MMSE Attention and Calculation 4 — Questions and Answers
Question 1: When scoring WORLD spelled backward as 'DLROW', how does the examiner determine the score?
- One point per letter in the correct position (max 5) (Correct answer)
- One point for the entire word if completely correct
- Two points if at least half the letters are correct
- No points; only serial 7s count
Correct answer: One point per letter in the correct position (max 5)
Each letter of 'DLROW' in the correct position earns 1 point, giving a maximum of 5 points for a perfect reversal.
Question 2: A patient spells WORLD backward as 'DLRWO'. How many points do they earn?
- 3 (Correct answer)
- 5
- 2
- 0
Correct answer: 3
D, L, and R are in positions 1, 2, and 3 correctly (D=1, L=2, R=3), but W and O are transposed, so 3 points are earned.
Question 3: Which of the following BEST describes why the Attention and Calculation subsection is sensitive to early cognitive decline?
- It demands simultaneous holding and manipulation of information in working memory (Correct answer)
- It relies heavily on procedural memory stored in the cerebellum
- It primarily measures language comprehension via frontal lobe pathways
- It tests autobiographical memory consolidated during sleep
Correct answer: It demands simultaneous holding and manipulation of information in working memory
Working memory capacity—needed to track a running total while performing repeated subtraction—is one of the earliest cognitive abilities to decline.
Question 4: An examiner administers serial 7s and the patient stops after 93, saying they cannot continue. The score should be:
- 1 out of 5 (Correct answer)
- 0 out of 5
- 5 out of 5 because they started correctly
- 2 out of 5 as partial credit
Correct answer: 1 out of 5
One correct subtraction (100 − 7 = 93) earns 1 point; stopping after that step means no additional points are awarded.
Question 5: How does the serial 7s task specifically engage the prefrontal cortex?
- It requires executive control to inhibit irrelevant thoughts while maintaining a calculation sequence (Correct answer)
- It activates visual cortex regions needed to read numbers
- It engages Broca's area to produce verbal counting
- It stimulates hippocampal circuits for episodic memory encoding
Correct answer: It requires executive control to inhibit irrelevant thoughts while maintaining a calculation sequence
The prefrontal cortex mediates executive functions such as working memory maintenance and interference suppression, both demanded by serial 7s.
Question 6: A patient being assessed with the MMSE is deaf and cannot hear verbal instructions. Which adaptation is MOST appropriate for the Attention and Calculation section?
- Provide written instructions and allow the patient to write responses (Correct answer)
- Skip the section and record it as not administered
- Administer the task via sign language without documentation
- Award full credit automatically
Correct answer: Provide written instructions and allow the patient to write responses
Written instructions and responses preserve the integrity of the cognitive assessment while accommodating the patient's sensory limitation.
Question 7: Which score on the Attention and Calculation subsection of the MMSE is associated with possible cognitive impairment when considered alongside other subsection scores?
- 2 or below out of 5 (Correct answer)
- 4 or above out of 5
- Exactly 3 out of 5
- Any score below 5 out of 5
Correct answer: 2 or below out of 5
A score of 2 or below on this subsection often contributes to a total MMSE score below 24, which is a commonly used threshold for cognitive impairment.
MMSE Attention and Calculation 4
When scoring WORLD spelled backward as 'DLROW', how does the examiner determine the score?