MINI-MENTAL STATUS QUESTIONNAIRE (Folstein=s) INSTRUCTIONS FOR ADMINISTRATION ORIENTATION 1. Ask the year, season, date, day, month. One point for each correct answer. Score 0-5. 2. Ask for whereabouts, "Can you tell me the name of _______?" (e.g., state, town, county, hospital or residence, street or floor). One point for each correct answer. Score 0-5. REGISTRATION Ask the patient if you may test his memory. Then say the names of three unrelated objects, clearly and slowly, l about one second for each. After you have said all three, ask him to repeat them. This first repetition determines his score (0-3) but keep saying them until he can repeat all three, up to six trials. If he does not eventually learn all three, recall cannot be meaningfully tested. Score 0-3. ATTENTION AND CALCULATION Ask the patient to begin with 100 and count backwards by seven. Stop after 5 subtractions (93, 86, 79, 72, 65). Score the total number of correct answers. If the patient cannot or will not perform this task, ask him to spell the word "world" backwards. The score is the number of letters in correct (e.g., dlrow - 5, dlorw = 3). Score 0-5 for either one. RECALL Ask the patient if he can recall the three words you previously asked him to remember. Score 0-3. LANGUAGE: NAMING Show the patient a wristwatch and ask him what it is. Repeat for pencil. Score 0-2. REPETITION Ask the patient to repeat the sentence, @No ifs, ands or buts!@ after you. Allow only one trial. Score 0 or 1. 3-STAGE COMMAND Give the patient a piece of plain blank paper and tell them to place it in their right hand, fold it in half and put it on the table. Score one point for each part correctly executed. Score 0-3 WRITTTEN COMMAND Write the following on a piece of paper, AClose your eyes!@ Ask the patient to read and follow the command. Score 0-1. WRITE A SENTENCE Have the patient write down a sentence. Score 0-1. VISUAL-SPATIAL Have the patient copy a design that you have drawn. Score 0-1. LEVEL OF CONSCIOUSNESS (No points attached) Determine their LOC on a continuum of alert, drowsy, stupor, coma.MINI-MENTAL EXAM WORKSHEET Areas to be assessed Maximum score Resident’s Initials________ Orientation 10 Registration 3 Attention and Calculation 5 Recall 3 Language:Naming 2 Repetition 1 3 stage command 3 Written command 1 Write a sentence 1 Visual spatial 1 Total Score 30 Score of 23 or less: A high likelihood of