Emergency Medicine

ALTERED CONSCIOUS LEVEL

General Medical Emergencies 83

(v) Blood cultures, MSU.

(vi) ECG, CXR.

(vii) CT brain scan.

(viii) Lumbar puncture. See page 482.

Table 2.7 Mini-Mental State Examination (MMSE)

Cognition tested Score

Orientation (10 points)

1. What is the date? 1
   What is the day? 1
   What is the month? 1
   What is the year? 1
   What is the season? 1


2. What is the name of this building? 1
   What floor of the building are we on? 1
   What city are we in? 1
   What state are we in? 1
   What country are we in? 1
   Registration (3 points)


3. I am going to name three objects. After I have
   said them I want you to repeat them. Remember
   what they are because I am going to ask you to
   name them in a few minutes. Apple. Table. Penny.
   (Code the first attempt and then repeat the
   answers until the patient learns all three)

Apple 1

Table 1

Penny 1

Attention and calculation (5 points max)

4. Either: Can you subtract 7 from 100, and then
   subtract 7 from the answer you get and keep
   subtracting until I tell you to stop?

93 1

86 1

79 1

72 1

65 1

5. Or: I’m going to spell a word forwards and I
   want you to spell it backwards. The word is
   W-O-R-L-D. Now you spell it backwards
   (Repeat if necessary)

D1

L1

R1

O1

W1