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Screening for Delirium, Dementia and Depression in Older Adults

Screening for Delirium, Dementia and Depression in Older Adults

Screening for Delirium, Dementia and Depression in Older Adults

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<strong>Screen<strong>in</strong>g</strong> <strong>for</strong> <strong>Delirium</strong>, <strong>Dementia</strong> <strong>and</strong> <strong>Depression</strong> <strong>in</strong> <strong>Older</strong> <strong>Adults</strong>Appendix E: M<strong>in</strong>i-Mental Status Exam(MMSE) Sample ItemsThe MMSE is a 30-po<strong>in</strong>t scale designed to assess a client’s cognitive per<strong>for</strong>mance <strong>in</strong>a cl<strong>in</strong>ical sett<strong>in</strong>g. It assesses orientation, attention, memory, <strong>and</strong> language. Below is a sampleof the MMSE.Orientation to Time “What is the date?”64Registration “Listen carefully, I am go<strong>in</strong>g to say three words. You say them back after I stop.Ready? Here they are . . .HOUSE (pause),CAR (pause),LAKE (pause).Now repeat those words back to me.” (Repeat up to 5 times, but score only the first trial.)Nam<strong>in</strong>g “What is this?” (Po<strong>in</strong>t to a pencil or pen.)Read<strong>in</strong>g “Please read this <strong>and</strong> do what it says.” (Show exam<strong>in</strong>ee the words on the stimulus <strong>for</strong>m.)CLOSE YOUR EYESReproduced by special permission of the Publisher, Psychological Assessment Resources, Inc., 16204 North Florida Avenue,Lutz, Florida 33549, from the M<strong>in</strong>i-Mental State Exam<strong>in</strong>ation, by Marshal Folste<strong>in</strong> <strong>and</strong> Susan Folste<strong>in</strong>, Copyright 1975,1998, 2001 by M<strong>in</strong>i Mental LLC, Inc. Published 2001 by Psychological Assessment Resources, Inc. Further reproductionis prohibited without permission of PAR, Inc. The MMSE can be purchased from PAR, Inc. by call<strong>in</strong>g (800) 331-8378 or(813) 968-3003.

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