| Orientation |
| 1. |
Ask the patient: "What is the year, season,
date, day, month?" |
/5 |
| 2. |
Ask: "Where are you?" -- State, country,
town, place, floor (or ward) |
/5 |
| Memory registration |
| 3. |
Tell the patient that you want him/her to remember
something for you, then name three unrelated objects (speak clearly and
slowly). Ask the patient to repeat the three objects (score 3 points if
correct first time, 2 if correct second time, 1 if correct third time).
Ask patient to keep the three things in mind. |
/3 |
| Attention and concentration |
| 4. |
Ask the patient to take seven from 100, then seven
from the result, and so on for five subtractions. Score 1 point for each
correct answer. |
|
OR |
|
Ask the patient to spell "world"
backwards, and score 1 point for each correct letter. |
/5 |
| Memory recall |
| 5. |
Ask the patient to recall the three objects from
test 3. |
/3 |
| Language |
| 6. |
Show the patient two familiar objects (e.g., a pen,
a watch) and ask him/her to name them. |
/2 |
| 7. |
Ask the patient to repeat a sentence after you:
"No ifs, ands or buts". |
/1 |
| 8. |
Ask the patient to follow a three-stage command:
"Please take this paper in your left hand, fold it in half and put
the paper on the floor". |
/3 |
| 9. |
Ask the patient to read and follow a written
instruction, e.g., "Close your eyes". |
/1 |
| 10. |
Ask the patient to write a simple sentence. The
sentence should contain a subject and a verb and should make sense. |
/1 |
| 11. |
Ask the patient to copy a picture of intersecting
pentagons.  |
/1 |
| Total score |
/30 |
|
A score below 24 indicates probable cognitive
impairment.
A score below 17 indicates definite cognitive impairment. |
