mmse score what is today’s date? (then ask for omitted) 1. date: _________________________ ______ can you tell me what yea

MMSE
Score
What is today’s date? (Then ask for omitted)
1. Date:
_________________________
______
Can you tell me what year it is?
2. Year:
_________________________
______
Can you tell me what month it is?
3. Month:
_________________________
______
Can you tell me what day of the week it is?
4. Day:
_________________________
______
Can you tell me what season it is?
5. Season:
_________________________
______
Can you tell me the name of this building we are in?
6. Building:
_________________________
______
What floor are we on?
7. Floor:
_________________________
______
What city/town are we in?
8. City:
_________________________
______
What county are we in?
9. County:
_________________________
______
What state are we in?
10. State
_________________________
______
May I test your memory? I will say three words and I would
11. BALL
_________________________
______
like you to repeat them after me.
12. FLAG
_________________________
______
(Allow 6 trials. Trial 1 determines score.)
13. TREE
_________________________
______
# TRIALS:_____ Ball:_____ Flag:_____ Tree:_____
Now what I would like you to do is start with the number
14. 93 / D
_________________________
______
100 and count backwards by 7s. Go until I say stop.
15. 86 / L
_________________________
______
(If subject cannot do 7s, ask:)
16. 79 / R
_________________________
______
I would like you to try to spell the word “WORLD”
17. 72 / O
_________________________
______
backwards
18. 65 / W
_________________________
______
Can you remember the 3 words I read to you earlier?
19. BALL
_________________________
______
20. FLAG
_________________________
______
21. TREE
_________________________
______
(Show subject wrist watch) What is this?
22. Watch
_________________________
______
(Show subject pen/pencil) What is this?
23. Pen/pencil:
_________________________
______
Repeat after me: “No ifs, ands, or buts”
24. Repeat:
_________________________
______
(Hold out blank paper)
25. R Hand:
_________________________
______
Take this piece of paper with your right hand, fold it in half,
26. Folds:
_________________________
______
and put it on the floor
27: Floor:
_________________________
______
Read this and do what it says: CLOSE YOUR EYES
28. Close eyes:
_________________________
______
Write a sentence on this paper. It can be any sentence.
29. Writing:
_________________________
______
Copy this drawing.
30. Copying:
_________________________
______
TOTAL:
______
CLOSE YOUR EYES


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