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Mini Mental Status Exam

This document appears to be a screening exam used to assess cognitive impairment in patients. It contains sections to test orientation, immediate and delayed recall, attention, language, and visual-spatial abilities. Scores are given in each section, with a maximum total score of 30, to indicate normal cognition, probable mild dementia, probable moderate dementia, or probable advanced dementia. The exam is not intended to be the sole tool used to diagnose dementia.

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Tauqeer Ahmed
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12K views2 pages

Mini Mental Status Exam

This document appears to be a screening exam used to assess cognitive impairment in patients. It contains sections to test orientation, immediate and delayed recall, attention, language, and visual-spatial abilities. Scores are given in each section, with a maximum total score of 30, to indicate normal cognition, probable mild dementia, probable moderate dementia, or probable advanced dementia. The exam is not intended to be the sole tool used to diagnose dementia.

Uploaded by

Tauqeer Ahmed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Mental Status Screening Exam: This page includes a structured format for evaluating orientation, immediate recall, and attention through a series of questions, and also provides space for scoring assessment.
  • Instruction and Visual Test: Contains a simple directive meant for use in visual cognitive assessment possibly pertaining to spatial recognition using the provided diagram.

MINI - MENTAL

STATUS
SCREENING
EXAM
PATIENT IDENTIFICATION

MAXIMUM RESIDENT'S
DESCRIPTION SCORE SCORE
ORIENTATION:
TIME: What is the ( year ), ( month ), ( date ), ( day ), ( season ) ? 5
PLACE: Name ( city ), ( 2 neighboring states ), ( place ), ( floor ) ? 5
IMMEDIATE RECALL:
Name 3 objects ( table, penny, apple ). Ask the resident to repeat the 3
words. Give one point for each correct answer. Repeat the words until all
3 words are learned ... up to 3 trials. Tell the resident to remember the 3
words and that you will ask him / her to repeat the words in 5 minutes.
Count trials and record number:
Number of Trials: _______

ATTENTION:
Begin with 100 and count backwards by 7 ( "93, 86, 79, 72, 65"; stop after 5
5 answers ) -or- spell world backwards ("dlrow").
DELAYED RECALL: ( Wait a full 5 minutes )
Ask for the 3 objects registered above. Give 1 point for each correct 3
answer.
LANGUAGE:
NAMING: Ask the name of 2 objects ( pen, watch, etc. ) 2
REPITITION: Repeat "no if's, and's or but's" 1
VERBAL COMMAND: "Take a paper in your right hand; fold it in half and 3
put it on the floor"
READING COMPREHENSION: "Close your eyes" ( over ) 1
DRAWING: Copy a design ( over ) 1
WRITING: Write a sentence ( over ) 1
VISUAL IMPAIRMENT:
HEARING IMPAIRMENT: 30
MAXIMUM TOTAL
EDUCATION LEVEL: TOTAL SCORE SCORE

SCORE ASSESSMENT
30 - 27 = Normal 9-0= Probable Advanced Dementia
26 - 20 = Probable Mild Dementia NOTE: Not to be used as the ONLY
19 - 10 = Probable Moderate Dementia tool to diagnose dementia.

RATER ( Print ): RATER ( Signature ): DATE:

8850372 Rev. 08/03 Mini Mental Status Screening Exam_LONG TERM CARE PAGE 1 of 2
CLOSE YOUR EYES

8850372 Rev. 08/03 Mini Mental Status Screening Exam_LONG TERM CARE PAGE 2 of 2

ORIENTATION: TIME: What is the ( year ), ( month ), ( date ), ( day ), ( season ) ? PLACE: Name ( city ), ( 2 neighboring s
8850372 Rev. 08/03 PAGE 2 of 2 CLOSE YOUR EYES Mini Mental Status Screening Exam_LONG TERM CARE

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