Mini-Mental State Examination (MMSE} r

I'

Patient's Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Date: _ _ _ _ __

Instructions: Ask the questions in the order listed. Score one point for each correct
response within each question or activity.

Maximum Patient's
Questions
Score Score
5 "What is the year? Season? Date? Day of the week? Month?"
5 "Where are we now: State? County? Town/city? Hospital? Floor?"
The examiner names three unrelated objects clearly and slowly, then
asks the patient to name all three of them. The patient's response is
3 used for scoring. The examiner repeats them until patient learns all of
them, if possible. Number of trials:
"I would like you to count backward from 100 by sevens." (93, 86, 79,
5 72, 65, ... ) Stop after five answers.
Alternative: "Spell WORLD backwards." (D-L-R-O-W)
"Earlier I told you the names of three things. Can you tell me what those
3
were?"
Show the patient two simple objects, such as a wristwatch and a pencil,
2 and ask the patient to name them.
1 "Repeat the phrase: 'No ifs, ands, or buts."'
"Take the paper in your right hand, fold it in half, and put it on the floor."
3 (\I
(The examiner gives the patient a piece of blank paper.)
"Please read this and do what it says." (Written instruction is "Close
1 your eyes.")
"Make up and write a sentence about anything." (This sentence must
1 contain a noun and a verb.)
"Please copy this picture." (The examiner gives the patient a blank
piece of paper and asks him/her to draw the symbol below. All 10
angles must be present and two must intersect.)
1 .

30 TOTAL
(Adapted from Rovner & Folstein, 1987)

1
Source·· www .med'1cine.u1owa.edu/igec/tools/cognitive/MMSE.pdf
. .
Provided by NHCQF. 0106-410
 NAME:
MONTREAL COGNITIVE ASSESSMENT (MOCA) Education : Date of birth :
Sex : DATE :
VISUOSPATIAL / EXECUTIVE Copy Draw CLOCK (Ten past eleven)
cube ( 3 points)

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Contour Numbers Hands

NAMING

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MEMORY Read list of words, subject FACE VELVET CHURCH DAISY RED
must repeat them. Do 2 trials.
1st trial No.
Do a recaTI after 5 minutes. i----+----+----+---~~-----+-----1
2nd trial points

ATTENTION Read list of digits (1 digit/ sec.). Subject has to repeat them in the forward order [ ] 2 1 8 54
Subject has to repeat them in the backward order [ ] 7 4 2 _/2
Read list ofletters. The subject must tap with his hand at each letter A. No points if 2 el'l'ors
[ ] FBACMNAAJKLBAFAKDEAAAJAMOFAAB _/1

Serial 7 subtraction starting at 100 [ ] 93 [ ] 86 [ ] 79 [ ] 72 [ ] 65

4 or 5 correct subtractions: 3 pts, 2 or 3 correct: 2 pts, 1 correct: 1 pt, o correct: 0 pt _/3
LANGUAGE Repeat: I only know that John is the one to help today. [ ]
The cat always hid under the couch when dogs were in the room. [ ] _/2
Auency / Name maximum number of words in one minute that begin with the letter F [ ] _ _ (N :? 11 words) _/1 \
ABSTRACTION Similarity between e.g. banana - orange = fruit [ ] train - bicycle [ ] watch - ruler - ~'.2
DELAYED RECALL Has to recan words FACE CHURCH DAISY RED Points for
UNCUED
_Is
WITH NO CUE [ ] [ ] [ ] [ ] recall only

~tegorycue
• Optional Multiple choke cue

ORIENTATION [ ] Date [ ] Month [ ] Year [ ] Day [ ] Place [ ] City _/6

© Z.Nasreddine MD Version November 7, 2004 Normal 26 / 30 TOTAL _/30

wwv,.mocatest.org Add 1 point if :S 12 yr edu
 PANGALAN :
MONTREAL COGNITIVE ASS Edukasyon: Kaarawan:
(MOCA-P} ESSMENT • PHILIPPINES Kasarl11n : PETSA:

V~UOSPATIAL I EXECUTIVE Kopyahln Gumuhll ng ORASAN (1ampung mlnuto

rnallallpaa ang alas onae) (3 points )

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Simula

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HUGIS NUMERO KAMAY

NAMING

[ 1 _J3
l l l l
MEMO RY Basahin ang listahan ng mga MUKHA ASUL SIMBAHAN ROSAS SEDA
salita. Oapat maulit ng sinusuri ang mga ito. Gawing l----1-.:::..:::.:.:.:..::....:.+-...!:!~~-l..::.::::.=::.:..::..::.~.:..:.:=~-t----twa1ang
1
2 pagsubok kahit nagtagumpay sa pang-una. Gawin Pagsubok puntos
ang naantalang pag-alaala pagkaraan ng 5 minutos. Pagsubok

ATTENTION Oapat ulitin ng sinusuri ang mga numero eksakto ayon sa pagkakablgkas [ ] 2 1 8 5 4
Oapat ulltin ng sinusuri eng mga numero ng pabaliktad [ ] 74 2 _J2
g g mero.
(1 numero / se undo
Basahin ang mga letra. Oapat tumapik ang /1
sinusuri sa mesa sa bawat blgkas ng letra "A". [ ]FBACMNAAJKLBAFAKOEAAAJAMOFAAB
Walang puntos 2 mall.
[]93 []86 []79 []72 []65
1 tama=1 puntos; 0 tama=0 puntos _}3
Bawasan ng 7 ang 100 4 o 5 na tamang sagot=3 puntos; · 2 o 3 tema=2 puntos;
Ulitin: Ang alam ko Ieng, si Juan ang siyang tutulong ngayong araw. [ )
LANGUAGE Ang pusa ay palaglng nagtatago sa ilalim ng supa kapag nasa kuwarto ang mga aso. [ )
_/2
a loob ng 1 mlnuto ng mga salitang FIiipino na nagslsimula sa letrang B. [ ] _ _ (N 11 salita) /1

Hallmbawa: Pagkakapareho ng t•range at saglng = prutas

] tren - blslkleta Jtlmbangan - ruler _}2
ABSTRACTION
Oapat matandaan ang MUKHA ASUL SIMBAHA ROSAS SEDA Bigyan ng puntos _/5
DELAY~D RECALL mga salita ng walang lamang ang mga
tako o 'cue' [ ]
l l [ l [ J. salltang
natandaan ng
Kategoryang tako walang tako o 'cue'
Opsyonal Maramlhang pagplllhan

[] Buwan [] Taon [] Araw [] Lugar [] Lungsod _/6

ORIENTATION (] Petsa

version 7.1
www.mocatest.org Normal ~6 / 30 TOTAL _}30
© z.Nasreddlne MD
Magdagdag 1puntos kapag s 12 yr edu
Philippine Version 4 March 2011
Adapted by Dominguez JC and the Dementia Study Group
Administered by. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __