DATE:           TIME (24hr): 

MIRECC Mini-Mental State Examination

ORIENTATION:
right / wrong
   1. What is the year?
   2. What season of the year is it?
During March, winter or spring is acceptable; during June, spring or summer is acceptable; during
September, summer, fall, or autumn is acceptable; during December, fall, autumn, or winter is acceptable).
   3. What is the month?
   4. What is date or day for the month? (+/-1 date is acceptable)
   5. What is the day of the week?                                             DATE
   6. What state are we in?
   7. What county are we in?
   8. What city/town are we in?
   9. What floor of this building are we on?
   10. What is the name or address of this place?                             PLACE

REGISTRATION:
I am going to name three objects. After I have said them, I want you to
repeat them. Remember what they are because I am going to ask you to name
them again in a few minutes.

The three objects are: "Apple","Table",and"Penny".

Could you please repeat these words for me?
The words should be read at a rate of 1 per second, speaking clearly and audibly.
You are allowed to read the words only once before scoring.

Score on first trial
right / wrong
   11. Apple
   12. Table
   13. Penny          IMMEDIATE RECALL:
Repeat the three words until: 1) the subject correctly repeats all three or
2) 3 total trials have been presented (including initial presentation).

Number of trials: 1    2    3

ATTENTION:
Now, I am going to give you a word and ask you to spell it forwards and
backwards. The word is "WORLD." Spell "WORLD" forwards.
If the subject is unable to spell the word, spell it outloud, and ask the subject to repeat the
spelling. Continue until it has been spelled successfully or until you have spelled it to the
subject three times.

Now spell the word "WORLD" backwards:
right / wrong
   14. D
   15. L
   16. R
   17. O
   18. W              "DLROW" TOTAL:
Score 5 points for a correct sequence. Count 1 error for each omission, letter transposition (switching
adjacent letters), insertion (inserting a new letter), or misplacemeent (moving W,O,R,L,D by more than one
space).

RECALL:
Now, what were the 3 objects I asked you to remember?
(This should administered as soon as the "WORLD backwards" item is completed. Cueing is
allowed if the subject is not able to recall words, but credit is not given for any word recalled
after a cue).
right / wrong
   19. Apple
   20. Table
   21. Penny         DELAYED VERBAL RECALL:

LANGUAGE:
Hold up a wrist watch and ask: what is this called? Repeat with a pencil.
right / wrong
   22. WATCH
   23. PENCIL

I would like you to repeat a phrase after me exactly as I say it. The phrase is:
   24. "No ifs, ands, or buts".
It is very important to speak loudly and enunciate clearly as you read this phrase. One repetition of the
phrase is permissible if it is clear that the phrase was not adequately heard. Otherwise, repetition is not
allowed. Accept "no if and or but" if the difficulty is clearly hi-pitch hearing loss.

A blank sheet of paper is required for this test. Hold it out and say:
Listen carefull, I am going to give you a piece of paper. When I do, take the paper
in your right hand, fold the paper in half, and put the paper down on your
lap.
It is permissible to repeat these instructions one time if it is clear that the subject has not
adequately heard the instructions. Otherwise, repetition or coaching is not allowed.
The paper should be handed to the midline of the subject at a sufficient distance that
(s)he has to reach out for it. Select "right" for each instruction correctly carried out. The
paper can be folded roughly in half in either direction. Credit is not given if the paper is
folded more than once.
right / wrong
   25. Took paper in right hand
   26. Folded paper in half
   27. Put paper down

Show the subject the stimulus page with "Close Your Eyes" at the top and say: Read the word on this page, then do what it says.
Score correctly only if the subject actually closes his/her eyes.
   28. Closes eyes

Give subject the blank piece of paper and pencil ask say
Write a any commplete sentence on this piece of paper for me.
The sentence must have a subject (which can be implied), and a predicate, and express a complete thought.
Spelling errors or illegible handwriting are allowed if the subject can say the sentence out loud and the
writing resembles the sentence that was said.
Correct grammar and punctuation are not necessary.
right / wrong
   34. Sentence                             LANGUAGE:    

Give the subject the stimulus page with the design on it (horizontal overlapping
pentagons) and say:
Here is a drawing. Please copy the drawing on this sheet of paper.
If the subject is not sure where to copy the design, point to the blank part of the page below the design
and instruct to place the copy there. In order to receive credit, the subject's copy must mee three
criteria: 1) there must be two five-sided polygons, 2) each angle of the two five-sided figures must point
outward, 3) the intersection of the five-sided figures must be a four-sided polygon. Any figure that meets
these criteria is acceptable.
right / wrong
   30. Pentagons                                 

TOTAL MMSE (score less than 15 to qualify for memantine prescription):   
(MMSE maximum score = 30)

24 - 30   normal, depending on age, education, complaints
20 - 23   mild
10 - 19   moderate
1   -   9   severe
0             profound

To calculate estimate of duration of illness from MMSE score, click here:    
TIME-INDEX for MMSE (estimated years into Alzheimer's disease):

TEXT FOR YOUR RECORDS - click here:

Electronic form developed at the Palo Alto Veterans Affairs Hospital
  by Wes Ashford, M.D., Ph.D., Anil Sharma, M.D., Jared Tinklenberg, M.D.,
Joy Taylor, Ph.D., Jerome Yesavage, M.D.
There is no individual or agency that takes responsibility for the results obtained
with this test or this form.