person to write on the next page: (I) would like to go home (out) (0 1 2 3 4 5)

13. COPYING TWO PENTAGONS (1 minute) (10)

Ask the person to copy the design on the next page.

· 5 approx equal sides: Pentagon 1(4)‚ Pentagon 2 (4)

· 5 unequal (2:1) sides: Pentagon 1(3)‚ Pentagon 2 (3)

· Other enclosed figures: Pentagon 1(2)‚ Pentagon 2 (2)

· 2 or more lines: Pentagon 1(1)‚ Pentagon 2 (1)

· Less than 2 lines: Pentagon 1(0)‚ Pentagon 2 (0)

Intersection

· 4 corners (2)

· Not 4 corner enclosure (1)

· No intersection or no enclosure (0)

14. THREE STAGE COMMAND (3)

Ask the person to follow a 3 command: ‘Take a piece of paper in your left/right hand‚ fold it in half‚ and hand it back to me’.

· Take this paper with your . . .

· Left/right hand (1 0)

· fold it in half (1 0)

· and hand it back to me (1 0)

15. SECOND (9)

Ask the person to the 3 words from 4^th question.

· Spontaneous : Shoes (3)

· Cue: Something to wear (2)

· Multiple: Shirt‚ shoes‚ socks (1)

· Missed completely (0)

· Spontaneous : Blue (3)

· Cue: A colour (2)

· Multiple: Black‚ brown‚ blue (1)

· Missed completely (0)

· Spontaneous : Modesty (3)

· Cue: A good personal (2)

· Multiple: Modesty‚ ch‎arity‚ honesty (1)

· Missed completely (0)

This instrument can be found at: www.a4ebm.org/sites/default/files/Measuring%20Health.pdf & http://pda.rnao.ca/sites/pda/files/images/exam.pdf

Teng‚ E.L.‚ Chui‚ H.C. (1987). The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry‚ 48(8):314-8.

Teng‚ E.L.‚ Chui‚ H.C.‚ Gong‚ A. (1990). Comparisons between the Mini-Mental State Examination (MMSE) and its modified version – the 3MS test. Excerpta Med‚189–192.

Lamarre‚ C.J.‚ Patten‚ S.B. (1991). Evaluation of the Modified Mini-Mental State Examination in a general psychiatric population. Can J Psychiatry‚ 36:507–511.

Schulzer‚ M.‚ Calne‚ D.B.‚ Snow‚ B.‚ et al. (1993). Ascoring error in the Mini-Mental State test. Can J Psychiatry‚ 38:603–605.

Nadler‚ J‚D.‚ Relkin‚ N.R.‚ Cohen‚ M.S.‚ et al.(1995). Mental status testing in the elderly nursing home population. J Geriatr Psychiatry Neurol‚ 8:177–183.

Bravo‚ G.‚ Hébert‚ R. (1997). Reliability of the Modified Mini-Mental State Examination in the context of a two-phase community prevalence study. Neuroepidemiol‚ 16:141–148.

McDowell‚ I.‚ Kristjansson‚ B.‚ Hill‚ G.B.‚ et al. (1997). Community screening for dementia: the Mini-Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. J Clin Epidemiol‚ 50:377–383.

Correa‚ J.A.‚ Perrault‚ A.‚ Wolfson‚ C. (2000). Reliable individual change scores on the 3MS in older persons with dementia: results from the Canadian Study of Health and Aging. Int Psychogeriatr‚ 12(suppl. 2):73–80.

Tschanz‚ J.T.‚ Welsh-Bohmer‚ K.A.‚ Plassman‚ B.L‚ et al. (2002). An adaptation of the Modified Mini-Mental State Examination: analysis of demographic influences and normative data. Neuropsychiatry Neuropsychol Behav Neurol;15:28–38.

McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS

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