Patient Information
1. Orientation to Time
Year, Season, Date, Day, Month
2. Orientation to Place
State, Country, Town, Hospital, Floor
3. Registration
Name and repeat: APPLE, PENNY, TABLE
4. Attention & Calculation
Serial 7s from 100 OR spell 'WORLD' backwards
5. Recall
Recall the 3 objects from question 3
6. Naming
Name the pencil and watch shown
7. Repetition
"No ifs, ands, or buts"
8. Three-Stage Command
Take paper, fold in half, place on floor
9. Reading
Read and obey: CLOSE YOUR EYES
10. Writing
Write a complete sentence
11. Drawing
Copy the intersecting pentagons
Clinical Notes
Assessment Results
Total Score:
0/30
Severe cognitive impairment
Cognitive Domain Analysis
Orientation: 0/10
Memory: 0/6
Attention: 0/5
Language: 0/4
Visual-Spatial: 0/1
Executive: 0/4
Curated insights • How it Works • Practical Pearls • Evidence Base
