Patient Information
Record basic demographic and clinical context before starting the assessment.
Recommended order: Administer the Clock Drawing Test first (brief, non-threatening), then the MMSE. The full assessment takes approximately 15-20 minutes.
Part 1: Shulman Clock Drawing Test
Administration time: 2-3 minutes. Score on the Shulman 6-point scale (0-5).
Materials needed: Blank paper with a pre-drawn circle (approx. 10 cm diameter), a pencil, and a flat surface. The patient should wear reading glasses if needed.
Step 1: Give the Instruction
Place the paper with the pre-drawn circle in front of the patient and say verbatim:
"I would like you to put the numbers on this circle to make it look like a clock face, and then put the hands on the clock to show the time 'ten past eleven.'"
Do not help. If the patient asks for clarification, respond only: "Do the best you can." Do not indicate where to start, explain what "ten past eleven" means, or gesture in any way.
▼ Why "ten past eleven"? (tap to expand)
This time requires the patient to place the minute hand toward the "2" on the clock, not the "10." The patient must recode the verbal command "ten" into the spatial position "2." Patients with early executive dysfunction often draw the minute hand toward the 10 (a stimulus-bound error). A simpler time like 3 o'clock would not reveal this error.
Step 2: Observe and Photograph
Observe the process (hesitation, erasure, starting over, confusion). When complete, photograph the clock drawing:
Tap to upload or take a photo of the clock drawing
Step 3: Score the Clock (Shulman 0-5)
▼ Scoring criteria reference (tap to expand)
Score holistically. Assign the single best-fitting score based on the overall drawing, not by counting individual errors.
Clinical cut-off: 3. Scores of 4-5 are normal. Scores of 0-3 indicate significant cognitive impairment warranting further assessment.
Caveat: Very low formal education (especially limited paper-and-pencil experience) can depress scores in cognitively intact individuals. Weigh against patient history.
Clinical cut-off: 3. Scores of 4-5 are normal. Scores of 0-3 indicate significant cognitive impairment warranting further assessment.
Caveat: Very low formal education (especially limited paper-and-pencil experience) can depress scores in cognitively intact individuals. Weigh against patient history.
Part 2: Mini-Mental State Examination
30-point questionnaire. Administration time: 5-10 minutes. Record scores as you go.
MMSE Timer: 0:00
Section 1: Orientation to Time (5 points)
Ask each question. Score 1 point for each correct answer. For seasons, use clinical judgment at boundary months.
What is the year?
What season is it?
What is today's date (day of the month)?
What day of the week is it?
What month is it?
Section 2: Orientation to Place (5 points)
Adapt to actual setting. For home visits, substitute neighborhood/street for building/floor.
What country are we in?
What state/province are we in?
What city or town are we in?
What is the name of this building (or hospital/clinic)?
What floor are we on?
Section 3: Registration (3 points)
Say: "I am going to name three objects. After I have said all three, I want you to repeat them back to me."
Speak clearly at ~1 second intervals. Score only the first attempt. Repeat up to 6 trials until learned, but record first-attempt score only. Tell the patient: "Try to remember those words. I will ask about them again in a few minutes."
Speak clearly at ~1 second intervals. Score only the first attempt. Repeat up to 6 trials until learned, but record first-attempt score only. Tell the patient: "Try to remember those words. I will ask about them again in a few minutes."
Words correctly repeated on first attempt
Number of trials needed to learn all 3 words (for clinical notes, not scored)
Section 4: Attention and Calculation (5 points)
Say: "Count backward from 100 by sevens. Start with 93." Stop after 5 responses. Score sequentially (each correct subtraction gets credit even if a prior step was wrong).
Alternative: If patient cannot/will not attempt serial 7s, ask them to spell WORLD backwards (D-L-R-O-W). Note which task was used.
Alternative: If patient cannot/will not attempt serial 7s, ask them to spell WORLD backwards (D-L-R-O-W). Note which task was used.
100 - 7 = 93
93 - 7 = 86
86 - 7 = 79
79 - 7 = 72
72 - 7 = 65
Section 5: Recall (3 points)
Say: "Earlier I told you the names of three objects and asked you to remember them. Can you tell me what those words were?"
No prompting. 1 point per word, any order. If the patient couldn't learn all 3 during registration (>3 trials), note recall as unreliable.
No prompting. 1 point per word, any order. If the patient couldn't learn all 3 during registration (>3 trials), note recall as unreliable.
Words correctly recalled
Section 6: Language and Praxis (9 points)
Naming (2 pts): Show a wristwatch and ask "What is this called?" Then show a pencil and ask the same.
Naming: Watch
Naming: Pencil
Repetition (1 pt): Say: "Repeat after me: No ifs, ands, or buts." One attempt only. 1 point if perfectly repeated.
Repetition: "No ifs, ands, or buts"
Three-stage command (3 pts): Hand patient a blank sheet and say: "Take this paper in your right hand, fold it in half, and put it on the floor." 1 point per step. Do not gesture or demonstrate.
Command: Takes paper in right hand
Command: Folds it in half
Command: Puts it on the floor
Reading (1 pt): Show card reading "CLOSE YOUR EYES." Say: "Read this and do what it says." Score 1 only if patient actually closes eyes (reading aloud without closing = 0).
Reading: Closes eyes on command
Writing (1 pt): Give blank paper and pencil. Say: "Write a complete sentence, anything you like." Must have subject + verb and make sense. Spelling/grammar don't matter.
Writing: Writes a complete sentence
Copying (1 pt): Show the intersecting pentagons figure. Say: "Copy this figure exactly as you see it." Score 1 if two 5-sided shapes with a 4-sided overlap. Tremor/rotation are acceptable.
Copying: Intersecting pentagons
Running MMSE Total
0 / 30
0 / 30
Screening Results Summary
MMSE Section Breakdown
Clinical Notes
Screening disclaimer: Neither the CDT nor the MMSE diagnoses dementia. Both are screening tools that signal the need for comprehensive clinical assessment, including patient history, collateral information from a family member or caregiver, laboratory workup to rule out reversible causes, and, when warranted, neuroimaging. The screen opens the door; it does not close the case.