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angel_bear
07-13-2005, 07:22 PM
MINI-MENTAL STATE EXAM (extended version)<> Folstein, Folstein, McHugh, 1975
Extension adapted from Ashford et al., 1992, Internatl. Psychoger. 4:55-74.


PATIENT NAME: _______________________________

Today's date: 2/25/2000


Enter birthdate (mm): Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec (dd): (yyyy):
Sex: []Male [] Female Enter education (years):
Race: []Caucasian []Black []Hispanic []Asian []Other

right / wrong
Orientation Questions: Ask the following questions:
[] [] x1. What is your last name?
[] [] x2. What is your first name?
[] [] x3. What is your birthday?
[] [] x4. What is your birth year?
[] [] x5.* How old are you?
[] [] x6. In what county/city were you born?
[] [] x7. In what state (country if not US) were you born?
[] [] x8. What is your mother's m***** name?
[] [] x9. How far did you go in school (years of education)?
[] [] x10. What is your address (or phone number)? PERSON ___________


[] [] 1.* What is today's date?
[] [] 2. What is the month?
[] [] 3. What is the year?
[] [] 4.* What day of the week is today?
[] [] 5. What season is it? DATE
[] [] 6. What is the name of this clinic (place)?
[] [] 7. What floor are we on?
[] [] 8. What city are we in?
[] [] 9. What county are we in?
[] [] 10. What state are we in? PLACE _____________


PRESIDENTS
[] [] x11.* Who is the President of the US?
[] [] x12.* Who was the President before him?
[] [] x13.* Who was the President before him?
[] [] x14. Who was the first President of the US?
[] [] x15. Name another US President? PRESIDENTS_________________


IMMEDIATE RECALL: Ask the subject if you may test his/her memory. Then say "ball", "flag", "tree" clearly and slowly, about 1 second for each. After you have said all 3 words, ask him/her to repeat them. The first repetition determines the score (0-3), but keep saying them until he/she can repeat all 3, up to 6 tries. If he/she does not eventually learn all 3, recall cannot be meaningfully tested:
[] [] 11. BALL
[] [] 12. FLAG
[] [] 13. TREE Note # trials: IMMEDIATE RECALL: _________________


ATTENTION
A) Ask the subject to begin with 100 and count backwards by 7. Stop after 5 subtractions. Score the correct subtractions.
[] [] 14. "93"
[] [] 15. "86"
[] [] 16. "79"
[] [] 17. "72"
[] [] 18.* "65" SERIAL 7's TOTAL: __________________


B) Ask the subject to spell the word "WORLD" backwards. The score is the number of letters in correct position. For example, "DLROW" is 5, "DLORW" is 3, "LROWD" is 0.
[] [] 19. "D"
[] [] 20. "L"
[] [] 21. "R"
[] [] 22. "O"
[] [] 23. "W" "DLROW" TOTAL: _____ Greater score of A or B: _____

DELAYED VERBAL RECALL: Ask the subject to recall the 3 words you previously asked him/her to remember.
[] [] 24.* BALL?
[] [] 25.* FLAG?
[] [] 26.* TREE? DELAYED VERBAL RECALL:

NAMING: Show the subject a wrist watch and ask him/her what it is. Repeat for pencil.
[] [] 27. WATCH
[] [] 28. PENCIL

REPETITION: Ask subject to repeat: "No ifs, ands, or buts" (accept "no if and or but")
[] [] 29. REPETITION

3-STAGE COMMAND: Give the subject a plain piece of paper and say, "Take the paper in your hand, fold it in half, and put it on the floor."
[] [] 30. TAKES ____________
[] [] 31. FOLDS_____________
[] [] 32. PUTS_______________

READING: Hold up the card reading, "Close your eyes", so the subject can see it clearly. Ask him/her to read it and do what it says. Score correctly only if the subject actually closes his/her eyes.
[] [] 33. CLOSES EYES

WRITING: Give subject a piece of paper and ask him/her to write 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.
[] [] 34. SENTENCE LANGUAGE:

COPYING: Ask subject to draw intersecting pentagons
[] [] 35. PENTAGONS

To calculate MMSE score automatically, click here:

TOTAL MMSE (serial7s): MMSE (dlrow): MMSE (max): (MAXIMUM score = 30)

TOTAL MMSE WITH EXTENSION: (maximum score = 50) ___________

WannaBeFreeToRoam
07-14-2005, 08:01 AM
Hi Sally,

Thanks for the MMSE. I copied it. I believe my dad had a very shortened version of this test in 2004. Probably because the dr. could tell that he had alzheimers just by talking and watching him. And because we asked for a test. His math and drawing ability at the time are what made him fail the test. I do not believe his neurologist scored him at all (in numbers). I do not know and will not ask in front of him. The dignity thing - my dad still asks the dr. if this disease will get better!

Thanks again Sally. Wannabe

Sandyspen
07-14-2005, 08:11 AM
Wannabe,

You're probably right about your doctor knowing by talking to him.

My Mom's doctor (of many years) just started a general conversation with Mom because I had called and told him in advance that we were concerned about her memory issues.

He asked about her health in general: Mom told him she had always been a healthy person and never spent a day in the hospital except to have her babies.

My Mom has had a hysterectomy, mastectomy, gallbladder surgery, ovarian cyst removed.......etc.

The doctor knew all this and didn't act surprised. But I was totally flabbergasted. I had no idea she had forgotten all that. A doctor can probe their memory in a way that we would never think to do.

angel_bear
07-14-2005, 03:01 PM
My MIL had a VERY shortened version of this, and the clock test. Because of her lack of speech, she cannot verbalise back to us the answers, so alot of it was 'assumed' she knew by watching her body language. If she 'looked' confident, it was ticked, if she looked 'unsure' it wasn't ....

The lack of language makes it so much harder to diagnose the dementia :-(

Hugs
Sally

angel_bear
07-21-2005, 11:52 PM
up we go to help our newbies ..... :bouncing:

angel_bear
01-13-2006, 05:50 PM
bumping up for Kim

fourt9rkim
01-14-2006, 05:45 AM
Thanks, Sally! This is a very good test to give! :wave:

FLA.Racing20Gal
01-16-2006, 08:37 AM
Thanks Angel bear my hubby is 65 and once referrals go throughhe will be getting tested for dementia and Alzheimrs on the scle is is #2 in Alzheimrs and # 3 in dementia. he was in a bad wreck back in 1966 coma for 3 monts had to learnt o walk talk eat all over again and it damged hismoter nerves like a stroke but blood work is ok. He forgets easily and in store forgets which isle stuff is on or even driving I am 15 years younger than him and was in the mediacl profesion till iquit to Home schooled ouor kids nad then he was getting worse so i nebver went back to work. But he reads paper all day in recliner and watches tv adn uts off doing stuff till the last pea in the dish. The dr told him watch quiz shows but he hates them and wilnot do it or read much. I was wondering could he have a residule effect from the wreck back in 1966 he also walks with a gait. But he f goes on and on about certian questions nd then mubbles nad slurs his words but the tests so far no stroke heart is opk and blood work great no diabets thyroid or Anemia and B vitmins are h great POSa is normal but prostrate a dab swollen for a man his age which is normal she told us. I am glad I fund this site forhelp forhim.
Heidi