Please watch the following video and complete the following form.

The form needs to be completed in its entirety.

Video Link: https://www.youtube.com/watch?v=trNpXHAsQtU

 MMSE Additional information: https://depts.washington.edu/psyclerk/secure/mentalstatusexam  

Form to complete is attached 

Mini-Mental State Examination (MMSE)

Patient’s Name: Date:

Instructions: Score one point for each correct response within each question or activity.

Maximum
Score

Patient’s
Score

Questions

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

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

3

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.

5
“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.

1 “Repeat the phrase: ‘No ifs, ands, or buts.’”

3 “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.)

1

“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.)

30 TOTAL

Interpretation of the MMSE:

Method Score Interpretation

Single Cutoff <24 Abnormal

Range
<

21

>25

Increased odds of dementia

Decreased odds of dementia

Education

21

<23

<24

Abnormal for 8th grade education

Abnormal for high school education

Abnormal for college education

Severity

24-30

18-23

0-17

No cognitive impairment

Mild cognitive impairment

Severe cognitive impairment

Interpretation of MMSE Scores:

Score Degree of
Impairment

Formal Psychometric
Assessment

Day-to-Day Functioning

25-30 Questionably
significant

If clinical signs of cognitive impairment
are present, formal assessment of
cognition may be valuable.

May have clinically significant but mild
deficits. Likely to affect only most
demanding activities of daily living.

20-25 Mild
Formal assessment may be helpful to
better determine pattern and extent of
deficits.

Significant effect. May require some
supervision, support and assistance.

10-20 Moderate Formal assessment may be helpful if
there are specific clinical indications.

Clear impairment. May require 24-hour
supervision.

0-10 Severe Patient not likely to be testable.
Marked impairment. Likely to require
24-hour supervision and assistance
with ADL.

Source:
• 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.