MMSE Visuoconstructional Skills 5 — Questions and Answers
Question 1: A patient scores 0 on the pentagon task but achieves 28/29 on all other MMSE items. Which additional test would BEST clarify the nature of the visuoconstructional deficit?
- Digit span forward
- Rey-Osterrieth Complex Figure Test (Correct answer)
- Boston Naming Test
- Verbal fluency category test
Correct answer: Rey-Osterrieth Complex Figure Test
The Rey-Osterrieth Complex Figure Test provides detailed analysis of visuoconstructional and visuospatial memory that far exceeds the single MMSE item.
Question 2: In what way does the MMSE pentagon task test 'construction' as opposed to purely 'perception'?
- It requires the patient to verbally describe the pentagons
- It requires physical reproduction of the figure, not just recognizing it (Correct answer)
- It asks the patient to count the sides of pre-drawn pentagons
- It measures how quickly the patient identifies the shape
Correct answer: It requires physical reproduction of the figure, not just recognizing it
Construction requires the patient to actively reproduce the figure using hand movements, integrating visual input with motor output rather than passively perceiving the image.
Question 3: Which scoring criterion is explicitly NOT required for the MMSE pentagon copy to receive full credit?
- Each figure must have five angles
- The figures must be approximately the same size as the model (Correct answer)
- The two figures must intersect
- The intersection region must form a four-sided shape
Correct answer: The figures must be approximately the same size as the model
Size matching is not a scoring criterion; only angle count (five per pentagon) and a four-sided intersection region are required for credit.
Question 4: A right-handed patient has a right hemisphere stroke. How would this most likely affect performance on the pentagon copy task?
- No effect, because language areas are in the left hemisphere
- Significant impairment, because the right hemisphere dominates visuospatial processing (Correct answer)
- Minor effect limited to speed of production
- Improved accuracy due to disinhibition of left hemisphere drawing
Correct answer: Significant impairment, because the right hemisphere dominates visuospatial processing
The right hemisphere is dominant for visuospatial and constructional abilities; right hemisphere stroke commonly causes severe difficulty with figure copying.
Question 5: Which of the following findings on the pentagon copy is an example of 'closing-in' phenomenon, associated with Alzheimer's disease?
- Drawing the copy far from the model on the page
- Drawing the copy directly on top of or immediately adjacent to the printed model (Correct answer)
- Refusing to attempt the copy after seeing the model
- Rotating the copy 180 degrees relative to the model
Correct answer: Drawing the copy directly on top of or immediately adjacent to the printed model
Closing-in is a recognized error pattern in Alzheimer's disease where patients draw their copy overlapping or immediately adjacent to the stimulus figure.
Question 6: The MMSE was originally published in 1975 by Folstein, Folstein, and McHugh. In their original validation, what was the purpose of including the pentagon copying item?
- To replace the more time-consuming Block Design subtest for bedside assessment
- To provide a brief bedside measure of visuoconstructional ability within a global cognitive screen (Correct answer)
- To diagnose apraxia specifically in stroke patients
- To measure processing speed as a marker of subcortical disease
Correct answer: To provide a brief bedside measure of visuoconstructional ability within a global cognitive screen
Folstein et al. included pentagon copying to briefly tap visuoconstructional skill as part of a rapid, clinician-administered bedside global cognitive screening tool.
Question 7: A geriatric patient fails the pentagon copy but passes all other MMSE items, yielding a score of 29/30. What MMSE score threshold is commonly used to suggest possible dementia in community-dwelling adults?
- 27 or below
- 25 or below
- 23 or below (Correct answer)
- 20 or below
Correct answer: 23 or below
A score of 23 or below on the MMSE is a widely cited threshold for possible cognitive impairment, though cutoffs vary by age and education level.
MMSE Visuoconstructional Skills 5
A patient scores 0 on the pentagon task but achieves 28/29 on all other MMSE items.
Which additional test would BEST clarify the nature of the visuoconstructional deficit?