Mental State Examination Filipino Version (MMSE-F) Personal Information Name. a Sex bos. _ ORIENTATION QUESTIONS Response Score 3 Year? Ano po ang taon ngayon? = 2. Season” dine pong panshon ng taonseason ngayon? —— . 3. Month? Ane pong buwwen ngayon? - 4 Date? An0 zong petsa ngayon? 5. 03y? Ano pong arww noayon? a — ‘Where are we?” or ‘Nasaan po layo ngayon? - 3 6 Name of sttee!? Nasaang kalye po ang lugar ne to? al 7. TowovCity? Nasaang siyudad 0 lungsod po tayo ngayon? SS 8 Place/Suiiirg/nstixtion? Ano eng pangalan ng lugar nit? — 8 Regionicourtry? Nasaang bansa po tayo ngayon? - 10 Foor of buikiing? Nasaang palanag po tayo ngayon? - Subtotal WORK REGISTRATION ATTEMPTS Score 1 2 3 4 . 11, Mango‘Mangga _ ee en 12 TabieMMesa — - — ~ 13 MoneyPe'a - — - a Subtotat NiIoM Given answer Score Correct answer - _ 14. 93 : = 15. 86 ———— 16 73 oO — = 7.7 OS — 8 - oe RECALL Given anawor Score Correct answer Mango (Mangga) 18, Table (Mesa) 16. Money (Pera)LANGUAGE Response Score a) Oral Naming 22 Show the patient a pencil, They are not allowed to touch it -What Is this? Or “Ano po ang tawag dio?” ‘Score 1 point for a correct answer. 23 Show the patent your wristwatch, They are not allowed to touch "What is this?" or “Ano po ang tawag dito?” ‘ ‘Score 1 poitit for @ correct answer. b)_ Repetition 24 “Listen carefully and repeat after me NO IFS, ANDIOR BUTS" or “Makinig kang mabuti sa sasabihin ko: WALA NGANG PLPO PERO PA Aliow oniy 4 altempl. Score only 4 point i the repetition is totally correct ¢} Obeying Oral Commanus Put a niece of blank paper in front of the patient and say: ‘Listen carefully and do what | say..." or “Gawin rninyo ang sasabihin ko...” 25 Take this paper in your right hand. Kunin ninyo ang papel na ito gamit ang inyong kanang kamay. 26, Fold tin half. Tiklupin sa gitna ang papel 27. And put iton the floor. At ilagay ito sa inyong kandungan. Score 1 point for each part correctly performed. @) Reading ‘Show the patient a blank piece of paper with sentence "close your eyes” or "pikit ang inyong mga mata 28 Read this silently and do wrat it says. Basan ninyo ito ng tahimik at gawin ninyo ang sinasabi. Score 1 point oniy if they actually perform the instruction. a _ fe) Writing Present a blank sheet of paper and pencil to the patient 28 Will you wnie @ sentence for me? Whte whatever you want but it must be whole sentence. Magsviat kayo sig kahit anong pangungusap. Do not dictate @ sentence. i has to be written spontaneously. It must contain at least a subject and a verb, and must make sense. Correct spelling and grammar are not necessary,1) Copying . . Execution 28 Can you copy this exactly as its? Pakikopya po to. fea MMSE Total Score Score