| |
Maximal score |
Patient's score |
| Orientation |
What is the year? season? date? day? month? |
5 |
_____ |
Where are we--state? country? town? building? floor? |
5 |
_____ |
| Registration |
Name 3 objects [apple, table, penny] (take 1 second to say each). Then ask the patient to name all 3 after you have said
them. Give 1 point for each correct answer.
Repeat them until the patient learns all 3.
Number of trials: _____
|
3 |
_____ |
| Attention and calculation |
Subtract serial 7s: 100, 93, 86, 79, 72, 65. Give 1 point for each correct number; stop after 5 answers. |
5 |
_____ |
| Recall |
Ask for the names of the 3 previously mentioned objects. Give 1 point for each correct answer.
|
3 |
_____ |
| Language |
Point to a pencil and a watch. Ask the patient to name them. |
2 |
_____ |
Have the patient repeat the following phrase:
"No ifs, ands, or buts." |
1 |
_____ |
Ask the patient to follow this command:
"Take a paper in your right hand, fold
it in half, and put it on the floor." |
3 |
_____ |
Ask the patient to read and obey the following:
"CLOSE YOUR EYES." |
1 |
_____ |
Ask the patient to write a sentence here:
____________________________
____________________________ |
1 |
_____ |
Have the patient copy this design:
 |
1 |
_____ |
| |
|
| TOTAL |
30 |
_____ |
