Global Research & Consulting - Mini-Mental State Examination (MMSE)

Mini-Mental State Examination (MMSE)

Investigator Name	Date Administered
Patient No.	Administered by

Max Score	Pt.’s Score
5		Orientation
		What is the year?	Season?
		Date?	Day of the week?
		Month?	(One point for each correct answer)
5		What state are we in?	County?
		City?	Name of place?
		Floor?	(One point for each correct answer)
3		Registration Ask the patient if you can test his/her memory. Name three unrelated objects and have the patient repeat them. (One point for each object named correctly on the 1^st repetition) Although 1^st repetition determines score, patient has up to 6 trials.
		Record # of trials.	# of Trials:
5		Attention and Calculation
		Spell W-O-R-L-D backwards. (one point for each letter in correct order)
3		Memory
		What are the three objects you were asked to remember? (One point for each correct answer)
2		Language and Visual-Spatial Skills Name these objects (point to a watch, then a pencil). (One point for each correct answer)
1		Repeat the following statement: “No ifs, ands, or buts”. (Allow only one trial)
3		Follow these directions: Take this paper in your right hand, fold it in half and put it on the floor. (Use attached blank page) (One point for each stage performed correctly)
1		Read and follow this direction: CLOSE YOUR EYES (Show attached page with large print) (One point only if patient closes eyes)
1		Write a sentence (on attached blank page) (Needs to contain a subject and a verb. Correct grammar/punctuation not required)
1		Copy this design (Show attached page with intersecting pentagons) (Patient may look at the design while drawing, but may not trace)
Total Score

On the corresponding CRF page, rate the patient’s level of consciousness
(along a continuum from alert to coma).

QS343txt