Mini Mental State Examination (Mmse) Form
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1Patient's name:
MINI MENTAL STATE
EXAMINATION
Hospital number:
(MMSE)
DATE
ONE POINT FOR EACH ANSWER
ORIENTATION
Year Month
Day
Date
Time
____/5
____/5
____/5 ____/5
____/5
____/5 ____/5
Country
Town
District
Hospital
Ward
____/5
REGISTRATION
Examiner names 3 objects (eg apple, table, penny)
Patient asked to repeat (1 point for each correct).
THEN patient to learn the 3 names repeating until
____/3 ____/3
____/3
____/3
correct.
ATTENTION AND CALCULATION
Subtract 7 from 100, then repeat from result.
____/5 ____/5
Continue 5 times: 100 93 86 79 65
____/5
____/5
Alternative: spell "WORLD" backwards - dlrow.
RECALL
____/3
____/3 ____/3
____/3
Ask for names of 3 objects learned earlier.
LANGUAGE
____/2
____/2 ____/2 ____/2
Name a pencil and watch.
Repeat "No ifs, ands, or buts".
____/1
____/1 ____/1 ____/1
Give a 3 stage command. Score 1 for each stage.
Eg. "Place index finger of right hand on your nose
and then on your left ear".
____/3
____/3 ____/3 ____/3
Ask patient to read and obey a written command
on a piece of paper stating "Close your eyes".
____/1
____/1 ____/1 ____/1
Ask the patient to write a sentence. Score if it is
____/1
____/1
____/1
sensible and has a subject and a verb.
____/1
COPYING
Ask the patient to copy a pair of intersecting
pentagons:
____/1 ____/1
____/1
____/1
TOTAL
____/30 ____/30 ____/30 ____/30
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Parent category: Medical