Mini-Mental State Examination (MMSE)
Interactive Mini-Mental State Examination (MMSE) scoring worksheet for NCHDs, with a printable PDF scoring sheet, interpretation bands, and when not to use MMSE.
Mini-Mental State Examination
Bedside scoring aid. Not a delirium screen or capacity test. Ask each item once; do not coach. Printable PDF
Orientation to time
0/5
Ask year, season, date, day of the week, and month. Score each separately.
Orientation to place
0/5
Ask country, county, town or city, hospital, and floor or ward. Accept the local name.
Registration
0/3
Name APPLE, PENNY, TABLE one per second. Score the first trial only, then ask them to remember the words.
Attention
0/5
Score serial 7s or WORLD backwards, not both. If serial 7s fails, switch to WORLD and score WORLD only.
Recall
0/3
Ask for the three words. No cues. Order does not matter.
Language
0/8
Name a watch and a pencil. Repeat the phrase once, exactly.
Naming
0/2
Show a watch and a pencil. Ask what each is called.
Repetition
0/1
Say the phrase once. It must be exact.
3-stage command
0/3
Give the full command before they start: right hand, fold in half, put on the table. Do not prompt between steps.
Reading
0/1
Say: Read this and do what it says. Score only if they close their eyes.
Writing
0/1
Sentence needs a subject and a verb. Ignore spelling.
Copy pentagons
0/1
Show the design. Score 1 if all 10 angles are present and the overlap is four-sided.
MMSE total
0 / 30
Tap items as you go. The total updates live.
No impairment ≥24/30. Not diagnostic.
When to use
- Suspected cognitive impairment after delirium has been considered, or when geriatrics or a memory clinic asks for a bedside score.
- Documenting cognition for discharge planning, nursing home discussions, or Fair Deal / NHSS paperwork when a score is requested.
- Baseline cognition once the patient is medically stable and able to participate (hearing, vision, language, and attention adequate).
- Repeat testing with the same method if you need to track change. Do not mix MMSE and MoCA totals.
When not to use
- Not a delirium screen. Use 4AT first if the picture is acute or fluctuating.
- Not a capacity assessment. A low MMSE does not mean the patient lacks decision-making capacity.
- Unreliable with aphasia, severe hearing or vision loss, language barrier, or very low literacy. Document the limitation instead of forcing a score.
- Do not diagnose dementia on MMSE alone. Education, depression, and practice effects all shift the total.
Interpretation
- These bands are teaching cutoffs, not a diagnosis. Local teams may use slightly different thresholds.
- Score serial 7s or WORLD backwards, not both. If serial 7s fails, switch to WORLD and score WORLD only.
24–30
- Band
- No cognitive impairment
- What to do
- Does not exclude mild cognitive impairment. Consider MoCA if the history is still concerning.
18–23
- Band
- Mild cognitive impairment
- What to do
- Look for reversible causes. Consider MoCA, collateral, and follow-up.
0–17
- Band
- Severe cognitive impairment
- What to do
- Escalate, protect from harm, and arrange formal assessment. Not a capacity test.
| MMSE /30 | Band | What to do |
|---|---|---|
| 24–30 | No cognitive impairment | Does not exclude mild cognitive impairment. Consider MoCA if the history is still concerning. |
| 18–23 | Mild cognitive impairment | Look for reversible causes. Consider MoCA, collateral, and follow-up. |
| 0–17 | Severe cognitive impairment | Escalate, protect from harm, and arrange formal assessment. Not a capacity test. |
After an abnormal score
- Review reversible causes: infection, metabolic disturbance, new medicines, constipation, pain, hypoxia, and alcohol withdrawal.
- If mild impairment is the question and education is high, MoCA is more sensitive than MMSE.
- Involve geriatrics, OT, and social work when function, safety, or placement is the issue.
- Copy note from the scorer so the domain breakdown is in the notes. A total without context is hard to interpret later.
Related NICE guidance
Full guidance on nice.org.uk. BetterCall is not endorsed by NICE.
External resources
Note Template
Ready-to-use clinical note structure
🕒 16 / 10 / 2026 — 16:26 ATRP re: cognitive screen (MMSE) Patient: [age] [sex] Admission Dx: [reason for admission] PMHx: [dementia / stroke / hearing or vision impairment / education] 🧾 Hx: • Cognitive concern: [memory / orientation / function] • Onset / course: [acute / fluctuating / gradual] • 4AT (if delirium considered): __ / 12 • MMSE: __ / 30 — band: [no cognitive impairment / mild / severe] • Orientation: __ / 10 (time __ / 5, place __ / 5) • Registration: __ / 3 • Attention: __ / 5 ([serial 7s / WORLD backwards]) • Recall: __ / 3 • Language: __ / 8 (naming __ / 2, repetition __ / 1, command __ / 3, reading __ / 1, writing __ / 1) • Copy pentagons: __ / 1 • Language / hearing / literacy barriers: [none / specify] • Collateral: [family / care home / none] 🩺 Exam: • Vitals: HR __ BP __ RR __ Temp __ SpO₂ __ • Focal neurology: [none / specify] 📋 Impression: MMSE __ / 30 — [no cognitive impairment / mild / severe] on this screen. Not a delirium screen or capacity assessment. 📌 Plan: • Reversible causes reviewed (infection, metabolic, drugs, constipation, pain): [ ] • Repeat / MoCA if MCI suspected: [ ] • Geriatrics / memory clinic / OT as indicated: [ ] • Escalate to Reg: [yes/no] 👤 [Your Name], [Role] IMC: _______
Educational reference only. Medical disclaimer