Enter birthdate (mm): Jan Feb Mar Apr May Jun Jul Ayg Sep Oct Nov Dec (dd): (yyyy):
Sex: []Male [] Female                      Enter education (years):
Race: []Caucasian []Black []Hispanic []Asian []Other

right / wrong
Orientation Questions: Ask the following questions:
[]   [] x1. What is your last name?
[]   [] x2. What is your first name?
[]   [] x3. What is your birthday?
[]   [] x4. What is your birth year?
[]   [] x5.* How old are you?
[]   [] x6. In what county/city were you born?
[]   [] x7. In what state (country if not US) were you born?
[]   [] x8. What is your mother's maiden name?
[]   [] x9. How far did you go in school (years of education)?
[]   [] x10. What is your address (or phone number)? PERSON

[]   [] 1.* What is today's date?
[]   [] 2. What is the month?
[]   [] 3. What is the year?
[]   [] 4.* What day of the week is today?
[]   [] 5. What season is it? DATE
[]   [] 6. What is the name of this clinic (place)?
[]   [] 7. What floor are we on?
[]   [] 8. What city are we in?
[]   [] 9. What county are we in?
[]   [] 10. What state are we in? PLACE

PRESIDENTS
[]   [] x11.* Who is the President of the US?
[]   [] x12.* Who was the President before him?
[]   [] x13.* Who was the President before him?
[]   [] x14. Who was the first President of the US?
[]   [] x15. Name another US President? PRESIDENTS:

IMMEDIATE RECALL: Ask the subject if you may test his/her memory. Then say "ball", "flag", "tree" clearly and slowly, about 1 second for each. After you have said all 3 words, ask him/her to repeat them. The first repetition determines the score (0-3), but keep saying them until he/she can repeat all 3, up to 6 tries. If he/she does not eventually learn all 3, recall cannot be meaningfully tested:
[]   [] 11. BALL
[]   [] 12. FLAG
[]   [] 13. TREE Note # trials: IMMEDIATE RECALL:

ATTENTION
A) Ask the subject to begin with 100 and count backwards by 7. Stop after 5 subtractions. Score the correct subtractions.
[]   [] 14. "93"
[]   [] 15. "86"
[]   [] 16. "79"
[]   [] 17. "72"
[]   [] 18.* "65" SERIAL 7's TOTAL:

B) Ask the subject to spell the word "WORLD" backwards. The score is the number of letters in correct position. For example, "DLROW" is 5, "DLORW" is 3, "LROWD" is 0.
[]   [] 19. "D"
[]   [] 20. "L"
[]   [] 21. "R"
[]   [] 22. "O"
[]   [] 23. "W" "DLROW" TOTAL: Greater score of A or B:

DELAYED VERBAL RECALL: Ask the subject to recall the 3 words you previously asked him/her to remember.
[]   [] 24.* BALL?
[]   [] 25.* FLAG?
[]   [] 26.* TREE? DELAYED VERBAL RECALL:

NAMING: Show the subject a wrist watch and ask him/her what it is. Repeat for pencil.
[]   [] 27. WATCH
[]   [] 28. PENCIL

REPETITION: Ask subject to repeat: "No ifs, ands, or buts" (accept "no if and or but")
[]   [] 29. REPETITION

3-STAGE COMMAND: Give the subject a plain piece of paper and say, "Take the paper in your hand, fold it in half, and put it on the floor."
[]   [] 30. TAKES
[]   [] 31. FOLDS
[]   [] 32. PUTS

READING: Hold up the card reading, "Close your eyes", so the subject can see it clearly. Ask him/her to read it and do what it says. Score correctly only if the subject actually closes his/her eyes.
[]  [] 33. CLOSES EYES

WRITING: Give subject a piece of paper and ask him/her to write a sentence. It is to be written spontaneously. It must contain a subject and verb and be sensible. Correct grammar and punctuation are not necessary.
[]   [] 34. SENTENCE LANGUAGE: 

COPYING: Ask subject to draw intersecting pentagons
[]   [] 35. PENTAGONS                       

To calculate MMSE score automatically, click here:

TOTAL MMSE (serial7s): MMSE (dlrow): MMSE (max):   (MAXIMUM score = 30)

TOTAL MMSE WITH EXTENSION: (maximum score = 50)

41 - 50 normal, depending on age, education, complaints (corresponds with MMSE > 23)
31 - 40 mild              (corresponds with MMSE = 20 - 23)
21 - 30 moderate     (corresponds with MMSE = 11 - 19) 
11 - 20 severe          (corresponds with MMSE = 2 - 10)
1 - 10 profound         (corresponds with MMSE = 0,1)
0 complete                                               (MMSE = untestable)

TIME-INDEX for MMSE (max) (estimated years into Alzheimer's disease):
(for MMSE > 24, years before expected dx; for MMSE = 0, at least this number)
(derived from Ashford et al., 1995; Mendiondo et al., 2000)

* 10 select items for dementia screening - if more than 3 errors, ask to name animals:

NAME AS MANY ANIMALS AS YOU CAN IN 1 MINUTE: TOTAL______
  (expect normal elderly to name at least 15) .

If more than 4 select items missed or names less than 15 animals, further evaluation indicated.

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