| Question | Response | Incorrect Responses |
|---|---|---|
| 1. What are the date, month, and year? | ||
| 2. What is the day of the week? | ||
| 3. What is the name of this place? | ||
| 4. What is your phone number? | ||
| 5. How old are you? | ||
| 6. When were you born? | ||
| 7. Who is the current president? | ||
| 8. Who was the president before him? | ||
| 9. What was your mother's maiden name? | ||
| 10. Can you count backward from 20 by 3's? |
SCORING:*
0-2 errors: normal mental functioningCompiled by the Great Plains Area Chapter of the Alzheimer's Association, 1999.
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