Substance Abuse Treatment for Persons With HIV/AIDS
Treatment Improvement Protocol (TIP) Series 37

Appendix H -- Mini Mental State Examination (MMSE)

Date: _____________________________ Patient's Name: _____________________________________________
Maximum Score	Score
		ORIENTATION
5	( )	What is the (year) (season) (date) (day) (month)?
5	( )	Where are we: (State) (county) (town or city) (hospital) (floor)?
		REGISTRATION
3	( )	Name 3 common objects (e.g., "apple," "table," "penny"):
		Take 1 second to say each. Then ask the patient to repeat all 3 after you have said them. Give 1 point for each correct answer. Then repeat them until he/she learns all 3. Count trials and record. Trials:
		ATTENTION AND CALCULATION
5	( )	Spell "world" backwards. The score is the number of letters in correct order. (D___L___R___O___W___).
		RECALL
3	( )	Ask for the 3 objects repeated above. Give 1 point for each correct answer. (Note: Recall cannot be tested if all 3 objects were not remembered during registration.)
		LANGUAGE
2	( )	Name a "pencil" and "watch."
1	( )	Repeat the following: "No ifs, ands, or buts."
3	( )	Follow a 3-stage command: "Take a paper in your right hand, fold it in half and put it on the floor."
1	( )	Read and obey the following:
1	( )	Close your eyes.
1	( )	Write a sentence.
1	( )	Copy the following design:
Total Score: _________________________________

Source: Folstein, M.F.; Folstein, S.E.; and McHugh, P.R. "Mini-mental state": A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3):189-198, 1975.