Jeff Baker, Ph.D. - Chief
Psychologist - (409) 747-2250
Folstein Mini-Mental State Exam
I.
ORIENTATION
(Maximum Score = 10 for
Section I)
What is today's date?
Date (eg, May 21)
What is today's year?
Year
What is the month?
Month
What day is today?
Day (e.g. Monday)
Can you also tell me what
season it is?
Season
Can you also tell me the name of this
hospital /clinic?
Hospital/Clinic
What floor are we on?
Floor
What city are we in?
City
What county are we in?
County
What state are we in?
State
II. IMMEDIATE
RECALL (Maximum
Score = 3)
Ask the subject if you may test his/her memory.
Say "ball, "flag," "tree" clearly and slowly, about one second
for each. Then ask the subject to repeat them. Give one point
each for each correct response. The FIRST repetition determines
the score. If he/she does not repeat all three correctly, keep
saying them up to six tries until he/she can repeat them.
Ball
Flag
Tree
Number of Trials:
III.
ATTENTION AND
CALCULATION
(Maximum Score = 5)
A. Counting
Backwards Test
Ask the subject to begin with 100 and count
backwards by 7. Record each response. Check one box at right for
each correct response. Any response 7 or less than the previous
response is a correct response. The score is the number of
correct subtractions. For example, 93, 85, 79, 72, 65 is a score
of 4; 93, 86, 78 70, 62, is 2; 92, 87, 78, 70, 65 is 0.
93
86
79
72
65
B. Spelling
Backwards Test
D
Ask the subject to spell the word "WORLD"
backwards. Record each response and check one box at
right for each correct response.
L
R
O
C. Final Score
Calculation
W
Compare the scores of the Counting Backwards and
Spelling Backwards tests. Write the greater of the two scores in
the box labeled FINAL SCORE on the next line, and use it in
deriving the
TOTAL SCORE.
FINAL SCORE For Attention or Calculation (Highest
Score for a Max of 5)
IV.
RECALL
(Maximum Score = 3)
Ask the subject to recall
the three words you previously asked him/her to remember. Give
one point for each correct response.
Ball
Flag
Tree
V. Language
(Maximum Score = 9)
Naming
Watch
Show the subject a wrist watch and ask him/her
what it is. Repeat for a pencil.
Pencil
Repetition
Ask the subject to repeat "No ifs, ands, or buts".
Repetition
Three Stage Command
Establish the subject's dominant hand. Give the
subject a sheet of blank paper and say, "Take the paper in your
right/left hand, fold it in half and put it on the floor."
Takes Paper in Hand
Folds Paper in Half
Puts Paper on Floor
Reading
Hold up the card that reads, "Close your eyes."
So the subject can see it clearly. Ask him/her to read it and do
what it says.
Give credit only if he/she actually closes
his/her eyes.
Writing
Give the subject a sheet of blank paper and ask
him/her to write a sentence. It is to be written spontaneously.
If the sentence contains a subject and a verb,
and is sensible, give credit. Correct grammar and punctuation
are not necessary.
Writes Sentence
Copying
Show the subject the drawing of the intersecting
pentagons. Ask him/her to draw the pentagons (about one inch
each side) on the paper provided. If ten angles are present and
two intersect, check the box at right. Ignore tremor and
rotation.
Copies pentagons
DERIVING THE TOTAL SCORE
Add the number of correct responses. The maximum is 30.
TOTAL SCORE
23-30 = Normal | 19-23 = Borderline
| <19 =Impaired
Folstein MF, Folstein SE, and McHugh PR, 1975
Copy this phrase on a Separate Card Before Testing
the Subject
CLOSE YOUR EYES
(Draw Intersecting pentagons on a separate card before
testing subject)
