Lewy Body Dementia
Parkinson's Disease
HIV Dementia
Vascular Dementia
Other Dementias

A popular measuring tool for clinicians for dementia is the Mini Mental Status Exam.  However, the MMSE does not differentiate depression in the elderly from mild cognitive impairment, although it successfully differentiated MCI patients from normal elderly or dementia (Prim Care Companion J Clin Psychiatry. 2005;7(2):62-69).  The MMSE correlates well with the cognitive scale of the Alzheimer's Disease Assessment Scale (ADAS), the standard cognitive measure in drug research studies. 

Questions (Total of 30 points)
  1. Orientation (10 points)
    1. Year, Season, Date, Day of week, and Month
    2. State, County, Town or City
    3. Hospital or clinic, Floor
  2. Registration (3 points)
    1. Name three objects: Apple, Table, Penny
    2. Each one spoken distinctly and with brief pause
    3. Patient repeats all three (one point for each)
    4. Repeat process until all three objects learned
    5. Record number of trials needed to learn all 3 objects
  3. Attention and Calculation (5 points)
    1. Spell WORLD backwards: DLROW
    2. Points given up to first misplaced letter
    3. Example: DLORW scored as 2 points only
  4. Recall (3 points)
    1. Recite the 3 objects memorized in Registration above
  5. Language (9 points)
    1. Patient names two objects when they are displayed
      1. Example: Pencil and Watch (1 point each)
    2. Repeat a sentence: 'No ifs ands or buts'
    3. Follow three stage command
      1. Take a paper in your right hand
      2. Fold it in half
      3. Put it on the floor
    4. Read and obey the following
      1. Close your eyes
      2. Write a sentence
      3. Copy the design (picture of 2 overlapped pentagons)

Interpretation of Mini-mental State Score (Maximum: 30)

  1. Normal score: 24 or higher
  2. Educational and Age Norms
    1. Fourth Grade Education
      1. Ages 18 to 69: Median MMSE Score 22-25
      2. Ages 70 to 79: Median MMSE Score 21-22
      3. Age over 79: Median MMSE Score 19-20
    2. Eighth Grade Education
      1. Ages 18 to 69: Median MMSE Score 26-27
      2. Ages 70 to 79: Median MMSE Score 25
      3. Age over 79: Median MMSE Score 23-25
    3. High School Education
      1. Ages 18 to 69: Median MMSE Score 28-29
      2. Ages 70 to 79: Median MMSE Score 27
      3. Age over 79: Median MMSE Score 25-26
    4. College Education
      1. Ages 18 to 69: Median MMSE Score 29
      2. Ages 70 to 79: Median MMSE Score 28
      3. Age over 79: Median MMSE Score 27

A score under 17 is considered at least probable dementia.

Folstein Mini Mental Status Examination




Date Orientation

"Tell me the date?" Ask for omitted items.

One point each for year, season, date, day of week, and month


Place Orientation

"Where are you?" Ask for omitted items.

One point each for state, county, town, building, and floor or room


Register 3 Objects

Name three objects slowly and clearly. Ask the patient to repeat them.

One point for each item correctly repeated


Serial Sevens

Ask the patient to count backwards from 100 by 7. Stop after five answers. (Or ask them to spell "world" backwards.)

One point for each correct answer (or letter)


Recall 3 Objects

Ask the patient to recall the objects mentioned above.

One point for each item correctly remembered



Point to your watch and ask the patient "what is this?" Repeat with a pencil.

One point for each correct answer


Repeating a Phrase

Ask the patient to say "no ifs, ands, or buts."

One point if successful on first try


Verbal Commands

Give the patient a plain piece of paper and say "Take this paper in your right hand, fold it in half, and put it on the floor."

One point for each correct action


Written Commands

Show the patient a piece of paper with "CLOSE YOUR EYES" printed on it.

One point if the patient's eyes close



Ask the patient to write a sentence.

One point if sentence has a subject, a verb, and makes sense



Ask the patient to copy a pair of intersecting pentagons onto a piece of paper.

One point if the figure has ten corners and two intersecting lines



A score of 24 or above is considered normal.


Adapted from Folstein et al, Mini Mental State, J PSYCH RES 12:196-198 (1975)

A full mental status exam for any psychiatric evaluation includes the following (from

Presenting Appearance including sex, chronological and apparent age, ethnicity, apparent height and weight (average, stocky, healthy, petite), any physical deformities (hearing impaired, injured and bandaged right hand).  Basic Grooming and Hygiene, dress and whether it was appropriate attire for the weather, for a doctor's interview, accessories like glasses or a cane.  Gait and Motor Coordination (awkward, staggering, shuffling, rigid, trembling with intentional movement or at rest), posture (slouched, erect), work speed, any noteworthy mannerisms or gestures.

Manner: 1) Interpersonal Characteristics and Approach to Evaluation (oppositional/resistant, submissive, defensive, open and friendly, candid and cooperative, showed subdued mistrust and hostility, excessive shyness). 2) Behavioral Approach (distant, indifferent, unconcerned, evasive, negative, irritable, depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive, frightened, alert, agitated, lethargic, needed minor/considerable reinforcement and soothing). 3) Speech (normal rate and volume, pressured, slow, accent, enunciation quality, loud, quiet, impoverished). 4) Eye Contact (makes, avoids, seems hesitant to make eye contact). 5) Expressive Language (no problems expressing self, circumstantial and tangential responses, anomia, difficulties finding words, misuse of words in a low-vocabulary-skills way, misuse of words in a bizarre-thinking-processes way, echolalia or perseveration, mumbling). 6) Note if English is not primary language here and comment on their command of the language. 7) Receptive Language (normal, able to comprehend questions, difficulty understanding questions). 8) Recall and Memory: could explain recent and past events in their personal history; recalls three words (e.g., Cadillac, zebra, and purple) immediately after two rehearsals, and then again five minutes later (five minutes is how long it takes for information to move from short-term to long term memory). If they can't, you can prompt them (e.g., Was the first one a kind of tree, color, or car? A car, OK was it a Camero, Continental, or Cadillac?)

Orientation (person, place, time, presidents, your name)

Thought Process: Alertness (sleepy, alert, tired for working late, dull and uninterested, highly distractible)
Coherence (responses were coherent and easy to understand, simplistic and concrete, lacking in necessary detail, overly detailed and difficult to follow)
Concentration and Attention (based on Digit Span and attention to your questions, serial 7's or 3's in which they count backwards from 100 to 50 by 7s or 3s, naming the days of the week or months of the year in reverse order, spelling the word "world", their own last name, or the ABC's backwards)
Thought Processes (could/could not recall the plot of a favorite movie or book logically, difficult to understand line of reasoning, showed loose associations, confabulations, flight of ideas, ideas of reference, illogical thinking, grandiosity, magical thinking, obsessions, perseveration, delusions, reports of experiences of depersonalization)
Hallucinations and Delusions (presence, absence, denied visual but admitted olfactory and auditory, denied but showed signs of them during testing, denied except for times associated with the use of substances, denied while taking medications)
Judgment and Insight (based on explanations of what they did, what happened, and if they expected the outcome, good, poor, fair, strong)
Intellectual Ability (roughly average, above average, or below average based on answers to questions like "name last four presidents," "who is the governor of the state," "what is the capitol of the state," "what direction does the sun set," etc...)
Abstraction Skills: These are based on proverbs and sayings ("What do people mean when they say..."), similarities ("How are a ______ and a ______ alike? Different?"), and giving both definitions for word ("What are two different meanings for the word 'right,' 'bit,' and 'left'?")

Mood and Affect: Mood or how they feel most days (happy, sad, despondent, melancholic, euphoric, elevated, depressed, irritable, anxious, angry).

Affect or how they felt and appeared during the exam (comments can include range of emotions like broad, restricted, blunted, flat, inappropriate, labile, consistent with the content of the conversation and facial expressions, pessimistic, optimistic) as well as inappropriate signs (began dancing in the office, verbally threatened examiner, cried while discussing recent happy event and unable to explain why).

Rapport (easy to establish, initially difficult but easier over time, difficult to establish, tenuous, easily upset)

Facial and Emotional Expressions (relaxed, tense, smiled, laughed, became insulting, yelled, happy, sad, alert, day-dreamy, angry, smiling, distrustful/suspicious, tearful when discussing such and such)

Suicidal and Homicidal Ideation (ideation but no plan or intent, clear/unclear plan but no intent, ideation coupled with clear plan and intent to carry it out)
Anxiety, impulsivity, irritability.

Risk for Violence (fair, low, high, uncertain, effected by substance use)