| Folstein Mini-Mental State Exam |
| I. ORIENTATION (Ask the following questions;
correct = þ ) |
Record Each Answer: |
(Maximum Score = 10) |
| What is today's date? |
Date (eg, May 21) |
1 ¨ |
| What is today's year? |
Year |
1 ¨ |
| What is the month? |
Month |
1 ¨ |
| What day is today? |
Day (eg, Monday) |
1 ¨ |
| Can you also tell me what season it is? |
Season |
1 ¨ |
| Can you also tell me the name of this hospital/clinic? |
Hospital/Clinic |
1 ¨ |
| What floor are we on? |
Floor |
1 ¨ |
| What city are we in? |
City |
1 ¨ |
| What county are we in? |
County |
1 ¨ |
| What state are we in? |
State |
1 ¨ |
| II. IMMEDIATE RECALL |
(correct = þ
) |
(Maximum Score = 3) |
| Ask the subject if you may test his/her memory.
Say "ball, "flag," "tree" clearly and slowly, about on second for
each. Then ask the subject to repeat them. Check the box at right 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 |
1 ¨ |
| Flag |
1 ¨ |
| Tree |
1 ¨ |
| |
NUMBER OF TRIALS: _________ |
| III. ATTENTION AND CALCULATION |
|
|
| A. Counting Backwards Test |
(Record each response, correct = þ ) |
(Maximum Score = 5) |
| 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 socre is the
number of correct subtractions. For example, 93, 87, 80, 72, 66 is a score of 4; 93, 86,
78 70, 62, is 2; 92, 87, 78, 70, 65 is 0. |
93 |
1 ¨ |
| 86 |
1 ¨ |
| 79 |
1 ¨ |
| 72 |
1 ¨ |
| 65 |
1 ¨ |
| B. Spelling Backwards Test |
|
|
| Ask the subject to spell the word
"WORLD" backwards. Record each response. Use the instructions to determine which
are correct responses, and check one box at right fore each correct response. |
D |
1 ¨ |
| L |
1 ¨ |
| R |
1 ¨ |
| C. Final Score |
O |
1 ¨ |
| Compare the scores of the Counting Backwards
and Spelling Backwards tests. Write the greater of the two socres in the box labeled FINAL
SCORE at right, and use it in deriving the TOTAL SCORE. |
W |
1 ¨ |
| |
FINAL SCORE_____ (Max of 5 or Greater of the two
Scores) |
| IV. RECALL |
(correct = þ
) |
(Maximum Score = 3) |
| Ask the subject to recall the three words you
previously asked him/her to remember. Check the Box at right for each correct response. |
Ball |
1 ¨ |
| Flag |
1 ¨ |
| Tree |
1 ¨ |
| V. Language |
(correct = þ
) |
(Maximum Score = 9) |
| Naming |
Watch |
1 ¨ |
| Show the subject a wrist watch and ask him/her what it is.
Repeat for a pencil. |
Pencil |
1 ¨ |
| Repetition |
|
|
| Ask the subject to repeat "No, ifs, ands, or
buts." |
Repetition |
1 ¨ |
| 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 |
1 ¨ |
| Folds paper in half |
1 ¨ |
| Puts paper on floor |
1 ¨ |
| 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.
Check the box at right only if he/she actually closes his/her eyes. |
Closes eyes |
1 ¨ |
| |
|
| |
|
| Writing |
|
|
| Give the subject a sheet of blank paper and ask him/her to
write a sentence. It is to be written sponataneously. If the sentence contains a subject
and a verb, and is sensible, check the box at right. Correct grammar and punctuation are
not necessary. |
Writes sentence |
1 ¨ |
| 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 |
1 ¨ |
| |
|
| 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
CLOSE YOUR EYES
(Draw Intersecting pentagons on the back of this page before
testing subject)
|
