Better Mental Health for Older People
IPA - A Guide to the Diagnosis and Assessment of Alzheimer's Disease: Appendix 3

A Guide to the Diagnosis and Assessment of Alzheimer's Disease

 

 

Appendix 3
Standardized Mini Mental State Examination (SMMSE) ­ directions for use

Directions for Administration of SMMSE
  1. Before the questionnaire is administered, try to get the subject to sit down facing you. Assess the subjects ability to hear and understand very simple conversation, e.g. What is your name? If the subject uses hearing or visual aids, provide these before starting.
  2. Introduce yourself and try to get the subject's confidence. Before you commence, get the subject's permission to ask questions, e.g. Would it be all right to ask you some questions about your memory? This helps to avoid catastrophic reactions.
  3. Ask each question a maximum of three times. If the subject does not respond ­ score 0.
  4. If the subject answers incorrectly ­ score 0. Do not hint, prompt or ask the question again, e.g. what year is this? ­ 1952. Accept that answer ­ do not ask the question again, hint or provide any physical clues such as head shaking, etc.
  5. The following equipment is required to administer the instrument: a watch, a pencil, and some blank paper. A piece of paper with CLOSE YOUR EYES is written in large letters and two 5-sided figures intersecting to make a 4-sided figure is also required.
  6. If the subject answers What did you say? ­ do not explain or engage in conversation ­ merely repeat the same directions (e.g. What year is this?) to a maximum of 3 times.
  7. If the subject interrupts, e.g. What is this for? ­ just reply:
    I will explain in a few minutes when we are finished. Now if we could just proceed please... we are almost finished.
Standardized Mini Mental State Examination (SMMSE)

I am going to ask you some questions and give you some problems to solve. Please try and answer as best as you can.

QUESTIONS MAXIMUM
SCORE
1. (Allow 10 seconds for each reply)

a) What year is this? (accept exact answer only)

b) What season is this?
(during last week of the old season or first week of a new season, accept either season)

c) What month of the year is this?
(on the first day of new month, or last day of the previous month, accept either)

d) What is today's date?
(accept previous or next date, e.g. on the 7th accept the 6th or 8th)

e) What day of the week is this? (accept exact answer only)

 1 point for each answer
2. (Allow 10 seconds for each reply)

a) What county are we in? (accept exact answer only)

b) What province/state/country are we in? (accept exact answer only)

c) What city/town are we in? (accept exact answer only)

d) (In clinic) What is the name of this hospital/building? (accept exact name of hospital or institution only)

(In home) What is the street address of this house? (accept street name and house number or equivalent in rural areas)

e) (In clinic) What floor of the building are we on? (accept exact answer only)

(In home) What room are we in? (accept exact answer only)

1 point for each answer
3. I am going to name 3 objects. After I have said all three objects, I want you to repeat them.

Remember what they are because I am going to ask you to name then again in a few minutes.
(say them slowly at approximately 1 second intervals)

Ball Car Man

For repeated use:

Bell Jar Fax
Bill Tar Can
Bull War Pan

Please repeat the 3 items for me.

(score 1 point for each correct reply on the first attempt)

Allow 20 seconds for reply, if subject did not repeat all 3, repeat until they are learned or up to a maximum of 5 times.

 3
4. Spell the word WORLD

(you may help subject to spell world correctly)

Say: now spell it backwards please. Allow 30 seconds to spell backwards.

(If the subject cannot spell backwards - even with assistance - score 0)

 5
5. Now what were the 3 objects that I asked you to remember?
Ball Car Man

Score 1 point for each correct response regardless of order, allow 10 seconds.

 3
6. Show wristwatch. Ask: what is this called?

Score 1 point for correct response. Accept "wristwatch" or "watch". Do not accept "clock", "time", etc. (allow 10 seconds)

 1
7. Show pencil. Ask: what is this called?

Score 1 point for correct response, accept pencil only - score 0 for pen.

 1
8. I'd like you to repeat a phrase after me: "No ifs, ands or buts".

(allow 10 seconds for response. Score 1 point for a correct repetition. Must be exact, e.g. No ifs or buts - score 0)

 1
9. Read the words on this page and then do what it says:

Hand subject a sheet of paper with CLOSE YOUR EYES written on it.

CLOSE YOUR EYES

If subject just reads and does not then close their eyes ­ you may repeat: read the words on this page and then do what it says to a maximum of 3 times. Allow 10 seconds, score 1 point only if subject closes their eyes. Subject does not have to read aloud.

1
10. Ask if the subject is right- or left-handed. Alternate right/left hand in statement, e.g. if the subject is right-handed, say: Take this paper in your left hand... Take a piece of paper ­ hold it up in front of subject and say the following:

"Take this paper in your right/left hand, fold the paper in half once with both hands and put the paper down on the floor."  

3
Takes paper in correct hand  1
Folds it in half   1
Puts it on the floor 1
Allow 30 seconds. Score 1 point for each instruction correctly executed.  
11. Hand subject a pencil and paper.

Write any complete sentence on that piece of paper.

Allow 30 seconds. Score 1 point. The sentence should make sense. Ignore spelling errors.

1
12. Place design, pencil, eraser and paper in front of the subject.

Say: copy this design please.

Allow multiple tries until patient is finished and hands it back. Score 1 point for correctly copied diagram. The subject must have drawn a 4-sided figure between two 5-sided figures. Maximum time - 1 minute.

1
Total Test Score 30
Scoring the figure

The subject must draw two 5-sided figures intersected by a 4-sided figure.

CORRECT
Score 1
INCORRECT
Score 0
CORRECT
Score 1
 INCORRECT
Score 0
CORRECT
Score 1
INCORRECT
Score 0
Time completed: _________ (minutes)
Scoring "WORLD" backwards
Correct response: DLROW Score 5
Omission of one letter:
e.g. DLRW; DLOW; DROW; DLRO 		Score 4
Omission of two letters:
e.g. DLR; LRO; DLW 		Score 3
Reversal of two letters:
e.g. DLORW; DRLOW; DLRWO; DLWOR 		Score 3
Omission/reversal of three letters:
e.g. DORLW; DL. OW 		Score 2
Reversal of four letters:
e.g. DRLWO; LDRWO 		Score 1
Standardized Mini Mental State Examination (SMMSE). Reproduced by kind permission. Molloy et al, Geriatric Research Group, McMaster University, Hamilton Civic Hospitals, Hamilton, Ontario, Canada.
IPA
Developed from scientific presentations at a special IPA meeting.
Sponsored by an educational grant from Pfizer Inc and Eisai Ltd.		 PFIZER   EISAI
©1997 Pfizer, Inc and Eisai Ltd.

 

Copyright 2010 International Psychogeriatric Association