Modified MMSE

Page 1 of 22 3MS Manual 1996
MANUAL FOR THE ADMINISTRATION AND SCORING OF

THE MODIFIED MINI-MENTAL STATE (3MS) TEST

(Updated May, 1996)

Evel yn Lee Teng, Ph. D. , and Hel ena Chang Chui , M. D.

( emai l : et eng@usc. edu)

Depar t ment of Neur ol ogy

Uni ver si t y of Sout her n Cal i f or ni a Keck School of Medi ci ne

2025 Zonal Avenue, Los Angel es, CA 90033, U. S. A.

Copyrighted. All rights reserved.

Do not duplicate or distribute without written permission
from Dr. Evelyn Teng.
Introduction

Mai n di f f er ences bet ween t he 3MS and t he MMSE

The Modi f i ed Mi ni - Ment al St at e ( 3MS) t est has been
desi gned t o enhance t he usef ul ness of t he popul ar Mi ni -
Ment al St at e Exami nat i on ( MMSE) ( Fol st ei n, Fol st ei n, and
McHugh, 1975) . Compar ed wi t h t he MMSE, t he 3MS has mor e
st andar di zed admi ni st r at i on and mor e gr aded scor i ng; i t
al so assesses a br oader var i et y of cogni t i ve domai ns and
cover s a wi der r ange of di f f i cul t y l evel s. The 3MS can
ext r act mor e i nf or mat i on about t he subj ect ' s cogni t i ve
st at us t han t he MMSE; i t i s al so mor e sensi t i ve t han t he
MMSE i n det ect i ng wi t hi n- i ndi vi dual changes over t i me ( Teng
and Chui , 1987) .

The 3MS i s not j ust a scr eeni ng t est f or dement i a

Nei t her t he MMSE nor t he 3MS has been desi gned
pr i mar i l y as a scr eeni ng t ool f or dement i a. For t hi s
pur pose t he 3MS Test i s onl y mar gi nal l y bet t er t han t he
MMSE ( Tombaugh, McDowel l , Kr i st j ansson, and Hubl ey, 1996) ;
as a mat t er of f act , compar abl e scr eeni ng ef f i cacy can be
achi eved wi t h t he use of a much shor t er t est , a shor t
ver si on of t he Cogni t i ve Abi l i t i es Scr eeni ng I nst r ument , or
CASI - Shor t ( Teng, Hasegawa, Homma, et al . , 1994) . Al t hough
many of t he i t ems i n t he MMSE and t he 3MS ar e not sensi t i ve
f or det ect i ng dement i a i n i t s ear l y st age, t hey ar e usef ul
f or ot her pur poses, i ncl udi ng t hat of moni t or i ng t he
pr ogr essi on of dement i a t o i t s mi ddl e and l at e st ages.

Thi s Manual cont ai ns answer s t o many f r equent l y asked
quest i ons

Thi s manual has been pr epar ed af t er mor e ext ensi ve use
of t he 3MS by us and ot her s si nce t he f i r st ar t i cl e on t he
3MS was publ i shed ( Teng and Chui , l 987) . I n t hi s manual we
have i ncor por at ed answer s t o many quest i ons t hat f r equent l y
ar i se dur i ng t he admi ni st r at i on and scor i ng of t he 3MS.
Mi nor changes have been made f r omt he or i gi nal ar t i cl e.
For exampl e: t he or der of aski ng t he t i me and pl ace of
bi r t h has been swi t ched; t he t hr ee choi ces f or spat i al
or i ent at i on have been modi f i ed. Wher ever i nf or mat i on
pr ovi ded i n t hi s manual di f f er s f r omt hat i n t he or i gi nal
ar t i cl e, f ol l ow t hi s manual .

The avai l abi l i t y of qui zzes on 3MS admi ni st r at i on and
scor i ng

When t he 3MS i s used i n a r esear ch set t i ng wher e
dat a wi l l be col l ect ed and used by di f f er ent i ndi vi dual s,
i t wi l l be cost ef f ect i ve t o make sur e t hat al l user s
f ol l ow t he same admi ni st r at i on and scor i ng gui des. We have
l ear ned t hat pr ovi di ng a manual and conduct i ng a wor kshop
i s no guar ant ee f or achi evi ng t hi s goal . Ther ef or e we have
pr epar ed t wo par al l el f or ms of a qui z as an ai d f or qual i t y
cont r ol . Each qui z cont ai ns 24 i t ems wi t h f our r esponse
choi ces each. We r ecommend t hat each pot ent i al user of t he
3MS f i r st r ead t he or i gi nal ar t i cl e ( Teng and Chui , 1987)
and st udy t hi s manual , t hen t ake t he qui z. We have used an
ar bi t r ar y gui del i ne t hat , i f a per son has made mor e t han
t hr ee er r or s on t he qui z, he or she be asked t o st udy t he
manual mor e car ef ul l y and t hen t ake an al t er nat e f or mof
t he qui z. Thi s pr ocedur e shoul d be r epeat ed unt i l or
unl ess t he number of er r or s i s l ess t han f our ; i n such case
t he cor r ect answer ( s) on t he mi ssed i t em( s) wi l l be
pr ovi ded, and t he i ndi vi dual i s consi der ed r eady f or f or mal
dat a col l ect i on.

The qui zzes and t hei r scor i ng keys shoul d be kept
separ at e f r omt he Manual and guar ded as conf i dent i al
mat er i al . We r ecommend t hat t he qui zzes be admi ni st er ed i n
an of f i ce set t i ng and al l qui z bookl et s be col l ect ed al ong
wi t h t he answer sheet s.

Comment s and suggest i ons ar e wel come

We pl an t o updat e t hi s Manual per i odi cal l y. I f you
have any comment s or suggest i ons f or i t s i mpr ovement ,
pl ease l et us know.


Some References

Br avo G, & Heber t R ( 1997) . Age- and educat i on- speci f i c
r ef er ence val ues f or t he Mi ni - Ment al and modi f i ed mi ni -
ment al st at e exami nat i ons der i ved f r oma non- dement ed
el der l y popul at i on. I nt . J Ger i at Psychi at , 12, 1008- 1018.

Fol st ei n MF, Fol st ei n SE, McHugh PR. ( 1975) . " Mi ni - Ment al
St at e" : A pr act i cal met hod f or gr adi ng t he cogni t i ve st at e
of pat i ent s f or t he cl i ni ci an. J our nal of Psychi at r i c
Resear ch 12: 189- 198.

McDowel l I . ( 2006) The Modi f i ed Mi ni - Ment al St at e Test .
Chapt er 8 ( pp 441 449) i n I McDowel l : Measur i ng heal t h: a
gui de t o r at i ng scal es and quest i onnai r es. New Yor k,
Oxf or d Uni ver si t y Pr ess.

Teng EL, Chui HC. ( 1987) . The Modi f i ed Mi ni - Ment al St at e
Exami nat i on. J our nal of Cl i ni cal Psychi at r y 48: 314- 318.

Teng EL, Hasegawa K, Homma A, I mai Y, Lar son E, Gr aves A,
Sugi mot o K, Yamaguchi T, Sasaki H, Chi u D, & Whi t e LR.
( 1994) The Cogni t i ve Abi l i t i es Scr eeni ng I nst r ument
( CASI ) : A pr act i cal Test f or Cr oss- Cul t ur al Epi demi ol ogi cal
St udi es of Dement i a. I nt er nat i onal Psychoger i at r i cs 6: 45-
58.

Tombaugh TN, McDowel l I , Kr i st j ansson B, Hubl ey AM. ( 1996) .
Mi ni - Ment al St at e Exami nat i on ( MMSE) and t he Modi f i ed MMSE
( 3MS) : A psychomet r i c compar i son and nor mat i ve dat a.
Psychol ogi cal Assessment 8: 48- 59.
General Considerations

Exami ner s shoul d t hor oughl y f ami l i ar i ze t hemsel ves
wi t h t he t est i ng pr ocedur es and t he scor i ng cr i t er i a bef or e
usi ng t he 3MS Test i n f or mal assessment . The 3MS r ecor d
sheet cont ai ns hi ghl y condensed i nf or mat i on f r omt hi s
manual . User s of t he r ecor d sheet must f i r st st udy t hi s
manual car ef ul l y, ot her wi se mi sunder st andi ngs of t he
condensed i nf or mat i on on t he r ecor d sheet can easi l y occur .

I n t he admi ni st r at i on of t he 3MS Test , do not offer
extra help or wait too long for responses. Al t hough
somet i mes i t i s appr opr i at e t o r e- pr esent or r ephr ase a
quest i on, i n gener al i f a subj ect gi ves an i ncor r ect
answer , says " I don' t know, " or i s unabl e t o gi ve an
answer , t he exami ner shoul d j ust scor e accor di ngl y and
pr oceed t o t he next i t em.

Al t hough t i me l i mi t s ar e set f or some i t ems, t hey ar e
st at ed i n t he Manual and on t he r ecor d sheet onl y f or
gui di ng t he exami ner s i n t he paci ng of t he admi ni st r at i on
and i n scor i ng. Subjects should never be told of any time
limit on any item.

The 3MS shoul d be admi ni st er ed i n a qui et pl ace wi t h
mi ni mal di st r act i ons. I f any t empor ar y condi t i on exi st s
t hat may det r act t he subj ect f r omhi s or her opt i mal
per f or mance, such shoul d be not ed on t he r ecor d sheet and
i n t he t est r epor t . Ot her f act or s t hat mi ght al t er t he
i nt er pr et at i on of t he t est scor e as an i ndi cat i on of
cer ebr al cogni t i ve abi l i t i es shoul d al so be not ed; exampl es
i ncl ude poor hear i ng, poor eyesi ght , i mpai r ed mot or
cont r ol , l anguage bar r i er .


ADMINISTRATION AND SCORING OF THE INDIVIDUAL ITEMS

PLACE AND DATE OF BIRTH

Pl ace: t own _____, st at e _____

Dat e: year _____, mont h _____, day _____

Thi s i t emi s a measur e of l ong- t er mmemor y. I t i s
assumed t hat i n t he past t he subj ect has had r epeat ed
oppor t uni t i es t o l ear n and r epor t hi s/ her dat e and pl ace of
bi r t h.

Fi r st ask " WHERE WERE YOU BORN?" , t hen ask " WHEN WERE
YOU BORN?" I f t he subj ect gi ves onl y par t of t he answer
( e. g. , onl y t he year of bi r t h t o t he second quest i on) , ask
f or t he mi ssi ng i nf or mat i on.

Scor i ng

One poi nt f or each ent r y. Obt ai n dat a f r oma r el i abl e
sour ce as a scor i ng gui de. I n case t her e i s no i ndependent
sour ce of i nf or mat i on, accept t he subj ect ' s answer t o be
cor r ect i f ( i ) i t i s gi ven pr ompt l y wi t h conf i dence, ( i i )
i t seems r easonabl e, and ( i i i ) t he subj ect ' s per f or mance on
t he ot her t est i t ems ar e gener al l y good. When i n doubt ,
r epeat t he quest i ons at t he end of t he t est . For each
component , i f t he subj ect ' s answer s on t he t wo occasi ons
ar e consi st ent , scor e l ; ot her wi se, scor e 0. ( The
assumpt i on i s t hat i f t he subj ect does not r emember and
gi ves a guessi ng answer , i t i s unl i kel y t hat t he t wo
guesses wi l l be i dent i cal . )

REGISTRATION # ____: ( No. Pr esent at i ons: ___ )

#1: SHI RT ___, BROWN ___, HONESTY ___
#2: SHOES ___, BLUE ___, MODESTY ___
#3: SOCKS ___, BLACK ___, CHARI TY ___

Tel l t he subj ect : " I AM GOING TO SAY THREE WORDS FOR YOU TO
REMEMBER. REPEAT THEM AFTER I HAVE SAID ALL THREE."

( Not e: The subj ect i s NOT t ol d t hat " I amgoi ng t o ask you
t o r ecal l t he t hr ee wor ds l at er . " Such an i nst r uct i on may
encour age r ehear sal and make t he gener al per f or mance l evel
of l at er r ecal l s t oo hi gh. )

Consi der usi ng di f f er ent ver si ons of t hr ee wor ds ( i )
f or consecut i ve subj ect s and ( i i ) when t he same subj ect i s
t est ed r epeat edl y.

Recor d t he ver si on number i n " # ____: " Ci r cl e t he
pr esent ed wor ds i n t he t wo r ecal l i t ems on t he r ecor d
sheet ; t hi s wi l l hel p make t he admi ni st r at i on and scor i ng
of t hese t wo l at er i t ems easi er .

Say t he t hr ee wor ds di st i nct l y at t he r at e of l . 5 sec.
per wor d.

I f t he subj ect r epeat s af t er each wor d, r equest
r epet i t i on of al l t hr ee i t ems at t he end of your
pr esent at i on ( " Tell me the three words again" ) and scor e
accor di ng t o t he r esponses t o t hi s r equest .

Some subj ect s wi l l i nt er r upt ( t ypi cal l y wi t h a
quest i on, e. g. , " What i s t he f i r st wor d?" ) dur i ng t he
pr esent at i on of t he t hr ee wor ds. Do not st op t o r espond.
Cont i nue t o f i ni sh t he pr esent at i on of t he t hr ee wor ds,
t hen ask: " What t hr ee wor ds do you t hi nk I have j ust sai d?"
Scor e accor di ng t o t he answer t o t hi s quest i on.

I f t he subj ect cannot r epeat al l t hr ee wor ds
cor r ect l y, r e- pr esent al l t hr ee wor ds, up t o t hr ee t i mes.
Then, whet her or not t he subj ect can r epeat al l t hr ee
wor ds, pr oceed t o t he next i t em.

Dur i ng t he f i r st r e- pr esent at i on of t he t hr ee wor ds,
i t i s advi sabl e t o cl ar i f y t he wor ds t o hel p under st andi ng.
For exampl e: " Let me say t he t hr ee wor ds agai n. They
ar e. . . SHI RT - - what you ar e wear i ng, BROWN - - a col or , and
HONESTY - - t o be t r ut hf ul ; t el l i ng t he t r ut h. Now say t he
t hr ee wor ds agai n. " )

Ent er t he t ot al number of pr esent at i ons gi ven i n
" ( No. Pr esent at i ons: ____) " ( The maxi mumnumber i s 4. )

Scor i ng

The scor e f or r egi st r at i on i s t he number of i t ems
cor r ect l y r epor t ed i n what ever or der af t er t he f i r st
pr esent at i on. Accept mi nor var i at i ons f r omt he pr esent ed
wor d ( e. g. , sock f or socks, honest l y f or honest y) as
cor r ect .

MENTAL REVERSAL

5 t o l ( Can ___ Can' t ___ do 1 t o 5)

Accur at e 2
l or 2 er r or s/ mi sses 1
Mor e t han 2 er r or s/ mi sses 0

DLROW( Can ___ Can' t ___ do f or war d)

0 1 2 3 4 5

Thi s i t emhas t wo par t s: count i ng backwar ds f r om5 t o
l , and spel l i ng WORLD backwar ds. For each par t , ask t he
subj ect t o do t he f or war d ver si on f i r st , coach once i f
needed.

Fi r st say: " COUNT FROM 1 TO 5. " I f t he subj ect can
do t hi s, check " Can ___" , ot her wi se check " Can' t ___" .

I f t he subj ect can count f r om1 t o 5, say " NOW COUNT
BACKWARDS FROM 5 TO 1. "

I f t he subj ect cannot count f r oml t o 5, coach and ask
t he subj ect t o r epeat : Say " SAY 'ONE, TWO, THREE, FOUR,
FIVE' " at t he r at e of l . 5 sec per di gi t . Coach onl y once,
t hen ask t he subj ect t o count backwar ds f r om5 t o l , even
i f t he per f or mance i n count i ng f or war d i s not per f ect .

Scor e 2, 1, or 0 accor di ng t o t he st at ed cr i t er i a on
t he r ecor d f or m.

Next say: " SPELL 'WORLD' . " Check t he appr opr i at e
bl ank on t he r ecor d f or mt o i ndi cat e whet her or not t he
subj ect can spel l WORLD f or war d cor r ect l y. I f not , coach
once and ask t he subj ect t o r epeat . Say " IT'S SPELLED W-O-
R-L-D. " I f t he subj ect does not r epeat spont aneousl y,
pr ompt wi t h " Say 'W-O-R-L-D'." Pr onounce t he l et t er s
di st i nct l y at t he r at e of l . 5 sec per l et t er . Whet her or
not t he subj ect spel l s cor r ect l y af t er coachi ng, next say:

" NOW SPELL 'WORLD' BACKWARDS. "

Scor e f r om0 t o 5, accor di ng t o t he f ol l owi ng r ul es:

1) Wr i t e down t he subj ect ' s r esponse; r ead backwar ds
and r ecor d t he hi ghest number of l et t er s t hat ar e i n
cor r ect r el at i ve or der f or WORLD. For exampl e:

4 poi nt r esponses: DLORW, DLWRO, DLDRW, DROW, DLOW,
DRLOW.

3 poi nt r esponses: DORW, DOLW, DORLW, DRLW.

2 poi nt r esponses: DOR, DL, DW.

2) Gi ve cr edi t f or t he subj ect ' s sel f - cor r ect i ons.
E. g. , i f t he subj ect says " D- R- L- O- W. . No! D- L- R- O- W, " t he
scor e i s 5.

3) I f t he subj ect says onl y one l et t er , scor e 1 i f i t
i s D, scor e 0 ot her wi se.

4) Subt r act one poi nt i f t her e ar e mor e t han f i ve
l et t er s.
For exampl e:

LDDLRO = 4 ( f or DLRO) - 1 = 3
LDOROL = 3 ( f or DRO) - 1 = 2

5) I f t he subj ect r epeat s W- O- R- L- D or par t of i t i n
t he f or war d di r ect i on, scor e 0.

6) The l owest scor e i s 0; do not gi ve negat i ve scor es.
For exampl e, i f t he subj ect says " W- W- O- R- L- D" , t he scor e
i s 0 i nst ead of { [ 0 ( r ul e #5) - 1 ( r ul e #4) ] = } - 1.

FIRST RECALL OF THREE WORDS

Spont aneous r ecal l 3
Af t er " Somet hi ng t o wear " 2
Af t er " SHOES, SHI RT, SOCKS" 1
St i l l i ncor r ect 0

Af t er " A col or " 2
Af t er " BLUE, BLACK, BROWN" 1

Af t er " A good per sonal qual i t y" 2
Af t er " HONESTY, CHARI TY, MODESTY" 1

Ask " WHAT THREE WORDS DID I ASK YOU TO REMEMBER EARLIER?"

For each wor d not r eadi l y r epor t ed, pr ovi de cat egor y
cui ng, f ol l owed by mul t i pl e choi ces i f necessar y. Do not
wai t mor e t han 3 sec. f or spont aneous r ecal l , and do not
wai t mor e t han 2 sec. af t er cat egor y cui ng, bef or e
pr ovi di ng t he next l evel of hel p.

I f t he subj ect st ar t s out gi vi ng an i ncor r ect answer
i n t he cor r ect cat egor y ( e. g. , r epor t s " shi r t " or " coat "
when t he cor r ect answer i s " shoes" ) , pr oceed t o pr ovi de t he
t hr ee al t er nat i ves f or hi mor her t o choose f r om, and scor e
1 i f t he choi ce i s cor r ect . I f af t er gi ven t hr ee choi ces
t he subj ect i ndi cat es t hat he or she st i l l does not
r emember , scor e 0. Do NOT pr ess f or a guessi ng answer .

I f t he subj ect has not chosen t he cor r ect answer f r om
t he t hr ee choi ces, scor e 0 but do t el l hi mor her t he
cor r ect answer . Thi s i s f or t he benef i t of t he second
r ecal l t o be r equest ed l at er .

Whenever a subj ect has not r epor t ed al l t hr ee wor ds
cor r ect l y wi t hout hel p ( i . e. , whenever t he t ot al scor e on
f i r st r ecal l i s < 9) , say t he t hr ee wor ds once mor e bef or e
pr oceedi ng t o t he next i t em. However , subj ect s ar e NOT
t ol d t hat t hey wi l l be asked t o r ecal l t he t hr ee wor ds
agai n.

Exampl e: ( Assumi ng t hat t he t hr ee wor ds pr esent ed by t he
exami ner ar e Shoes, Bl ack, Modest y) .

Exami ner : " What t hr ee wor ds di d I ask you t o r emember
ear l i er ?"

Subj ect : " Shoe. . . . " ( 3 sec. pause)

E: " Anot her wor d i s a col or . " S: " Bl ack! "

E: " That ' s r i ght . Anot her wor d i s a good per sonal
qual i t y. "

S: " Honest y?"

E: " I ' l l gi ve you t hr ee wor ds t o choose f r om- - Honest y,
Char i t y, Modest y. "

S: " Honest y! " ( Or : No r esponse f or 2 sec. )

E: " ( No. ) The wor d i s ' Modest y' . . . . The t hr ee wor ds I
asked you t o r emember ar e Shoes, Bl ack, and Modest y. "

Scor i ng

The or der i n whi ch t he t hr ee wor ds ar e r epor t ed i s not
i mpor t ant .

Accept mi nor var i at i ons f r omt he pr esent ed wor d ( e. g. ,
sock f or socks, honest l y f or honest y) as cor r ect .

For each wor d, scor e 3 f or spont aneous r ecal l .
2 f or cor r ect r ecal l af t er cui ng.
1 f or cor r ect i dent i f i cat i on f r om
t hr ee al t er nat i ves.

For t he above exampl e, t he scor es ar e 3, 2, and 0
r espect i vel y f or Shoes, Bl ack, and Modest y.

TEMPORAL ORIENTATION

Year Accur at e 8
Mi ssed by l yr . 4
Mi ssed 2- 5 yr s. 2
Mi ssed by > 5 yr s. 0

Mont h Accur at e or wi t hi n 5 days 2
Mi ssed by 6 days t o 1 mo. 1
Mi ssed by > l mont h 0

DATE ( of t he mont h) Accur at e 3
Mi ssed l - 2 days 2
Mi ssed 3- 5 days 1
Mi ssed > 5 days 0

DAY ( of t he week) Accur at e 1
I naccur at e 0

Season Accur at e or wi t hi n l mo. 1
Mi ssed by > l mo. 0

Ask " WHAT IS TODAY's DATE?" and pr obe f or i t ems not
r epor t ed.
( e. g. , " What year i s t hi s?" )

For t he season, do not accept " Chr i st mas season, " " r ai ny
season, " or si mi l ar r esponses. I f t he subj ect appear s
puzzl ed or gi ves an answer t hat i s not one of t he f our
seasons, pr ovi de t he names of t he f our seasons f or t he
subj ect t o choose f r omand put t he cor r ect choi ce i n t he
second posi t i on.

Scor i ng

Answer s f or year , mont h, and dat e of mont h ar e scor ed
i n a gr aded manner accor di ng t o t he cl oseness of t he
r esponse t o t he cor r ect answer . Fol l ow t he cr i t er i a l i st ed
above. For each sub- i t em, i f t he subj ect cannot answer ,
scor e 0.

For Season ( SSN) : Gi ve l poi nt i f t he answer i s
cor r ect or i f t he change of t he season occur r ed ( or wi l l
occur ) wi t hi n 30 days and t he subj ect r epor t s t he l ast ( or
next ) season.

The seasons change ar ound t he 21st of Mar ch, J une,
Sept ember and December .

Exampl e:

The cor r ect dat e i s Mar ch 3, 1991.
The subj ect r epor t s Feb. 28, 1975.

Scor e f or YR: 0. ( 1975 i s mor e t han 5 yr s. f r om
1991. )

Scor e f or MO: 2. ( Febr uar y 28 i s l ess t han 5 days
f r omMar ch. )

Scor e f or DATE: 1. ( Febr uar y 28 i s wi t hi n 3- 5 days
of Mar ch 3. )

SPATIAL ORIENTATION

St at e 0 2
Count y 0 1
Ci t y 0 1
St or e/ Hospi t al ( Cl i ni c) / Home? 0 1

Ask " WHAT ___ ARE WE IN?"

For t he l ast sub- i t em, ask " ARE WE IN A STORE, A
HOSPITAL (/MEDICAL CLINIC), OR A HOME?" *

Pr esent t he cor r ect choi ce i n t he mi ddl e. For
exampl e, when t est i ng at a subj ect ' s home, ask " Ar e we i n a
st or e, a home, or a hospi t al ?" I f t he cor r ect answer
( e. g. , a seni or - ci t i zens' act i vi t y cent er ) i s not among t he
t hr ee al t er nat i ves gi ven above, use i t t o r epl ace t he
mi ddl e choi ce.

* A change has been made f r omt he publ i shed paper ,
wher e t he t hr ee choi ces ar e hospi t al , of f i ce bui l di ng, and
home. I n many cl i ni cal set t i ngs t he answer of ei t her
" hospi t al " or " of f i ce bui l di ng" woul d be cor r ect . The
cur r ent t hr ee choi ces r educe t he pr obabi l i t y of bei ng
cor r ect by chance.

Scor e accor di ng t o t he cr i t er i a l i st ed above.

NAMING

For MMSE: Penci l ____, Wat ch ____

For 3MS: For ehead ____, Chi n ____, Shoul der ____,
El bow ____, knuckl e ____

Thi s i t emt est s whet her or not t he subj ect can
pr ompt l y name t he t wo obj ect s and t he f i ve body par t s. I f
t he subj ect cannot name wi t hi n 2 sec, or i f t he answer i s
i ncor r ect , do not hel p or quest i on agai n; j ust scor e 0 and
move on t o t he next par t .

For t he MMSE sub- i t ems, t he exami ner pi cks up a penci l
and asks " WHAT IS THIS?" , and t hen poi nt s t o a wat ch and
asks " WHAT IS THIS?"

For t he 3MS Test sub- i t ems, t he exami ner asks whi l e
poi nt i ng t o t he appr opr i at e par t on hi s or her own body:
" WHAT DO YOU CALL THIS PART OF THE FACE? ( poi nt i ng t o t he
mi ddl e of t he f or ehead) . . . AND THIS PART? ( poi nt i ng t o t he
chi n) . . AND THIS PART OF THE BODY? ( poi nt i ng t o t he
shoul der ) . . . AND THIS PART? ( poi nt i ng t o t he el bow) . . . AND
THIS PART OF THE HAND? ( poi nt i ng t o t he knuckl e) "

Scor e 1 poi nt f or each i t emnamed cor r ect l y within 2
sec.

FOUR-LEGGED ANIMALS ( 30 sec)

Ask " WHAT ANIMALS HAVE FOUR-LEGS? TELL ME AS MANY AS
YOU CAN."

St ar t t i mi ng at t he end of t hi s r equest .

I f t he subj ect says " Al l ani mal s have f our l egs, " say
" Tel l me t hei r names" but do NOT r e- st ar t t he t i mi ng.

The f i r st t i me an i ncor r ect answer i s pr ovi ded, gent l y
r emi nd " I want f our - l egged ani mal s. " Do not cor r ect f or
subsequent er r or s.

Di scont i nue af t er 30 sec. or af t er 10 cor r ect
r esponses, whi chever occur s f i r st .

I f t he subj ect gi ves no r esponse i n 10 sec. and t her e
ar e st i l l at l east 10 sec. of r emai ni ng t i me, gent l y r emi nd
( once onl y) : " What ( ot her ) ani mal s have f our l egs?"

Scor e one poi nt f or each cor r ect ani mal name.
Di f f er ent names f or t he same ani mal of di f f er ent ages or
gender s count as one. ( E. g. , ki t t en and cat , puppy and
dog, deer and doe. ) Accept mar gi nal cases such as monkeys,
chi mpanzees, baboons, and kangar oos as cor r ect r esponses.

SIMILARITIES

ARM- LEG

Body par t , l i mb, ext r emi t i es 2
Long, bend, muscl es, bones, et c. 1
I ncor r ect ; DK; t el l s di f f er ence 0

LAUGHI NG- CRYI NG

Expr essi ons of f eel i ngs/ emot i ons 2
Ot her cor r ect answer 1

EATI NG- SLEEPI NG

Necessar y bodi l y f unct i ons 2
Ot her cor r ect answer 1

I nt r oduce t hi s i t emby sayi ng:

" AN APPLE AND A BANANA ARE ALIKE IN THAT THEY ARE BOTH
FRUIT."

Emphasi ze t he wor ds " al i ke" and " bot h. " Pause f or 2
sec. f or t he subj ect t o pr ocess t hi s st at ement , t hen ask:

" IN WHAT WAY ARE ___ AND ___ ALIKE?" or :

" __ AND __ ARE BOTH......?"

For t he f i r st sub- i t em( ar mand l eg) onl y: I f t he
subj ect ' s answer i s l ess t han 2 poi nt s, coach f or a 2- poi nt
answer .

For t he next t wo sub- i t ems: No coachi ng. I f t he
subj ect gi ves an i ncor r ect si mi l ar i t y, or t el l s t he
di f f er ence, or says " They ar e di f f er ent " or " I don' t know, "
j ust scor e 0 and move on.

Scor i ng

Scor e 2 poi nt s f or concept ual si mi l ar i t i es whi ch ar e
pr i mar i l y per t i nent f or bot h member s of t he pai r . Scor e 1
poi nt f or ot her answer s t hat ar e cor r ect . I n gener al , be
l eni ent i n awar di ng 1 poi nt ; subj ect s ar e gi ven cr edi t as
l ong as t hey can see beyond t he di f f er ences and come up
wi t h a r easonabl e answer . Exampl es:

Ar m- Leg:

2 poi nt s: l i mbs, ext r emi t i es, par t s of body

1 poi nt : bend, move, l ong, have bones

0 poi nt : usef ul ( Comment : t oo vague. )

Laughi ng- Cr yi ng:

2 poi nt s: ( expr essi ons of ) emot i ons, f eel i ngs

1 poi nt : expr essi ons, sounds, i nvol ve t he mout h

0 poi nt : pr oduce t ear s ( Comment : l aughi ng usual l y
Does not pr oduce t ear s) ;

somet i mes you l augh when you cr y, somet i mes
you cr y when you l augh ( Comment : t hi s
st at ement i s not about t hei r si mi l ar i t y,
but about t hei r r el at i onshi p) .

Eat i ng- Sl eepi ng:

2 poi nt s: necessar y bodi l y f unct i ons; essent i al f or
l i f e

1 poi nt : bodi l y f unct i ons, r el axi ng, " good f or you, "
r ef r eshi ng, enj oyabl e, dai l y act i vi t i es,
" I l i ke bot h. "

0 poi nt : I don' t know ( DK)

REPETITION

" HE WOULD LI KE TO GO HOME. " 2
One or 2 mi ssed or wr ong wor ds 1
Mor e t han 2 mi ssed or wr ong wor ds 0

" NO I FS ___ ANDS ___ OR BUTS ___"

The i nt ended f unct i on of t hi s i t emi s t o assess
at t ent i on and t he abi l i t y t o r epeat or al l y pr esent ed ver bal
messages. The t wo sub- i t ems r espect i vel y r equi r e a l ow and
a hi gh l evel of at t ent i on f or cor r ect r esponse.

Tel l t he subj ect : " REPEAT EXACTLY WHAT I SAY -- 'HE
WOULD LIKE TO GO HOME.'" Af t er t he r esponse, say " NOW
REPEAT -- 'NO IFS, ANDS, OR BUTS.' " Speak di st i nct l y, but
not par t i cul ar l y sl owl y.

Scor i ng

Fi r st sub- i t em: 2 poi nt s f or per f ect r epet i t i on.
1 poi nt i f t her e i s 1 or 2 mi ssed or wr ong
wor ds.

Second sub- i t em: For each of t he t hr ee par t s ( no i f s;
ands; or but s) , l poi nt f or per f ect
r epet i t i on. Gi ve no cr edi t i f t he " s" i s
mi ssed. )

READ AND OBEY "CLOSE YOUR EYES."

Cl oses t he eyes wi t hout pr ompt i ng 3

Cl oses t he eyes af t er pr ompt i ng 2

Reads al oud t he command, ei t her spont aneousl y or 1
af t er pr ompt i ng, but does not cl ose t he eyes

Nei t her r eads cor r ect l y, nor cl oses t he eyes 0


The command i s pr i nt ed i n al l capi t al l et t er s,
appr oxi mat el y 2. 5 cmi n hei ght , wi t hi n t he t op one t hi r d of
t he back- si de of t he r ecor d f or m.

Fol d t he sheet of paper one- t hi r d down t o show t he
command and say " PLEASE DO THIS. " Keep t he paper cl ose t o
t he sur f ace of t he t abl e so t hat t her e i s not enough
l i ght i ng f r ombehi nd t o show t he wor ds on t he f r ont si de of
t he r ecor di ng sheet .

I f t he subj ect does not r espond, or mer el y r eads t he
command, poi nt t o t he command and say " DO WHAT THIS SAYS."
Al l ow up t o 5 sec. f or r esponse, t hen move on t o t he next
i t em. As soon as t he subj ect cl oses t he eyes, say:
" Thanks. You can open your eyes now. "

Scor e accor di ng t o t he cr i t er i a st at ed above.

WRITING ( l mi nut e)

HE WOULD LI KE TO GO HOME.

Fol d t he sheet of paper once mor e t o show t he bl ank,
mi ddl e one- t hi r d of t he sheet . Tel l t he subj ect :

" I WOULD LIKE TO HAVE A SAMPLE OF YOUR HANDWRITING.
WRITE 'HE WOULD LIKE TO GO HOME.'"

Al l ow ei t her cur si ve or pr i nt i ng. I f t he subj ect
seems t o have t r oubl e r emember i ng t he sent ence, di ct at e t he
sent ence wor d by wor d as t he subj ect wr i t es.

Al l ow up t o one mi nut e f or r esponse, t hen move on t o
t he next i t em. I f at t he end of one mi nut e t he subj ect i s
st i l l wor ki ng on t he t ask i n ear nest , consi der al l owi ng
hi m/ her t o f i ni sh f or t he sake of mai nt ai ni ng r appor t and
mor al e, but mar k t he l mi n. poi nt on t he pr oduct dur i ng
scor i ng, and do not cr edi t par t s f i ni shed af t er l mi n.

Scor i ng

One poi nt f or each wor d, but do not scor e t he f i r st
wor d " I / He" . Scor e each wor d accor di ng t o whet her or not
i t can be r eadi l y i dent i f i ed wi t hout t he cont ext . For each
wor d, scor e 0 i f t her e i s spel l i ng er r or or i ncor r ect mi xed
capi t al i zat i on ( e. g. , I woul d Li ke t o Go homE) . Do not
penal i ze i f t he subj ect pr i nt s al l l et t er s i n t he
upper case.

COPYING INTERSECTING PENTAGONS ( l mi nut e)

Each Pent agon:
5 appr ox. equal si des 4 4
5 but un- equal ( >2: 1) si des 3 3
Ot her encl osed f i gur e 2 2
2 or mor e l i nes 1 1
Less t han 2 l i nes 0 0

I nt er sect i on:
4- cor ner ed encl osur e 2
Not 4- cor ner ed encl osur e 1
No encl osur e 0

Show onl y t he l ower one t hi r d of t he sheet t hat
cont ai ns t he sampl e pent agons. For r i ght - handed subj ect s,
pr esent t he sampl e on t hei r l ef t si de. For l ef t - handed
subj ect s, pr esent t he sampl e on t hei r r i ght si de. Thi s way
t he sampl e wi l l not be bl ocked by t he dr awi ng hand.

Al l ow up t o one mi nut e f or r esponse, t hen move on t o
t he next i t em. I f at t he end of one mi nut e t he subj ect i s
st i l l wor ki ng on t he t ask i n ear nest , consi der al l owi ng hi m
or her t o f i ni sh f or t he sake of mai nt ai ni ng r appor t and
mor al e. Do mar k t he l mi n. poi nt on t he pr oduct dur i ng
scor i ng, and do not cr edi t par t s f i ni shed af t er l mi n.

Somet i mes t he subj ect i s not sat i sf i ed wi t h t he
pr oduct and want s t o t r y agai n. Thi s i s per mi t t ed, but do
not r e- st ar t t he t i mi ng. Scor e f or t he bet t er pr oduct
compl et ed wi t hi n one mi nut e.

Scor e accor di ng t o t he cr i t er i a l i st ed above.


THREE-STAGE COMMAND

_____ TAKE THIS PAPER WITH YOUR L (R) HAND,
_____ FOLD IT IN HALF, AND
_____ HAND IT BACK TO ME.

Thi s i t emt est s t he subj ect ' s abi l i t y i n
under st andi ng, r emember i ng, and execut i ng a t hr ee- par t
command. The t hr ee par t s of t he command ar e spoken cl ear l y
i n appr oxi mat el y 6 sec. , wi t hout i nt er r upt i on, and ar e
gi ven onl y once. I f t he subj ect i nt er r upt s wi t h " What di d
you say?" or t he l i ke, do NOT st op t o r espond; cont i nue t o
f i ni sh t he command, t hen say: " Do what you t hi nk I asked
you t o do. "

Use a bl ank pi ece of paper f or t hi s t est .

The f i r st st age of t he command asks t he subj ect t o
t ake t he pi eces of paper wi t h hi s or her NON- pr ef er r ed hand
( t he hand not used i n t he pr ecedi ng wr i t i ng and dr awi ng
t asks) .

The exami ner hol ds t he pi ece of paper i n pl ai n vi ew of
t he subj ect whi l e gi vi ng t he command. Some subj ect s t end
t o r each f or t he paper i mmedi at el y af t er hear i ng t he f i r st
par t . When t hi s happens, t he exami ner shoul d t empor ar i l y
move hi s or her hand away f r omt he subj ect t o keep t he
paper out of r each whi l e cont i nui ng t o st at e t he next t wo
par t s of t he command wi t hout i nt er r upt i on.

Af t er sayi ng t he command, t he exami ner shoul d t ake
car e not t o move t he paper t owar ds t he subj ect bef or e he or
she r eaches f or i t ; t hi s i s t o avoi d pr ovi di ng nonver bal
cues f or t he subj ect t o t ake t he paper .

Some subj ect s at t empt t o f ol d t he paper wi t h one hand.
Do not di sr upt i f you t hi nk t he subj ect can accompl i sh t he
t ask despi t e some cl umsi ness. I f t he subj ect i s havi ng
consi der abl e di f f i cul t y, say " You can use bot h hands now. "

Af t er t he subj ect has t aken ( and f ol ded) t he pi ece of
paper , t he exami ner shoul d t ake car e not move hi s or her
hand t owar ds t he subj ect i n a gest ur e t o r ecei ve t he paper
unt i l t he subj ect has st ar t ed t o hand t he paper back.
Agai n t hi s i s t o avoi d gi vi ng nonver bal cues.

Do not r epeat any par t of t he command. I f t he subj ect
r equest s t he exami ner t o do so, say " SORRY, I CANNOT
REPEAT. J UST DO WHAT YOU THI NK I ASKED YOU TO DO. " I f t he
ci r cumst ances ar e such t hat i t i s desi r abl e t o obl i ge f or
t he sake of mai nt ai ni ng a f r agi l e r appor t , scor e accor di ng
t o t he r esponse( s) execut ed bef or e t he r epeat pr esent at i on
of t he command.

Scor i ng

One poi nt f or each par t of t he command.

Fi r st par t : Scor e 0 i f t he subj ect uses t he pr ef er r ed
hand.

Second par t : Scor e 0 i f t he subj ect f ol ds t he paper
mor e t han once.

Thi r d par t : Scor e 0 i f t he subj ect si mpl y put s t he
paper down i nst ead of handi ng i t back t o t he exami ner .

The subj ect may f ol d t he paper wi t h bot h hands, and
may hand back t he paper wi t h ei t her hand.

SECOND RECALL OF THREE WORDS

( Cl ot hi ng: SHOES/ SHI RT/ SOCKS) 0 1 2 3
( Col or : BLUE/ BLACK/ BROWN) 0 1 2 3
( Vi r t ue: HONESTY/ CHARI TY/ MODESTY) 0 1 2 3

Al ways admi ni st er t hi s i t em, even i f t he subj ect has
scor ed 0 on Fi r st Recal l .

Ask " WHAT THREE WORDS DID I ASK YOU TO REMEMBER
EARLIER?"

Fol l ow t he same t est i ng and scor i ng pr ocedur e as f or
Fi r st Recal l , except t hat at t he end do not coach f or t he
cor r ect t hr ee wor ds even when t he scor e i s not per f ect .

Modified MMSE

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Page 1 of 22 3MS Manual 1996

MANUAL FOR THE ADMINISTRATION AND SCORING OF

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