Mini-Mental State Examination
Name: Date:
Instructions: Ask the questions in specified sequence and give one point for each correct response for each
question or task.
Questions Maximum score Patient score
What is the year? Season? Date? Day of the week? Month? 5
Where are we now: State? County? Town/city? Hospital? Floor? 5
The examiner names three unrelated objects clearly and slowly,
then asks the patient to name all three of them. The patient’s 3
response is used for scoring. The examiner repeats them until
patient learns all of them, if possible. Number of trials: _______
“I would like you to count backward from 100 by sevens.” (93,
86, 79,72, 65, …) Stop after five answers.
5
Alternative: “Spell WORLD backwards.” (D-L-R-O-W)
“Earlier I told you the names of three things. Can you tell me 3
what those were?”
Show the patient two simple objects, such as a wristwatch and a 2
pencil, and ask the patient to name them.
“Repeat the phrase: ‘No ifs, ands, or buts.’” 1
“Take the paper in your right hand, fold it in half, and put it on the 3
floor.” (The examiner gives the patient a piece of blank paper.)
“Please read this and do what it says.” (Written instruction is 1
“Close your eyes.”)
“Make up and write a sentence about anything.” (This sentence 1
must contain a noun and a verb.)
“Make up and write a complete sentence on a piece paper.” 1
(Sentence must contain a verb and noun.)
“Please copy this picture.” (The examiner gives the patient a
blank piece of paper and asks him/her to draw the symbol
below. ll angles must be present and two must intersect.
A 10 )
T otal: 3 0 r
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Administration and scoring of the MMSE
Orientation (10 points)
Ask for the date. Then specifically ask for parts omitted (e.g., “Can you also tell me what season it is?”).
One point for each correct answer
Ask in turn, “Can you tell me the name of this hospital (town, county, etc.)?” One point for each correct
answer.
Registration (3 points)
Say the names of three unrelated objects clearly and slowly, allowing approximately one second for each.
After you have said all three, ask the patient to repeat them. The number of objects the patient names
correctly upon the first repetition determines the score (0-3).
If the patient does not repeat all three objects the first time, continue saying the names until the patient is
able to repeat all three items, up to six trials. Record the number of trials it takes for the patient to learn
the words. If the patient does not eventually learn all three, recall cannot be meaningfully tested
After completing this task, tell the patient, “Try to remember the words, as I will ask for them in a little
while.”
Attention and calculation (5 points)
Ask the patient to begin with 100 and count backward by sevens. Stop after five subtractions (93, 86, 79,
72, 65). Score the total number of correct answers
If the patient cannot or will not perform the subtraction task, ask the patient to spell the word “world”
backwards. The score is the number of letters in correct order (e.g., dlrow=5, dlorw=3).
Recall (3 points)
Ask the patient if he or she can recall the three words you previously asked him or her to remember.
Score the total number of correct answers (0-3).
Language and praxis (9 points)
Naming: Show the patient a wrist watch and ask the patient what it is. Repeat with a pencil. Score one
point for each correct naming (0-2)
Repetition: Ask the patient to repeat the sentence after you (“No ifs, ands, or buts.”). Allow only one trial.
Score 0 or 1
3-Stage command: Give the patient a piece of blank paper and say, “Take this paper in your right hand,
fold it in half, and put it on the floor.” Score one point for each part of the command correctly executed
Reading: On a blank piece of paper print the sentence, “Close your eyes,” in letters large enough for the
patient to see clearly. Ask the patient to read the sentence and do what it says. Score one point only if the
patient actually closes his or her eyes. This is not a test of memory, so you may prompt the patient to “do
what it says” after the patient reads the sentence
Writing: Give the patient a blank piece of paper and ask him or her to write a sentence for you. Do not
dictate a sentence; it should be written spontaneously. The sentence must contain a subject and a verb
and make sense. Correct grammar and punctuation are not necessary
Copying: Show the patient the picture of two intersecting pentagons and ask the patient to copy the
figure exactly as it is. All ten angles must be present and two must intersect to score one point. Ignore
tremor and rotation.
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Interpretation of the MMSE
Method Score Interpretation
Single cutoff <24 Abnormal
<21
Increased odds of dementia
Range
>25 Decreased odds of dementia
21
Abnormal for 8th grade education
Education <23
Abnormal for high school education
<24 Abnormal for college education
24-30
No cognitive impairment
Severity 18-23
Mild cognitive impairment
0-17 Severe cognitive impairment
References:
Crum, R. M., Anthony, J. C., Bassett, S. S., & Folstein, M. F. (1993). Population-based norms for the Mini-
Mental State Examination by age and educational level. JAMA, 269(18), 2386–2391. https://doi.org/10.1001/
jama.1993.03500180078038
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-mental state: A practical method for grading the
cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://
doi.org/10.1016/0022-3956(75)90026-6
Rovner, B. W., & Folstein, M. F. (1987). Mini-mental state exam in clinical practice. Hospital Practice (Office
ed.), 22(1A), 99–110.
Tombaugh, T. N., & McIntyre, N. J. (1992). The mini-mental state examination: a comprehensive review.
Journal of the American Geriatrics Society, 40(9), 922–935. https://doi.org/10.1111/
j.1532-5415.1992.tb01992.x
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