MMSE Following a 3-Stage Command 2 — Questions and Answers
Question 1: In the MMSE 3-stage command, what does each successfully completed stage contribute to the total score?
- 3 points per stage
- 2 points per stage
- 1 point per stage (Correct answer)
- The stage score varies by examiner
Correct answer: 1 point per stage
Each stage of the 3-stage command is worth 1 point, for a maximum of 3 points total.
Question 2: A patient picks up the paper with both hands instead of one hand. How should this be scored?
- Full credit because the paper was picked up (Correct answer)
- Partial credit for attempting the stage
- No credit because the instruction was not followed precisely
- Credit depends on whether the examiner specified which hand
Correct answer: Full credit because the paper was picked up
The standard scoring gives credit for picking up the paper regardless of which hand is used, as the instruction simply says 'take the paper.'
Question 3: Which of the following best describes why the 3-stage command tests executive function in addition to comprehension?
- It requires the patient to read written text
- It requires planning, sequencing, and holding multiple steps in working memory (Correct answer)
- It tests long-term memory for procedures
- It measures visuospatial ability
Correct answer: It requires planning, sequencing, and holding multiple steps in working memory
Executing a multi-step command requires working memory to hold the sequence and frontal lobe executive function to plan and carry out each step in order.
Question 4: A patient folds the paper first and then picks it up. How should the examiner score this?
- Full credit, because all steps were completed
- No credit for the folding stage, since steps were out of order (Correct answer)
- Only the fold stage receives credit
- The entire task is scored zero for incorrect sequencing
Correct answer: No credit for the folding stage, since steps were out of order
The MMSE 3-stage command requires steps to be completed in the correct sequence; credit for the fold stage is not given if it precedes picking up the paper.
Question 5: Which cognitive domain is PRIMARILY assessed by the 3-stage command in the MMSE?
- Orientation to time and place
- Language comprehension and command execution (Correct answer)
- Visual construction
- Attention and calculation
Correct answer: Language comprehension and command execution
The 3-stage command specifically assesses language comprehension and the ability to follow multi-step verbal instructions.
Question 6: Why is the MMSE 3-stage command read aloud rather than shown as written text?
- To prevent the patient from re-reading the steps
- To test auditory comprehension and verbal command following (Correct answer)
- To reduce test administration time
- Written instructions would make the task too easy
Correct answer: To test auditory comprehension and verbal command following
Reading the command aloud tests auditory comprehension; a separate MMSE item (the written 'Close your eyes' command) tests reading comprehension.
Question 7: A patient with severe hearing loss cannot hear the 3-stage command. What is the best approach?
- Score the item zero automatically
- Write the command on paper and present it visually as an accommodation
- Repeat the command more loudly and score normally
- Skip the item and adjust the total score denominator (Correct answer)
Correct answer: Skip the item and adjust the total score denominator
When a sensory deficit prevents administration of an item, the item is typically omitted and the score is prorated over the remaining items rather than penalizing the patient.
MMSE Following a 3-Stage Command 2
In the MMSE 3-stage command, what does each successfully completed stage contribute to the total score?