1. Information and Orientation (Optional) RECORDING: SCORING RULE: All responses verbatim ® tems 1-14: 0-1 pt. for each item Do not score Items 1 Response, af tem 1. What is your full name? 2, How old are you? 3, When were you bora? / Date of birth / approximate Year of birth, 4, Where were you born? 5, What is your mother's name? “Who is the Prime Minister of India? / Who is the Chief Minister of your State? / Who is the Chief of your Village Panchayat?| 6 7. Who was Prime Minister before him? 8, What year is this? 9, What month is this? 10. What day of the month is this? 11, What is the name of the place you are in? 12, In what city/town is i? 13, What day of the week is it ‘Without looking at the clock, what time is it now? response ‘actual time difference in mins_ 14 15, Are you left-handed or right-handed? 16. Do you have any difficulty in hearing? 17. Do you need glasses for reading? 18, Are you colour-blind? Total Score Range =0t0 14 2. Logical Memory I RULE: RECORDING: SCORING RULE: Pla tick () next to each unit 0-1 pt. for each story or thematic unit recaled verb, Whe non-verm Kana ‘and Scoring Manual (Chapter 4 responses next to the story unit. “Appendix A) for scoring criteria. Story A ‘Asha Kumari of South Kanara, employed as a maid servant in an office building, reported at the police station that she had been held up on the Bazaar Street the night before and robbed of fifty-six rupees. She had four emall children, the rent was due, and they had not eaten for two days. The police, touched by the woman’s story, gave some money for her. (lun page to record Story A Responses.) i aa |2. Logical Memory I continues score 00r1 _ je ory Unit [Trematic Unit] Scoring Crleri - = Galion ofa main arate who female fe indication tht she held 2 jb ace offices reuited —| rain building is equired « indication that main characteris employed ois working indication that a formal statement was made to someone in autho Gin ary ex) atte pole Plc Gn any contend a [ Staton Gin any contex) ora wor or prase denoting a police sion had been held up indication that she had been held up (Le., gunpoint or knife) on the Bazaar Sree the Bazaar Street (in any context) the nigh before indication thatthe hold-up occured the previous night and robbed indication that a robbery took place of itysix rupees. indication that an amount of money greater than Rs. 56 but less than Rs. waste indication that main character reported that she was robbed She had four fours requited together with an indication thatthe children were hers cildren ora synonym is requied indication that main character had children phrase indicating thatthe rent was due indication that her children or the family were without food Ser [ 2 word or phase signifying one or more members ofthe police (in any conte indication that her story evoked sympathy. ior two da The poli touched by the woman's sy ic Unit Score Range = 0 to 7story B-1st Recall 2. Logical Memory I wenn at 600 on Me ‘watching television as he dressed to go out. A flash news report interrupted the programme to inform that the train Rajdhani Express had an accident at 100’ clock that morning, The announcer said the accident involved 4 bogies of the train and had about home. He changed his dress and sat down to nore de ‘Score 0.011 Soy b= I Reco Seoing Ciera xe 600i equi cn oe Mondays reed ew cena fin ay context) c Joe variant fhe name hana hana equ of karwar Karas eqited indication ofa main character who is male ET * indication that he was watchig/stering to the television indication that he was geting desed indication that he was going ou indiaon hat there was a Rash news report ‘eas watching television ashe dresed pou fash news repo imerropted the programme indication of breakin the regu scheduled programme to mor ta he wan aidan Express indiation that there was a news about a tain indication of name ofthe tain |__| icon tatters was an formation abortnin indication ofan accident had an accent 110 dock that moming, phase meaning 100 lock or neuer to it ‘he announcer sid indication that someone was reporting about an accident be xd incon at hee was ha cased rched Vigo “gies required fe tain rain routed 7a ann indication of people involved 15 pases int a number 1505 reguie [ination fan acces fe ae ination hat be change his dress He changed hs dress and sat down indo hat be was sting down 10 pet moe dels ination of geting more deta sreeLE —————— B-2nd Recall 2. Logical Memory I iconwea To er puibiay evening, Jal Chancira of Karnvar wes wats SO® television as he flash news report interrupted the programme (0 inform that the train Rajdhani Expresg hadi bo, oat ae ock that morning. The announcer said the accident involved 4 bogies of the tain ang 150 passengers init. Jai decided to stay home. He changed his dress and sat down to get oye ental ‘Story 8 — 2nd Rect ‘Scoring Ciera “ato of mal character whois tale ‘wach len ication tat be was wacngstening to the television ase dese ‘nda tha he was ein ese [| stat csr a Alas news report ication ta there was a fash news report Tadao fa fash ev z ‘ajdhand Express eB icaion francolite tala @ a ri = ieraed the programe ef ht he ae — ‘indication that the character decided tn stay home ae. ee = the dan J Prwre ere Range = 01025, Rangesdto6 ol CK [esees> Tiere] as Be (omc en yA 9a, Soya) ‘Gammemaic inticowiertoy A Soy is.saybang — LORE sesh3. Faces I TIME LIMIT: the 24 ta faces for 2 seconds each, SCORING RULE: 1 pt for each item Score do % Z z 3. %, 3 = 3. a 3B Fr. % B. @. I z & a B 4. Verbal Paired Associates I TIME LMI: RECORDING: = Read one pair of words every 3 seconds, Pause 5 ae Vaart st a tf Syulnce does nor respond win 5 scons aia oe SCORING RULE: Uist A Recall A/Response Dot ‘0-1 pt for each item BussArrow 1. Bank acu) Buttertij-Frak [2 Toro othe) Toroie-Rabber [3 Nar (adden a Sitader [5 Hephant (Gh) Tear Paper | 6s (row) ese-Bag___ 7 Bterty ra) - Hephan-Glas [6 Hear Pape =e Ust A Recal Range = 0108 ustB Recall B/Response Sardar [1 Hephant (Gls) Hephant-Giss [2 Buterliy ru) 3. Tortose (Robbe) Rose Ci) 5. Star (adder ane 7 ak Pu) Des (Amon) Ust 6 Reco Range =0108 score ust Recall C/Response Dot ose-ag__ Buterfy Cru) Tear-Paper [2 Str Gade) SerLakder [3s row) Tortoise Robber | & Hove a) Hephani-Ghass_[§.Hephant Gs) Taterliy rat 6 Tortoise (Robber) Bank-Picture 7. Bank (Pure) Tas-trrow [Bear Pape) list Recall Range = 0108 tistD Recall D/Response mM Tar faper J Star adden Tus-Arrow [2 Rose og) Sardar [3 Buterliy Cra TraterfigeFrat 4. Bea Piper Tove-fag J. lephant (Gs. Toroie Rober | 6 tank tue) Tank Pisure 7 Tortoise (Robbe) Teyana CAO Learning Slope Coleuiation C-O-CK weer atwcat rergnediot Ranges dt08Scene 2 (Department Store) Scene 3 (Garden) ‘Scene 4 (Meal) Gating ce cream Grandma Grandfater Trewin ball ating hal Pulling out cla Mother eI Oper ve puine Faber ooking at sir Bs ooking in mirror i fatally x 3 it = a Pil rate as Woiber as ; Faber 3 an 21 Eng fal Daughter ‘Som Dom [mv Recall Total Score Range = 01064 AL6. Word Lists I (Optional) ES) RECORDING: ‘SCORING RULE: Place a tick () next to 0-1 pt for each term each word recalled, ‘White intrusions verbatim aA Target Finger Evening Crocodile Rupee Field Student Crowd Broom’ Ocean Wing) Giant Tnrsions + + + = Tal | Recall Tih 2 Recall ‘ial 3 Recall Tial 4 Recall Ronges 01012 Range =0fo12 —«Range=O1o12, Range =Oo 12 Racal Toll Score Ronge = 010 48 Ta Recot Total Score Range = Do 12 ak Satbaay ] Centos! 1 Colewaton uta __|_ st BResponses (ono ead) Diamond Target Garden Finger Office Evening, King a Crocodile ail Sand Rupee Cat 7 Field Branch Sadent Kitchen, awed Totus = aa Lae: ‘Ocean Monkey Wing i aaa) UstB Recal Range = 0f0 127. Visual | Reproduction I (Optional) ven ie marae ce nthe val nares ores 7 Hand used: Right — Qlet Design A Total Score ‘Observations Design B Taal Score Design C Teal Sore Design D Teal Score [eign Teal Score 8. Letter-Number Sequencing DISCONTINUE RULE: ==) RECORDING: SCORING RULE: Alter scores of 0 for all B All responses verbatim (0-1 pt. for each trial three trials of an item, Hem/Triat (Correct Response)/Response Gort 1 Tala Tala Tal 3 2 ral Tral2 Tals 3. Teal Tral2 Trial 3 < Tall Tala Tals 5. malt Tala Tals Trald Trial 3 7 ral t Tral2 Trial 39. Spatial Span ECON ae RULE: scores of 0 on both trials of any item, or both Spatial Span Forward & Spatial Span Backward, administer both tras of each item even if Trial 1 is passed. Spatial Span Forward ttem/tial Response 1 Walt 3-10 Tal? 7-4 Z Walt 1-9-3 Tmal2__6-2-7 3 alt 4-9-1-6 Tual2_10-6-2-7 7 tall 6-5-1-4-8 Tial?__5-7-9-8-2 5 tall 4-1-9-3-8-10 Tal2_9=2-6-7-3-5 @ tall__10-1-6-4-8-5-7 Tul2__2-6-3-8-2-10-1 7, tml 7=3-10-5-7-6-4-9 Tul2_6-9-3-2-1-7-10-5 @ tmll__5=6-4-10-7-3-1-9-6 Tmal2?__8-2-6-1-10-3-7-4-9 a ‘Spatial Span Backward Forward Total Score ltem/Trial Tal 1 Tal? 2 Tuli 6-2-7 @-2-8) Tal2__1-9-3 @-9-D 3 mall 10-6-2-7 (7-2-6-10) Z Taal? =6 _(6-1-9-4 no 4 Tall §-7-9-8-2 @-8-9-7-5) Tia? 6-5-1-4-8 (@-4-1-5-6) 5. Tall 9-2-6-7-3-5 (6-3-7-6-2- Til? 4-1-9-3-8-10 (10-8-3-9 4) 6 Tall 2-6-3-8-2-10-1 (1-10-2-8-9-6-2) Twal2__10-1-6-4-8-5-7 @-5-8-4-6-1-10) a 7. Tall 6-9-3-2-1-7-10-5 (6-10-7-1-2-3-9-6) Tial2__7-3-10-8-7-6-4-9 (9-4-8-7-5-10-3-1) ® Tall 6-2-6-1-10-3-7-4-9 (@-4-7-3-10-1-6-2-8) Tiala__5-6-4-10-7-3-1-9-6 (-9-1-9-7-10-4-8-6) 7 | [nas Range.10. Mental Control (Optional) LS RECORDING: Gross out any elements omitted and write ‘elements said in the wrong sequence, Write response time in seconds for each item. ‘SCORING RULE: For each item, circle the number of errors and the Score which corresponds to the number of errors. ‘Award bonus points for item Accuracy Scores of 2 r S| , Item/Correct Response/Response eee) oo. pa » > 0 ie ib 8] 123456789 0 0 213 415 6 17 8 19 20 a ae os2fo 4 woo 1 58 2aBcDEFGHIsKLMNOPQRSTUVWxYZ ey 0+ 2/0 1 oo fe B | sty sonty sty Yeeay Ty iy Soy en CEST UT woo A may Fay Sich Ap ay me jy re 5 Tee osz|o 4 ar ie aoa Z| saver ws usnnwss76sear ni 0+ 2 1/0 1 woo E org IB | & Sut scuiy ty Try Winey Tey Ney 134 osafo 4 ws 0 1 liegedpapelasedeeendnn me ee 1 1 FB) dy Yee ey Apt nach Rima jay 2 oazlo 4 r eeo 1 osmiy Gdn 12Tasay ay 20a we tooo ‘30/Friday 36/Saturday_ VS oszfo 411. Digit Span (Optional) 7 INUE RULE: Me ore of eta beh Epa esch on cren' eel Digits Forward item/Trial Response Tal 1 Taz 6 2 tall 5 Tral2_ 6 Tall 6 Tala 7 7 tar 4 Tala 7 Tall 6— 3 5 a 5 3 2 7 Tal2 6 Thal Tral2 Trial 1 Tal @ Tall Tal? Forward Total Score Range = 010 16, Digits Backward Hem/trial (Correct Response)/Response 1 Wall 2-4 Tal? 8-7 2 Wall 6-2 Tad? 4-1 3 Walt 3-2 Tal? 4=9 @-6-9-4 T Tali 1-5 6-8-2-8-1) |__ tala 6-1- @-4-8-1-9 5-3 @-1-4-9-3-9) 7-2 (-5-8-4-2-7) 3-1 4-7 9-4 T=2 3. ral Tal © Walt Tal. 7, Tali Tal12. Logical Memory II @ Aowivster 25-35 MINUTES AFTER Recall (725) RECORDING: SCORING RULE: ES Place a tick () next to each story unit a Fe an «te recalled verbatim, Write non-verbatim responses next to the story unit, Reminder Given? Yes No [ ata ‘Sery A ‘Story Unit [Thematic Unt] Scoring Ciera ‘Asha o variant ofthe name Kiar required South fn any context) Kanara im any contex) indication ofa main character who is Female emploved indication that she held ajo 364 maid servant Servant or some frm ofthe word is requied indication that main character is employed or is working indication that main character reported that she was robe Sbe hod four Jour's required together with an indication thatthe chien were hers call didren children ora synonyan required indication that main character had hldren| the rent was due, phrase indicating tha the rene was due ray ial atcam indication tat her chen or the Family were without fod for two days wo days equired, oF pase meaning about wo days indaon a cancers ween eed or ind aN 1 ward cr pins sgnying one or mre mers othe ple in any conte The pale, wuched bythe woman's cy, indication that her sory evoke sympathy eS ee ieee [sieeve eae fe [nts ey one mrennn Bie [Fits ta te price rey pon ‘A Recal Unit Score SN baie, |12. Logical Memory II ccontnuea) Reminder Given? QYes No ae ‘Score 0 or | sad ‘Story Unt] Thematic Uni] Searing Crono a 6008 required ny Monday is required ae evening (in any context) Ja Jai or variant of the name Chania Chandra is required cof Karavar Karavar is required oe as he dressed indication that he was geting dressed oe “indication tht the charader was preparing to leave A flash news report TIN] icccation thar there was «Nash news report interrupted the programme es indication of a break in the regularly scheduled programme ne indaton ofa ash news ae am - Toa indication of time of accident ee involved 4 bogies. bo. 4 bogies is required indication of an accidents eet i ‘indication that the character decided to stay | ‘home i ‘He changed his dress indication that he changed his des and sat down indication that he was siting down: a ‘dation that the character decided =reses>_T Range = 010 25 Range = 0108 — Total Score “Thematic Total Score Us Scores fr ony A Soy) (Gum Terai Un Sco Son A 8 Sto12. Logical Memory II connvec) Recognition Se ® ops ct ‘Story A 1, Was the woman's name Asha Kuma? ‘2 Was the story setting in South Konara? '3_Was the woman @ maidservant? 4 Did she work in an office building? 5. Did she have four children? 6, Were the children teenagers? 7. Did the robbery lake place on Bazaar Steet? 8. Did the woman report being robbed hwo nights before? 9._Did she report the robbery af the Police Staion? 10._Was the woman robbed of 75 rupees? 11 Did the family go without food forfour days? 12, Was the rent due? 13 Did the police catch ihe thet? | |< foc} |< |e fe foe] fae [|e fre |e 14. Didthe police feel sony forthe woman? 15, Did he police glve money? Soy 6 : 16, Was the man's name Jai Krishna? 17, Was it Sunday evening? 18, Was t 600? 19. Was the story selfing in Karavar? 20, Was Jal dressing fo go oul? 21, Was Jai watching television? 22. Wate TV programme inierupied? 23, Didithe accident happen on Tuesday? 24 Die asian happenin he naming? 25, Was the number of bogies involved 87 26, Did the announcer say 200 people were inf? 27, Didihe announcer predict the ain accident? 28, Didthe announcer fell about rain accident? 29, Did Jal decide to stay homme? re foe tne [ne |< |e Joe] fae] ae] fc fe [= =\z|z|=|=|=|2|/=|2]2|z\2l2/= '20_Did Jl si down to waich sporls programme? 4 Recognition Total Range = 00 30