| Purpose:
To distinguish significant memory problems from the normal wear and tear of
normal ageing. Instructions:
Print this page. Let a friend or family member administer this test
or do it with a loved one. Score 1 point for each wrong answer and enter under errors. Keep in mind the
maximum number or errors for each question. Multiply the number of errors by the
given weight. Then add each score to come to the final score.
| Questions: |
Max. no. of errors |
Errors |
x by weight |
Score |
| 1. What is year is it now? |
1 |
|
x4 |
|
| 2. What month is it now? |
1 |
|
x3 |
|
| 3. Repeat this memory phrase after me and try to
remember it: “John Brown, 42 Market Street, Cape Town”. |
|
|
|
|
| 4. About what time is it now? (within 1 hour) |
1 |
|
x3 |
|
| 5. Count backwards from 20 to 1. |
2 |
|
x2 |
|
| 6. Say the months in reverse order. |
2 |
|
x2 |
|
| 7. Repeat the memory phrase again |
5 |
|
x2 |
|
| Total: |
|
|
|
|
Total score can range from 0 (no
mistakes) to 28 (all wrong). A score greater than 10 is usually
consistent with significant memory problems.
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