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Title

Mini-Mental State Examination (MMSE)

CDISC ReferenceFunctional Test Supplement to the Study Data Tabulation Model Implementation Guide for Human Clinical Trials
QRS Short Name

MMSE

QRS Permission StatusApproved
TeamCDISC Questionnaires, Ratings, and Scales (QRS) Subteam
Supplement Version1.0
StatusDRAFT
Date2020-09-1417
NotesThis supplement is intended to be used with other CDISC User Guides for specific therapeutic/disease areas and follows the CDISC Study Data Tabulation Model Implementation Guide for Human Clinical Trials.


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Revision History

DateVersion
2020-09-14171.0 Draft

© 2020 Clinical Data Interchange Standards Consortium, Inc. All rights reserved. 

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Dataset wrap
Nameft


Dataset2


311MMS109Read This and Do What It SaysMMS110Write a SentenceMMS111Copy This Design00MMS112Total Score252525MMS113Level of Consciousness.20MMS104Attention and Calculation Subtotal21MMS105ARecall Word 1122MMS105BRecall Word 2123MMS105CRecall Word 3124MMS106ANaming Object 1.
RowSTUDYIDDOMAINUSUBJIDFTSEQFTTESTCDFTTESTFTCATFTSCATFTORRESFTSTRESCFTSTRESNFTSTATFTREASNDFTLOBXFLVISITNUMFTDTC
1STUDYXFT2324-P00011MMS101AMMS1-What Is the YearMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
2STUDYXFT2324-P00012MMS101BMMS1-What Is the SeasonMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
3STUDYXFT2324-P00013MMS101CMMS1-What Is the Month of YearMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
4STUDYXFT2324-P00014MMS101DMMS1-What Is the Day of WeekMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
5STUDYXFT2324-P00015MMS101EMMS1-What Is the DateMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
6STUDYXFT2324-P00016MMS102AMMS1-What Is the StateMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
7STUDYXFT2324-P00017MMS102BMMS1-What Is the CountyMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
8STUDYXFT2324-P00018MMS102CMMS1-What Is the City/TownMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
9STUDYXFT2324-P00019MMS102DMMS1-What Is the BuildingMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
10STUDYXFT2324-P000110MMS102EMMS1-What Is the FloorMMSEORIENTATION TO PLACECORRECT11

Y12015-05-15
11STUDYXFT2324-P000111MMS103AMMS1-Repeat Word 1MMSEREGISTRATIONCORRECT11

Y12015-05-15
12STUDYXFT2324-P000112MMS103BMMS1-Repeat Word 2MMSEREGISTRATIONCORRECT11

Y12015-05-15
13STUDYXFT2324-P000113MMS103CMMS1-Repeat Word 3MMSEREGISTRATIONCORRECT11

Y12015-05-15
14STUDYXFT2324-P000114MMS104AAMMS1-What is 100 Take Away 7MMSEATTENTION AND CALCULATIONCORRECT11

Y12015-05-15
15STUDYXFT2324-P000115MMS104ABMMS1-Keep Subtracting 7 Step 2MMSEATTENTION AND CALCULATIONCORRECT11

Y12015-05-15
16STUDYXFT2324-P000116MMS104ACMMS1-Keep Subtracting Step 3MMSEATTENTION AND CALCULATIONCORRECT11

Y12015-05-15
17STUDYXFT2324-P000117MMS104ADMMS1-Keep Subtracting Step 4MMSEATTENTION AND CALCULATIONINCORRECT00

Y12015-05-15
18STUDYXFT2324-P000118MMS104AEMMS1-Keep Subtracting Step 5MMSEATTENTION AND CALCULATIONINCORRECT00

Y12015-05-15
19STUDYXFT2324-P000119MMS104MMS104BAMMS1-Attention and Calculation SubtotalSpell Backward Letter 1MMSEATTENTION AND CALCULATION33


NOT DONELOGICALLY SKIPPED ITEMY12015-05-15
20STUDYXFT2324-P000120MMS105AMMS104BBMMS1-Recall Word 1Spell Backward Letter 2MMSERECALLCORRECT1ATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMY12015-05-15
21STUDYXFT2324-P000121MMS105BMMS104BCMMS1-Recall Word 2Spell Backward Letter 3MMSERECALLCORRECT11ATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMY12015-05-15
22STUDYXFT2324-P000122MMS105CMMS104BDMMS1-Recall Word 3Spell Backward Letter 4MMSERECALLCORRECT1ATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMY12015-05-15
23STUDYXFT2324-P000123MMS106AMMS104BEMMS1-Naming Object 1Spell Backward Letter 5MMSENAMINGCORRECT11ATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMY12015-05-15
24STUDYXFT2324-P000124MMS106BMMS104MMS1-Naming Object 2Attention and Calculation SubtotalMMSENAMINGATTENTION AND CALCULATIONINCORRECT30303

Y12015-05-15
25STUDYXFT2324-P000125MMS107MMS105AMMS1-Repeat What I SayRecall Word 1MMSEREPETITIONRECALLCORRECT11

Y12015-05-15
26STUDYXFT2324-P000126MMS108AMMS105BMMS1-Take in Right HandRecall Word 2MMSECOMPREHENSIONRECALLCORRECT11

Y12015-05-15
27STUDYXFT2324-P000127MMS108BMMS105CMMS1-Fold in HalfRecall Word 3MMSECOMPREHENSIONRECALLCORRECT11

Y12015-05-15
28STUDYXFT2324-P000128MMS108CMMS106AMMS1-Put on Floor (or Table)Naming Object 1MMSECOMPREHENSIONNAMINGCORRECT11

Y12015-05-15
29STUDYXFT2324-P000129MMS106BMMS1-Naming Object 2MMSEREADINGNAMINGINCORRECT00

Y12015-05-15
30STUDYXFT2324-P000130MMS107MMS1-Repeat What I SayMMSEWRITINGREPETITIONCORRECT11

Y12015-05-15
31STUDYXFT2324-P000131MMS108AMMS1-Take in Right HandMMSEDRAWINGCOMPREHENSIONINCORRECTCORRECT11

Y12015-05-15
32STUDYXFT2324-P000132MMS108BMMS1-Fold in HalfMMSECOMPREHENSIONCORRECT11

Y12015-05-15
33STUDYXFT2324-P000133MMS108CMMS1-Put on Floor (or Table)MMSECOMPREHENSIONAlert/ResponsiveAlert/ResponsiveCORRECT11

Y12015-05-15
34STUDYXFT2324-P0002P0001134MMS101AMMS109MMS1-What Is the YearRead This and Do What It SaysMMSEORIENTATION TO TIMEREADINGCORRECTINCORRECT1010

Y12015-05-15
35STUDYXFT2324-P0002P0001235MMS101BMMS110MMS1-What Is the SeasonWrite a SentenceMMSEORIENTATION TO TIMEWRITINGCORRECT11

Y12015-05-15
36STUDYXFT2324-P0002P0001336MMS101CMMS111MMS1-What Is the Month of YearCopy This DesignMMSEORIENTATION TO TIMEDRAWINGCORRECTINCORRECT1010

Y12015-05-15
37STUDYXFT2324-P0002P0001437MMS101CMMS112MMS1-What Is the Month of YearTotal ScoreMMSE
ORIENTATION TO TIME25CORRECT251251

Y12015-05-15
38STUDYXFT2324-P0002P0001538MMS101DMMS113MMS1-What Is the Day of WeekLevel of ConsciousnessMMSEORIENTATION TO TIMECORRECT11
Alert/ResponsiveAlert/Responsive.

Y12015-05-15
39STUDYXFT2324-P000261MMS101EMMS101AMMS1-What Is the DateYearMMSEORIENTATION TO TIMECORRECT11

Y12015-05-15
40STUDYXFT2324-P000272MMS102AMMS101BMMS1-What Is the StateSeasonMMSEORIENTATION TO PLACETIMECORRECT11

Y12015-05-15
41STUDYXFT2324-P000283MMS102BMMS101CMMS1-What Is the CountyMonth of YearMMSEORIENTATION TO PLACETIMECORRECT11

Y12015-05-15
42STUDYXFT2324-P000294MMS102CMMS101CMMS1-What Is the City/TownMonth of YearMMSEORIENTATION TO PLACETIMECORRECT11

Y12015-05-15
43STUDYXFT2324-P0002105MMS102DMMS101DMMS1-What Is the BuildingDay of WeekMMSEORIENTATION TO PLACETIMECORRECT11

Y12015-05-15
44STUDYXFT2324-P0002116MMS102EMMS101EMMS1-What Is the FloorDateMMSEORIENTATION TO PLACETIMECORRECT11

Y12015-05-15
45STUDYXFT2324-P0002127MMS103AMMS102AMMS1-Repeat Word 1What Is the StateMMSEREGISTRATIONORIENTATION TO PLACECORRECT11

Y12015-05-15
46STUDYXFT2324-P0002138MMS103BMMS102BMMS1-Repeat Word 2What Is the CountyMMSEREGISTRATIONORIENTATION TO PLACECORRECT11

Y12015-05-15
47STUDYXFT2324-P0002149MMS103CMMS102CMMS1-Repeat Word 3What Is the City/TownMMSEREGISTRATIONORIENTATION TO PLACECORRECT11

Y12015-05-15
48STUDYXFT2324-P00021510MMS104BAMMS102DMMS1-Spell Backward Letter 1What Is the BuildingMMSEATTENTION AND CALCULATIONORIENTATION TO PLACECORRECT11

Y12015-05-15
49STUDYXFT2324-P00021611MMS104BBMMS102EMMS1-Spell Backward Letter 2What Is the FloorMMSEATTENTION AND CALCULATIONORIENTATION TO PLACECORRECT11

Y12015-05-15
50STUDYXFT2324-P00021712MMS104BCMMS103AMMS1-Spell Backward Letter 3Repeat Word 1MMSEATTENTION AND CALCULATIONREGISTRATIONINCORRECTCORRECT0101

Y12015-05-15
51STUDYXFT2324-P00021813MMS104BDMMS103BMMS1-Spell Backward Letter 4Repeat Word 2MMSEATTENTION AND CALCULATIONREGISTRATIONINCORRECTCORRECT0101

Y12015-05-15
52STUDYXFT2324-P00021914MMS104BEMMS103CMMS1-Spell Backward Letter 5Repeat Word 3MMSEATTENTION AND CALCULATIONREGISTRATIONCORRECT11

Y12015-05-15
53STUDYXFT2324-P000215MMS104AAMMS1-What is 100 Take Away 7MMSEATTENTION AND CALCULATION333


NOT DONELOGICALLY SKIPPED ITEMY12015-05-15
54STUDYXFT2324-P000216MMS104ABMMS1-Keep Subtracting 7 Step 2MMSERECALLCORRECT1ATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMY12015-05-15
55STUDYXFT2324-P000217MMS104ACMMS1-Keep Subtracting Step 3MMSERECALLCORRECT1ATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMY12015-05-15
56STUDYXFT2324-P000218MMS104ADMMS1-Keep Subtracting Step 4MMSERECALLCORRECT1ATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMY12015-05-15
57STUDYXFT2324-P000219MMS104AEMMS1-Keep Subtracting Step 5MMSENAMINGCORRECT11ATTENTION AND CALCULATION


NOT DONELOGICALLY SKIPPED ITEMY12015-05-15
58STUDYXFT2324-P00022520MMS106BMMS104BAMMS1-Naming Object 2Spell Backward Letter 1MMSENAMINGATTENTION AND CALCULATIONINCORRECTCORRECT0101

Y12015-05-15
59STUDYXFT2324-P00022621MMS107MMS104BBMMS1-Repeat What I SaySpell Backward Letter 2MMSEREPETITIONATTENTION AND CALCULATIONCORRECT11

Y12015-05-15
60STUDYXFT2324-P00022722MMS108AMMS104BCMMS1-Take in Right HandSpell Backward Letter 3MMSECOMPREHENSIONATTENTION AND CALCULATIONCORRECTINCORRECT1010

Y12015-05-15
61STUDYXFT2324-P00022823MMS108BMMS104BDMMS1-Fold in HalfSpell Backward Letter 4MMSECOMPREHENSIONATTENTION AND CALCULATIONCORRECTINCORRECT1010

Y12015-05-15
62STUDYXFT2324-P00022924MMS108CMMS104BEMMS1-Put on Floor (or Table)Spell Backward Letter 5MMSECOMPREHENSIONATTENTION AND CALCULATIONCORRECT11

Y12015-05-15
63STUDYXFT2324-P00023025MMS109MMS104MMS1-Read This and Do What It SaysAttention and Calculation SubtotalMMSEREADINGATTENTION AND CALCULATIONINCORRECT30303

Y12015-05-15
64STUDYXFT2324-P00023126MMS110MMS105AMMS1-Write a SentenceRecall Word 1MMSEWRITINGRECALLCORRECT11

Y12015-05-15
65STUDYXFT2324-P00023227MMS111MMS105BMMS1-Copy This DesignRecall Word 2MMSEDRAWINGRECALLINCORRECTCORRECT0101

Y12015-05-15
66STUDYXFT2324-P00023328MMS112MMS105CMMS1-Total ScoreRecall Word 3MMSERECALLCORRECT26261261

Y12015-05-15
67STUDYXFT2324-P00023429MMS113MMS106AMMS1-Level of ConsciousnessMMSEDrowsyDrowsyNaming Object 1MMSENAMINGCORRECT11

Y12015-05-15
68STUDYXFT2324-P000230MMS106BMMS1-Naming Object 2MMSENAMINGINCORRECT00

Y12015-05-15
69STUDYXFT2324-P000231MMS107MMS1-Repeat What I SayMMSEREPETITIONCORRECT11

Y12015-05-15
70STUDYXFT2324-P000232MMS108AMMS1-Take in Right HandMMSECOMPREHENSIONCORRECT11

Y12015-05-15
71STUDYXFT2324-P000233MMS108BMMS1-Fold in HalfMMSECOMPREHENSIONCORRECT11

Y12015-05-15
72STUDYXFT2324-P000234MMS108CMMS1-Put on Floor (or Table)MMSECOMPREHENSIONCORRECT11

Y12015-05-15
73STUDYXFT2324-P000235MMS109MMS1-Read This and Do What It SaysMMSEREADINGINCORRECT00

Y12015-05-15
74STUDYXFT2324-P000236MMS110MMS1-Write a SentenceMMSEWRITINGCORRECT11

Y12015-05-15
75STUDYXFT2324-P000237MMS111MMS1-Copy This DesignMMSEDRAWINGINCORRECT00

Y12015-05-15
76STUDYXFT2324-P000238MMS112MMS1-Total ScoreMMSE
262626

Y12015-05-15
77STUDYXFT2324-P000239MMS113MMS1-Level of ConsciousnessMMSE
DrowsyDrowsy.

Y12015-05-15
78STUDYXFT2324-P00031MMS101AMMS1-What Is the YearMMSEORIENTATION TO TIME


NOT DONE
Y12015-05-15
79STUDYXFT2324-P00032MMS101BMMS1-What Is the SeasonMMSEORIENTATION TO TIME


NOT DONE
Y12015-05-15
80STUDYXFT2324-P00033MMS101CMMS1-What Is the Month of YearMMSEORIENTATION TO TIME


NOT DONE
Y12015-05-15
81STUDYXFT2324-P00034MMS101DMMS1-What Is the Day of WeekMMSEORIENTATION TO TIME


NOT DONE
Y12015-05-15
82STUDYXFT2324-P00035MMS101EMMS1-What Is the DateMMSEORIENTATION TO TIME


NOT DONE
Y12015-05-15
6883STUDYXFT2324-P0001P000316MMS101AMMS102AMMS1-What Is the YearStateMMSEORIENTATION TO TIMEPLACE


NOT DONE
Y12015-05-15
6984STUDYXFT2324-P0001P000327MMS101BMMS102BMMS1-What Is the SeasonCountyMMSEORIENTATION TO TIMEPLACE


NOT DONE
Y12015-05-15
7085STUDYXFT2324-P0001P000338MMS101CMMS102CMMS1-What Is the Month of YearCity/TownMMSEORIENTATION TO TIMEPLACE


NOT DONE
Y12015-05-15
7186STUDYXFT2324-P0001P000349MMS101DMMS102DMMS1-What Is the Day of WeekBuildingMMSEORIENTATION TO TIMEPLACE


NOT DONE
Y12015-05-15
7287STUDYXFT2324-P0001P0003510MMS101EMMS102EMMS1-What Is the DateFloorMMSEORIENTATION TO TIMEPLACE


NOT DONE
Y12015-05-15
7388STUDYXFT2324-P0001P0003611MMS102AMMS103AMMS1-What Is the StateRepeat Word 1MMSEORIENTATION TO PLACEREGISTRATION


NOT DONE
Y12015-05-15
7489STUDYXFT2324-P0001P0003712MMS102BMMS103BMMS1-What Is the CountyRepeat Word 2MMSEORIENTATION TO PLACEREGISTRATION


NOT DONE
Y12015-05-15
7590STUDYXFT2324-P0001P0003813MMS102CMMS103CMMS1-What Is the City/TownRepeat Word 3MMSEORIENTATION TO PLACEREGISTRATION


NOT DONE
Y12015-05-15
7691STUDYXFT2324-P0001P0003914MMS102DMMS104AAMMS1-What Is the Buildingis 100 Take Away 7MMSEORIENTATION TO PLACEATTENTION AND CALCULATION


NOT DONE
Y12015-05-15
7792STUDYXFT2324-P0001P00031015MMS102EMMS104ABMMS1-What Is the FloorKeep Subtracting 7 Step 2MMSEORIENTATION TO PLACEATTENTION AND CALCULATION


NOT DONE
Y12015-05-15
7893STUDYXFT2324-P0001P00031116MMS103AMMS104ACMMS1-Repeat Word 1Keep Subtracting Step 3MMSEREGISTRATIONATTENTION AND CALCULATION


NOT DONE
Y12015-05-15
7994STUDYXFT2324-P0001P00031217MMS103BMMS104ADMMS1-Repeat Word 2Keep Subtracting Step 4MMSEREGISTRATIONATTENTION AND CALCULATION


NOT DONE
Y12015-05-15
8095STUDYXFT2324-P0001P00031318MMS103CMMS104AEMMS1-Repeat Word 3Keep Subtracting Step 5MMSEREGISTRATIONATTENTION AND CALCULATION


NOT DONE
Y12015-05-15
8196STUDYXFT2324-P0001P00031419MMS104AAMMS104BAMMS1-What is 100 Take Away 7Spell Backward Letter 1MMSEATTENTION AND CALCULATION


NOT DONE
Y12015-05-15
8297STUDYXFT2324-P0001P00031520MMS104ABMMS104BBMMS1-Keep Subtracting 7 Step Spell Backward Letter 2MMSEATTENTION AND CALCULATION


NOT DONE
Y12015-05-15
8398STUDYXFT2324-P0001P00031621MMS104ACMMS104BCMMS1-Keep Subtracting Step Spell Backward Letter 3MMSEATTENTION AND CALCULATION


NOT DONE
Y12015-05-15
8499STUDYXFT2324-P0001P00031722MMS104ADMMS104BDMMS1-Keep Subtracting Step Spell Backward Letter 4MMSEATTENTION AND CALCULATION


NOT DONE
Y12015-05-15
85100STUDYXFT2324-P0001P00031823MMS104AEMMS104BEMMS1-Keep Subtracting Step Spell Backward Letter 5MMSEATTENTION AND CALCULATION


NOT DONE
Y12015-05-15
86101STUDYXFT2324-P0001P00031924MMS104MMS1-Attention and Calculation SubtotalMMSEATTENTION AND CALCULATION


NOT DONE
Y12015-05-15
87102STUDYXFT2324-P0001P00032025MMS105AMMS1-Recall Word 1MMSERECALL


NOT DONE
Y12015-05-15
88103STUDYXFT2324-P0001P00032126MMS105BMMS1-Recall Word 2MMSERECALL


NOT DONE
Y12015-05-15
89104STUDYXFT2324-P0001P00032227MMS105CMMS1-Recall Word 3MMSERECALL


NOT DONE
Y12015-05-15
90105STUDYXFT2324-P0001P00032328MMS106AMMS1-Naming Object 1MMSENAMING


NOT DONE
Y12015-05-15
91106STUDYXFT2324-P0001P00032429MMS106BMMS1-Naming Object 2MMSENAMING


NOT DONE
Y12015-05-15
92107STUDYXFT2324-P0001P00032530MMS107MMS1-Repeat What I SayMMSEREPETITION


NOT DONE
Y12015-05-15
93108STUDYXFT2324-P0001P00032631MMS108AMMS1-Take in Right HandMMSECOMPREHENSION


NOT DONE
Y12015-05-15
94109STUDYXFT2324-P0001P00032732MMS108BMMS1-Fold in HalfMMSECOMPREHENSION


NOT DONE
Y12015-05-15
95110STUDYXFT2324-P0001P00032833MMS108CMMS1-Put on Floor (or Table)MMSECOMPREHENSION


NOT DONE
Y12015-05-15
96111STUDYXFT2324-P0001P00032934MMS109MMS1-Read This and Do What It SaysMMSEREADING


NOT DONE
Y12015-05-15
97112STUDYXFT2324-P0001P00033035MMS110MMS1-Write a SentenceMMSEWRITING


NOT DONE
Y12015-05-15
98113STUDYXFT2324-P0001P00033136MMS111MMS1-Copy This DesignMMSEDRAWING


NOT DONE
Y12015-05-15
99114STUDYXFT2324-P0001P00033237MMS112MMS1-Total ScoreMMSE



NOT DONE
Y12015-05-15
100115STUDYXFT2324-P0001P00033338MMS113MMS1-Level of ConsciousnessMMSE



NOT DONE
Y12015-05-15



...