MMSE Following a 3-Stage Command 3 — Questions and Answers
Question 1: In clinical practice, which neurological condition most classically impairs the 3-stage command due to motor programming deficits while leaving comprehension relatively intact?
- Broca's aphasia
- Apraxia (Correct answer)
- Wernicke's aphasia
- Anomia
Correct answer: Apraxia
Apraxia disrupts the motor programming needed to execute learned purposeful movements, causing command failure despite intact comprehension.
Question 2: The standard 3-stage command paper used in MMSE administration should be:
- A blank sheet of any size
- A pre-printed form with instructions
- A blank piece of paper provided by the examiner (Correct answer)
- A piece of paper the patient has brought
Correct answer: A blank piece of paper provided by the examiner
The examiner provides a blank piece of paper as a neutral prop for the task to ensure standardization.
Question 3: A patient completes the first two stages of the 3-stage command and then asks, 'What do I do next?' How should this be scored?
- Give credit for the two completed stages and prompt for the third
- Give credit for the two completed stages only, without prompting (Correct answer)
- Give no credit since the patient asked for help
- Repeat the entire command once and re-score from the beginning
Correct answer: Give credit for the two completed stages only, without prompting
Prompting is not allowed; the patient receives credit for stages independently completed, and the third stage scores zero if prompting was required.
Question 4: Which stage of the 3-stage command do patients with mild cognitive impairment most commonly fail first?
- Picking up the paper
- Folding it in half
- Placing it on the floor (Correct answer)
- All three stages fail simultaneously
Correct answer: Placing it on the floor
The final stage (placing the paper on the floor) is most often missed because working memory decay causes loss of the last instruction in a sequence.
Question 5: How does the 3-stage command differ from a 1-stage command in terms of cognitive demands?
- A 3-stage command adds visuospatial demands not present in 1-stage commands
- A 3-stage command additionally taxes working memory and executive sequencing (Correct answer)
- A 3-stage command tests hearing acuity while 1-stage tests reading
- There is no meaningful cognitive difference; only the number of actions differs
Correct answer: A 3-stage command additionally taxes working memory and executive sequencing
Multi-step commands require simultaneous retention of the full sequence in working memory and executive control to carry out steps in order.
Question 6: An examiner repeats the 3-stage command a second time after the patient fails. How does this affect scoring?
- The higher score across both attempts is recorded
- Only performance on the first administration is scored (Correct answer)
- The second attempt is scored if it occurs within 30 seconds
- Repetition is allowed once and the result is averaged
Correct answer: Only performance on the first administration is scored
Standardized MMSE administration allows only one presentation of the command; repetition invalidates the standardized score.
Question 7: What is the maximum score a patient can obtain on the 3-stage command item of the MMSE?
- 1
- 2
- 3 (Correct answer)
- 5
Correct answer: 3
The 3-stage command is worth a maximum of 3 points, one point for each successfully completed stage.
MMSE Following a 3-Stage Command 3
In clinical practice, which neurological condition most classically impairs the 3-stage command due to motor programming deficits while leaving comprehension relatively intact?