Mini-Mental State Examination (Mmse) printable pdf download

Mini-Mental State Examination (Mmse)

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

Patient’s

Questions

Score

“What is the year? Season? Date? Day of the week? Month?”

“Where are we now: State? County? Town/city? Hospital? Floor?”

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: ___________

“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)

“Earlier I told you the names of three things. Can you tell me what those

were?”

Show the patient two simple objects, such as a wristwatch and a pencil,

and ask the patient to name them.

“Repeat the phrase: ‘No ifs, ands, or buts.’”

“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.)

“Please read this and do what it says.” (Written instruction is “Close

your eyes.”)

“Make up and write a sentence about anything.” (This sentence must

contain a noun and a verb.)

“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.)

TOTAL

(Adapted from Rovner & Folstein, 1987)

Source:

Provided by NHCQF, 0106-410

Mini-Mental State Examination (Mmse)