MMSE Attention and Calculation 3 — Questions and Answers
Question 1: The sequence 93 → 86 → 79 → 72 → 65 represents which MMSE task performed correctly?
- Serial 7 subtractions from 100 (Correct answer)
- Counting forward by 7s from 65
- Spelling 'WORLD' backward
- Recalling three words in sequence
Correct answer: Serial 7 subtractions from 100
This sequence shows five correct serial subtractions of 7 starting from 100, the standard MMSE attention task.
Question 2: A clinician notes that a patient's serial 7s performance may be confounded by poor arithmetic education. What is the MOST appropriate response?
- Administer the WORLD backward spelling alternative and note the substitution (Correct answer)
- Skip the attention section entirely
- Award full credit to avoid penalizing education level
- Repeat the task three times and average the scores
Correct answer: Administer the WORLD backward spelling alternative and note the substitution
The MMSE allows substituting 'WORLD' backward for serial 7s, and the examiner should document which task was used.
Question 3: Which response to the serial 7s task would earn a score of 0?
- The patient refuses to attempt the task (Correct answer)
- The patient correctly says 93 only
- The patient says 93 then makes an error
- The patient spells WORLD forward
Correct answer: The patient refuses to attempt the task
Refusing to attempt the task results in 0 points because no subtraction steps are completed or credited.
Question 4: What does a perfect score on the MMSE Attention and Calculation subsection indicate?
- The patient correctly performed all five serial 7 subtractions (Correct answer)
- The patient scored 30 out of 30 overall
- The patient has no cognitive impairment
- The patient accurately recalled all three memory words
Correct answer: The patient correctly performed all five serial 7 subtractions
A perfect subsection score of 5 means the patient correctly subtracted 7 five consecutive times starting from 100.
Question 5: A 78-year-old patient with an eighth-grade education scores 2/5 on serial 7s. Which interpretation is MOST appropriate?
- Limited education may contribute to the low score, and context must be considered (Correct answer)
- The score definitively indicates moderate dementia
- The score is invalid and should be discarded
- The patient should be retested immediately
Correct answer: Limited education may contribute to the low score, and context must be considered
Serial 7s performance is influenced by educational background, so low scores must be interpreted in the context of the patient's history.
Question 6: In the MMSE, the phrase 'beginning with 100, count backward by sevens' is an instruction for which task?
- Serial 7 subtractions (Correct answer)
- Days of the week backward
- Month naming in reverse
- Counting objects on a page
Correct answer: Serial 7 subtractions
This phrasing is the standardized instruction for the serial 7s task in the Attention and Calculation section of the MMSE.
Question 7: Which of the following patients would MOST likely score highest on the serial 7s MMSE task?
- A retired accountant with mild subjective memory concerns (Correct answer)
- A 90-year-old with a confirmed diagnosis of moderate Alzheimer's disease
- A patient with severe aphasia following a left hemisphere stroke
- A patient with profound intellectual disability
Correct answer: A retired accountant with mild subjective memory concerns
A retired accountant with extensive arithmetic practice and only mild subjective concerns is most likely to perform serial 7s accurately.
MMSE Attention and Calculation 3
The sequence 93 → 86 → 79 → 72 → 65 represents which MMSE task performed correctly?