The Mental Status Examination Chart Page 3
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Memory can be assessed by asking about news events,
sports, television shows, or recent meals.
Mini-Mental State Examination
MAXIMAL
Long-term memory can be assessed by using past events
SCORE
SCORE
confirmed by family members and also by repeating names
of historical figures, such as presidents of the U.S.
Orientation
5
) (
What is the (year) (season) (date)
Language ability can be assessed by asking patients to
(day) (month)?
explain similarities and differences between common objects
5
) (
Where are we: (state) (country)
(e.g., tree-bush, car-plane, air-water).
(town) (hospital) (floor)?
Registration
Thinking processes can be assessed by asking patients to
explain common proverbs with which they are familiar.
3
) (
Name 3 objects: take 1 second to
say each. Then ask patient to repeat
8. Can the MSE help to detect organic brain disease?
them. Give 1 point for each correct
answer.
Emotional and behavioral change is frequently the first
Attention and Calculation
presentation of organic brain disease, especially in patients
5
) (
Serials 7s from 100. 1 point for
with frontal and temporal tumors, hydrocephalus, or cortical
each correct answer. Stop after 5
atrophy. Brain tumors, subdural hematomas, small infarcts,
answers. Alternatively, spell
and cerebral atrophy may be undetected on routine
“world” backward.
neurologic exam, whereas the cognitive effects of such
lesions may be apparent on mental status examination. For
Recall
patients with known brain lesions, a thorough MSE
documents cognitive or emotional changes.
3
) (
Ask for the 3 objects named above.
1 point for each correct answer.
9. Does a normal MSE or MMSE score mean
Language
competence?
9
) (
Ask patient to name a pencil and
watch. (2 points)
No. Competence relates to patients’ ability to make
reasonable decisions for themselves and others. Such
Repeat the following: “No ifs, ands,
decisions include ability to provide food and shelter, to
or buts.” (2 points)
manage money, and to participate in activities such as
Follow a 3-stage command: “Take
deciding a course of medical care. Patients who score well on
a paper in your right hand, fold it in
an MSE may have deficits in understanding or completing
half, and put it on the table.” (3
common tasks of daily living. Among a population with a
points)
probable diagnosis of Alzheimer’s disease, 50% of patients
scoring between 26 and 30 on the MMSE had difficulty with
Read and obey the following:
basic tasks such as coping with small sums of money or
Close your eyes (1 point)
finding their way around familiar streets. The MSE is only
one component needed to assess competency. Medical
Write a sentence (1 point)
condition, current ability for self-care, and corroborating
information from family or friends must be taken in
Copy a drawing of intersecting
consideration.
pentagons (1 point)
Adapted from Folstein MF, Folstein SE, McHugh PR: Mini-
Mental State: A practical method for grading the cognitive
states of patients for the clinician. J Psychiatr Res 12:189–
198, 1975.
Additional questions can be used to extend and expand the
components of a screening exam:
Attention can be tested by counting by 2s to 20. This task is
easier and can be used for patients with poor arithmetic skills.
Calculation abilities can be tested by asking the patient to
add simple combinations of two-digit numbers. The task can
be graded in difficulty.
Immediate recall can be assessed by asking patients to
repeat number sequences up to seven forward and four in
reverse order. Start with shorter sequences.
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