Mini-Mental State Examination (MMSE)
Patient’s
Name: Date:
Instructions:
Ask the questions in the order listed. Score one point for each correct
response within each question or activity.
|
Maximum
Score
|
Patient’s
Score
|
Questions
|
|
5
|
|
“What is the year? Season?
Date? Day of the week? Month?”
|
|
5
|
|
“Where are we now: State?
County? Town/city? Hospital?
Floor?”
|
|
3
|
|
The examiner names three unrelated objects
clearly and slowly, then asks the patient to name all three of them. The
patient’s response is used for scoring. The examiner repeats them until
patient learns all of them, if possible. Number of trials: ___________
|
|
5
|
|
“I would like you to
count backward from 100 by sevens.” (93, 86, 79, 72, 65, …) Stop after five
answers.
Alternative: “Spell WORLD backwards.” (D-L-R-O-W)
|
|
3
|
|
“Earlier I told you the names of three things. Can you tell me what those
were?”
|
|
2
|
|
Show the patient two simple objects, such as a wristwatch
and a pencil, and ask the patient to name them.
|
|
1
|
|
“Repeat the phrase: ‘No ifs, ands, or
buts.’”
|
|
3
|
|
“Take the paper in your right hand, fold it in half, and
put it on the floor.”
(The examiner gives the patient a piece of blank paper.)
|
|
1
|
|
“Please read this and do what it says.” (Written
instruction is “Close your eyes.”)
|
|
1
|
|
“Make up and write a sentence about anything.” (This
sentence must contain a noun and a verb.)
|
|
1
|
|
“Please copy this picture.” (The examiner gives the patient
a blank piece of paper and asks him/her to draw the symbol below. All 10
angles must be present and two must intersect.)
 |
|
30
|
|
TOTAL
|
(Adapted from Rovner &
Folstein, 1987)
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Instructions for administration and scoring of
the MMSE
Orientation
(10 points):
•
Ask for the date. Then specifically ask for parts
omitted (e.g., "Can you also tell me what season it is?"). One point
for each correct answer.
•
Ask in turn, "Can you tell me the name of this
hospital (town, county, etc.)?" One point for each correct answer.
Registration
(3 points):
•
Say the names of three unrelated objects clearly and
slowly, allowing approximately one second for each. After you have said all
three, ask the patient to repeat them. The number of objects the patient names
correctly upon the first repetition determines the score (0-3). If the patient
does not repeat all three objects the first time, continue saying the names
until the patient is able to repeat all three items, up to six trials. Record
the number of trials it takes for the patient to learn the words. If the
patient does not eventually learn all three, recall cannot be meaningfully
tested.
•
After completing this task, tell the patient, "Try
to remember the words, as I will ask for them in a little while."
Attention
and Calculation (5 points):
•
Ask the patient to begin with 100 and count backward by
sevens. Stop after five subtractions (93, 86, 79, 72, 65). Score the total
number of correct answers.
•
If the patient cannot or will not perform the
subtraction task, ask the patient to spell the word "world"
backwards. The score is the number of letters in correct order (e.g., dlrow=5,
dlorw=3).
Recall (3
points):
•
Ask the patient if he or she can recall the three words
you previously asked him or her to remember. Score the total number of correct
answers (0-3).
Language and
Praxis (9 points):
•
Naming: Show the patient a wrist watch and ask the
patient what it is. Repeat with a pencil. Score one point for each correct
naming (0-2).
•
Repetition: Ask the patient to repeat the sentence
after you ("No ifs, ands, or buts."). Allow only one trial. Score 0
or 1.
•
3-Stage Command: Give the patient a piece of blank
paper and say, "Take this paper in your right hand, fold it in half, and
put it on the floor." Score one point for each part of the command
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 the patient to read the
sentence and do what it says. Score one point only if the patient actually
closes his or her eyes. This is not a test of memory, so you may prompt the
patient to "do what it says" after the patient reads the sentence.
•
Writing: Give the patient a blank piece of paper and
ask him or her to write a sentence for you. Do not dictate a sentence; it
should be written spontaneously. The sentence must contain a subject and a verb
and make sense. Correct grammar and punctuation are not necessary.
•
Copying: Show the patient the picture of two
intersecting pentagons and ask the patient to copy the figure exactly as it is.
All ten angles must be present and two must intersect to score one point.
Ignore tremor and rotation.
(Folstein, Folstein &
McHugh, 1975)
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Interpretation of the MMSE
|
Method
|
Score
|
Interpretation
|
|
Single Cutoff
|
<24 o:p="">
|
Abnormal
Range
<21 o:p="">
>25
Increased odds of dementia
Decreased odds of dementia
Education
21
<23 o:p="">
<24 o:p="">
Abnormal
for 8th grade education
Abnormal
for high school education
Abnormal for college education
Severity
24-30
18-23
0-17
No cognitive impairment
Mild cognitive impairment
Severe cognitive impairment
Sources:
• Crum RM,
Anthony JC, Bassett SS, Folstein MF. Population-based norms for the mini-mental
state examination by age and educational level. JAMA. 1993;269(18):2386-2391.
• Folstein
MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method
for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-198.
• Rovner BW,
Folstein MF. Mini-mental state exam in clinical practice. Hosp Pract. 1987;22(1A):99, 103, 106, 110.
• Tombaugh
TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992;40(9):922-935.
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