This is how a doctor performs the test and how a patient is scored:
1. MAKE ALTERNATE TRAILS
PROOF: The patient is asked to match five numbers and letters (1-5, AE) in ascending order (matching 1 with A, 2 with B, etc.) while drawing lines to connect the dots.
RESULT: The patient gets one point for each successful pair: 1-A; 2-B; 3-C; 4-D; 5-E. Lines cannot be crossed. The patient earns 0 if he makes an error that is not immediately corrected.
2. VISUOCONSTRUCTION SKILLS (CUBE)
PROOF: Draw your own version of the cube in the space next to it.
It must be exactly the same as the one printed on the page.
RESULT: A point if drawn correctly (i.e. three-dimensional, all lines drawn, no lines added, lines are relatively parallel and similar in length; no point if any of those criteria are missing).
3. VISUOCONSTRUCTION SKILLS (CLOCK)
PROOF: Draw a clock, putting all the numbers and set the time to 11 and 10 minutes.
RESULT: One point is assigned for each of the following three criteria:
- Outline (ONE POINT): The watch face should be a circle with minimal acceptable distortion (i.e. a slight imperfection when closing the circle).
- Numbers (ONE POINT): All numbers on the clock must be present without additional numbers; The numbers must be in the correct order and placed in the approximate quadrants of the clock face. Roman numerals are acceptable. Numbers can be placed outside the circle outline.
- Hands (ONE POINT): there must be two hands together indicating the correct time; the hour hand should be clearly shorter than the minute hand. The hands should be centered within the clock face with their junction near the center of the clock.
A point is not assigned for a given item if any of the above criteria is not met.
4. NAME
PROOF: Name each animal.
- Lion
- Rhinoceros (or rhinoceros)
- Camel (or dromedary)
RESULT: One point for each
5. MEMORY
PROOF:
The doctor tells the patient that he is going to read a list of words that the patient must remember. In the end the patient has to tell them as many as he remembers; No matter the order.
The doctor then reads five words, one per second:
FACE, VELVET, CHURCH, DAISY, RED
While the patient recites the words, the doctor checks a box for each word said aloud.
The patient indicates when he has remembered everything he can.
The doctor reads the list a second time. In the end the patient has to remember them all again.
As the patient recites the words, the doctor checks a box for each word said aloud, including the first five again.
The patient indicates when he has remembered everything he can.
At the end of the test, the doctor asks the patient to remember the five words, without prompting. This is the portion of the test that is graded.
PUNCTUATION: There are no positive points, only negative points if they make a mistake.
6. ATTENTION
PROOF (NUMBERS):
Withdrawal numbers: The doctor reads a list of five numbers at a rate of one number per second; the patient remembers them exactly as they were said:
2 1 8 5 4
Remember numbers backwards: The doctor reads three numbers at the rate of one number per second; the patient remembers them backwards:
7 4 2
PUNCTUATION: One point per sequence recited correctly.
TEST (LETTERS): The doctor reads a list of letters at a rate of one per second. Every time they say the letter ‘A’, the patient has to tap themselves with their hand:
FBACMNAAJKLBAFAKDEAAA JAMOFAAB
PUNCTUATION: One point if there are no errors or only one error (i.e., the patient touched another letter only once).
TEST (MATHEMATICS): The patient starts at 100, then must count backwards by subtracting seven each time, until the examiner tells him or her to stop:
PUNCTUATION: Total three points.
- There are no points if there are no correct subtractions
- One point for just one correct subtraction
- Two points for two or three correct subtractions
- Three points for four or five correct subtractions
If the first subtraction is incorrect, but each subsequent subtraction follows the pattern of seven, they still earn every other point. For example, they can say ’92 – 85 – 78 – 71 – 64′. While ’92’ is incorrect, all subsequent numbers are subtracted by seven, meaning they only made one mistake and would get a score of three.
7. REPETITION OF PRAYERS
PROOF:
Step one: The examiner reads this sentence and the patient has to repeat it exactly: ‘I just know that John is the one who is going to help today’.
Step two: The examiner then reads another sentence, with the same instruction: ‘The cat always hid under the couch when there were dogs in the room’.
PUNCTUATION: One point for each correct sentence.
- exact repetition
- No synonyms are substituted (i.e. it must be “hidden”, not “hidden”)
8. VERBAL FLUENCY
PROOF: The doctor reads a letter (F), and the patient has to think of words that begin with that letter. The goal is to reach 11 words or more in 60 seconds.
- The words cannot be proper nouns, such as Bob or Boston.
- The words cannot be the same word that sounds the same but with different suffixes (such as love, lover, amar)
PUNCTUATION: One point if they reach 11 words or more in one minute.
9. ABSTRACTION
PROOF: The patient has to describe what the relationship is between certain words (i.e., an orange and a banana; a train and a bicycle; a ruler and a clock).
There is a practice test (ORANGE AND BANANA) before two scored pairs (TRAIN AND BIKE; CLOCK AND RULER).
PUNCTUATION: One point for each of the last two pairs.
Acceptable answers:
- Train and bicycle: means of transport, means of travel, used to make trips
- Ruler and clock: means of measurement, measuring instruments.
Unacceptable responses:
- Train and bicycle: they have wheels
- Ruler and clock: they have numbers.
10. DELAYED REMEMBER
PROOF: The patient must remember all the words he heard previously (FACE, VELVET, CHURCH, DAISY, RED).
PUNCTUATION: One point for each word remembered (without instructions from the examiner).
11. ORIENTATION
TEST: Give the exact date, and the name of the place where they are, including the city.
SCORE: One point for each correct answer. There are no points if they make a mistake.
TOTAL SCORE:
Add all accumulated points, adding one point if the patient has less than 12 years of formal education.
- Around 16: cognitive health of a patient with Alzheimer’s
- Around 22: Cognitive health of a person with mild cognitive impairment (MCI)
- Over 26: Normal
- 30: perfect score