Orientation |
Year Month Day Date Time |
___/5 |
Country Town District Hospital Ward |
___/5 |
|
Registration |
Examiner names 3 objects (e.g. apple, table, and penny). Patient asked to repeat (1 point for each correct answer). THEN patient to learn the 3 names repeating until correct. |
___/3 |
|
Attention and calculation |
Subtract 7 from 100 and then repeat from result. Continue 5 times: 100 93 86 79 65 Alternative: spell “WORLD” backwards-“DLROW” |
___/5 |
|
Recall |
Ask for names of 3 objects learned earlier. |
___/3 |
|
Language |
Name a pencil and watch |
___/2 |
Repeat “No fits, ands, or buts” |
___/1 |
Give a 3-stage command. Score 1 for each stage. E.g., “Place index finger of right hand on your nose and then on your left ear” |
___/3 |
Ask patient to read and obey a written command on a piece of paper stating “Close your eyes” |
___/1 |
Ask patient to write a sentence. Score if it is sensible and has a subject and a verb |
___/1 |
|
Copying |
Ask the patient to copy a pair of intersecting pentagons:
|
___/1 |
|
|
Total |
___/30 |