| Question | Score 0 or 1 | |
| 1. | How old are you? | |
| 2. | What is the time (nearest hour)? | |
| 3. | Address for recall at the end of test – this should be repeated by the patient, e.g. 42 West Terrace | |
| 4. | What year is it? | |
| 5. | What is the name of this place? | |
| 6. | Can the patient recognise two relevant persons (e.g. nurse/doctor) | |
| 7. | What was the date of your birth? | |
| 8. | When was the second World War? | |
| 9. | Who is the present Prime Minister? | |
| 10. | Count down from 20 to 1 (no errors, no cues) | |
| TOTAL CORRECT | ||
Source: Hodkinson (1972) Evaluation of a mental test score for assessment of mental impairment in the elderly. Age and Ageing 1: 233–8. Reproduced with permission of Oxford University Press.