OnExam

Report as score out of 30:

  • Normal Range: 24-30
  • Mild Cognitive Impairment: 20-23
  • Moderate Cognitive Impairment: 10-19
  • Severe Cognitive Impairment: 0-9
  • Orientation (10)

    • Patient scores one point for identifying the correct: year, season, month, day, and date
    • Patient scores one point for identifying each of the following: country, province, city, hospital, and floor

    Registration (3)

    • Ability to repeat 3 unrelated words: name 3 unrelated items to the patient (e.g., cup, phone, water). Patient scores one point for each word that they are able to recall on the first attempt.

    Attention (5)

    • Spelling “world” backwards or counting down from 100 by 7s or naming the months of the year backwards

    Recall (3)

    • Repeating the previous 3 unrelated words after a delay

    Language (9)

    • Naming objects (2): point to two common objects (e.g. pen and clock) and ask the patient to identify them
    • Repetition of simple phrases (1): ask patient to repeat “no ifs, ands, or buts”
    • 3-step commands (3): have patient follow a 3-step command: “Take this piece of paper with your right hand, fold it in half, and give it back to me”
    • Follow a written command (1): write a simple command on a piece of paper (e.g. touch your nose) and ask the patient to read it and follow the command
    • Writing full sentences (1): ask the patient to write out a full sentence. Keep the paper for future comparison
    • Drawing simple objects (1): ask the patient to copy a simple object that you have drawn

    References

    1. Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins: 2003.
    2. Lincoln, Matthew, McSheffrey eds. Essentials of Clinical Examination Handbook. 6th ed. Toronto, ON: University of Toronto Medical Society: 2010.