——'- J— u- ~-.

~v-

The components of the MSE are as follows:

1. Appearance: How does the patient look? Neatly dressed with clear attention to detail? Well groomed?
2. Level of alertness: Is the patient conscious? If not, can they be aroused? Can they remain focused on
your questions and conversation? What is their ____Lattention
san?
3. Speech: Is it normal in _,—g_fltone
volume and uant'?
4. Behavior: Pleasant? Cooperative? Agitated? _gp_p_Aroriate for the particular Situation?
5. Awareness of environment, also referred to as orientation: Do they know where they are and what
they are doing here? Do they know who you are? Can they tell you the __y,____y__da
date and ear?
6. Mood: How do they feel? You may ask this directly (e.g. "Are y0u happy, sad, depressed, angry?"). Is it
_pp__p__aroriate for their current srt'uation?
7. Affect: How do they appear to you? This _Q________y________interretation
is based on our observation of their
interactions during the interview. Do they make _y____ee
contact? Are they excitable? Does the tone of
their voice change? Common assessments include: ___atfl (unchanging throughout), excitable,
a_pp_p_roriate.
8. Thought Process: This is a description of _y________y____the
wa in which the think. Are their comments __g_|oica| and
presented in an J4_oranizd
fashion? If not, how off base are they? Do they tend to stray quickly to
related topics? Are their thoughts appropriately linked or simply all over the map?
9. Thought Content: A description of what __L__g__the
atient is thinkin about. Are they paranoid? Delusional
(i.e. hold beliefs that are untrue)? If so, about what? Phobic? Hallucinating (y_______y___ou
need to ask if the see
hear thins that others do not)? Fixated on a single idea? if so, about what. Is the thought content
___g_____or
consistent With their affect? If there is any concern regarding possible interest in *g—committin
suicide or
homi___,cide the patient should be asked this directly, including a search for details (e.g. specific plan,
time etc.). Note: These questions have never been shown to plant the seeds for an otherwise
unplanned event and may provide critical information, so they should be asked!
10. Memory: Short term memory is assessed by _g_____|__,listin
three ob'ects asking the patient to _p__reeatthem to
you to insure that they were heard correctly, and then checking recall at 5 minutes. Long term
memory can be evaluated by asking about the patients job history, where they were born and raised,
family history, etc.
11. Ability to perform calculations: Can they perform _p____,_p__simle
addit‘ion multilication? Are the responses
appropriate for their level of education? Have they noticed any problems balancing their check books
or calculating correct change when making purchases? This is also a test of the patient's attention
span/ability to focus on a task.
12. Judgment: Provide a common scenario and ask what they would do (e.g. "If you found a letter on the
ground in front of a mailbox, what would you do with it?").
13. Higher cortical functioning and reasoning: Involves interpretation of complex ideas. For example, you
may ask them the meaning of the phrase, "People in glass houses should not throw stones." A few
common interpretations include: concrete (e.g. "Don't throw stones because it will break the glass");
abstract (e.g. "Don'tjudge others"); or bizarre
 Mini-Mental State Examination (MMSE)

Patient’s Name: Date:

Instructions: Score one point for each con'ect response within each question or activity.

Maximum Patient’s
Score Score

- “What is the year? Season? Date? Day? Month?”

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

The examiner names three unrelated objects clearly and slowly, then
the instructor 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.

“I would like you to count backward from 100 by sevens." (93. 86, 79,
72, 65. ...)
Alternative: “Spell WORLD backwards." (D-L-R—O-W)

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

2 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.)
1 “Please read this and do what it says." (Written instruction is “Close
your eyes”)
1 “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.)
__L_____Interretation
of the MMSE:

Increased odds of dementia

>25 Decreased odds of dementia

-
21 Abnormal for 8‘h grade education
Education <23 Abnormal for high school education
Abnormal for college education

24-30 No cognitive impairment

Severity 18-23 Mild cognitive impairment

0-17 Severe cognitive impairment

_Q______lnterretation
of MMSE Scores:

Degree of Formal Psychometric Day-to-Day Functioning

Impairment Assessment

lf clinical signs of cognitive impairment May have clinically significant but mild
Questionably
are present, formal assessment of deficits. Likely to affect only most
significant
cognition may be valuable. demanding activities of daily living.

Formal assessment may be helpful to Significant effect. May require some

20-25 better determine pattern and extent of supervision, support and assistance.
deficits.

1020 Moderate Formal assessment may be helpful if Clear impairment. May reqUIre 24-hour
there‘are speCIfic clinical Indications. supermsron.

Marked impairment. Likely to require

Patient not likely to be testable. 24-hour supervision and assistance
Wit'h ADL.

Source:
0 Folstein MF, Folstein SE. McHugh PR: “Mini-mental state: A practical method for grading the cognitive
state of patients for the clinician." J Psychiatr Res 1975;12:189—198.