MMSE SCORE WHAT IS TODAY’S DATE? (THEN ASK FOR

0 SELECTED PEFA INDICATOR SCORES FOR UGANDA
(PROJECT TITLE) SCORE SHEET FOR SCORING ENDPOINTS EXPERIMENTAL TREATMENT
2003 SCOREBOARD 08192003 BEDFORD TIGER STADIUM TWINSBURG 130W 08232003

2006 PERCENTAGES AND COMPREHENSIVE ACT SCORES REPORTED BY ADE
2009 GRADES 38 MATHEMATICS RAW SCORE TO SCALE SCORE
2009 HARDAWAY INVITATIONAL RESULTS (TEAM INDIVIDUAL) TEAM SCORES NORTHVIEW

SUBJECT # _____

MMSE


Score

What is today’s date? (Then ask for omitted)

1. Date:

_________________________

______

Can you tell me what year it is?

2. Year:

_________________________

______

Can you tell me what month it is?

3. Month:

_________________________

______

Can you tell me what day of the week it is?

4. Day:

_________________________

______

Can you tell me what season it is?

5. Season:

_________________________

______

Can you tell me the name of this building we are in?

6. Building:

_________________________

______

What floor are we on?

7. Floor:

_________________________

______

What city/town are we in?

8. City:

_________________________

______

What county are we in?

9. County:

_________________________

______

What state are we in?

10. State

_________________________

______

May I test your memory? I will say three words and I would

11. BALL

_________________________

______

like you to repeat them after me.

12. FLAG

_________________________

______

(Allow 6 trials. Trial 1 determines score.)

13. TREE

_________________________

______

# TRIALS:_____ Ball:_____ Flag:_____ Tree:_____




Now what I would like you to do is start with the number

14. 93 / D

_________________________

______

100 and count backwards by 7s. Go until I say stop.

15. 86 / L

_________________________

______

(If subject cannot do 7s, ask:)

16. 79 / R

_________________________

______

I would like you to try to spell the word “WORLD”

17. 72 / O

_________________________

______

backwards

18. 65 / W

_________________________

______

Can you remember the 3 words I read to you earlier?

19. BALL

_________________________

______


20. FLAG

_________________________

______


21. TREE

_________________________

______

(Show subject wrist watch) What is this?

22. Watch

_________________________

______

(Show subject pen/pencil) What is this?

23. Pen/pencil:

_________________________

______

Repeat after me: “No ifs, ands, or buts”

24. Repeat:

_________________________

______

(Hold out blank paper)

25. R Hand:

_________________________

______

Take this piece of paper with your right hand, fold it in half,

26. Folds:

_________________________

______

and put it on the floor

27: Floor:

_________________________

______

Read this and do what it says: CLOSE YOUR EYES

28. Close eyes:

_________________________

______

Write a sentence on this paper. It can be any sentence.

29. Writing:

_________________________

______

Copy this drawing.

30. Copying:

_________________________

______



TOTAL:

______








CLOSE YOUR EYES



MMSE SCORE WHAT IS TODAY’S DATE? (THEN ASK FOR


MMSE SCORE WHAT IS TODAY’S DATE? (THEN ASK FOR


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