Memory Test at Home | Dementia Support Forum
What is the (year) (season) (date) (day) (month)?
Where are we? (state) (country) (town) (hospital) (floor)
Registration
Name 3 objects:
Examiner is to say each, then ask the patient all 3 after saying them. Give 1 point for each correct answer. Then repeat them until patient learns all 3. Count trials and record.
Trials_________
Attention and calculation
Serial 7s. 1 point for each correct. Stop after 5 answers. Alternatively, spell "world" backward.
Recall
Ask for the objects repeated above. Give 1 point for each correct.
Language
Name a pencil and watch (2 points)
Repeat the following "No ifs, ands, or buts" (1 point)
Follow a 3-stage command:
"Take a paper in your right hand, fold it in half, and put it on the floor" (3 points)
Read and obey the following:
Close your eyes (1 point)
Write a sentence (1 point)
Copy design (1 point)
Total score
Assess level of consciousness along a continuum
Alert Drowsy Stupor Coma
*A score <20 is indicative of a dementia. Patients with the benign forgetfulness of senility generally score >25.
