HINDI MENTAL STATE EXAMINATION

 (HMSE)
 
A Hindi Version of the MMSE 
Adapted for illiterate Hindi-speaking Populations
 
Developed by:
 
INDO-US CROSS NATIONAL  DEMENTIA  EPIDEMIOLOGY STUDY
 
A collaborative program of :
 
UNIVERSITY OF PITTSBURGH
School of Medicine, Department of Psychiatry
Graduate School of Public Health, Department of Epidemiology 
Pittsburgh, PA, USA
and
CENTRE FOR AGEING RESEARCH IN INDIA
New Delhi, India
                                                                                                                          
Supported by : Grant # AG09202, AG07562 and AG00312 from the National Institute on Aging, (National Institutes of Health, 
United States Department of Health and Human Services)
 
 
                                                             HINDI MENTAL STATE EXAMINATION (HMSE)
 
The HMSE is intended only to screen individuals and populations for cognitive impairment, and not for diagnostic purposes. 
Training in the administration, scoring, and interpretation of the HMSE should precede its use. Within these guidelines, the 
Indo-US Study places no further restrictions on the use of the HMSE. It is a modified version of the MMSE (Folstein, M.F., 
Folstein, S.E., and McHugh, P.R. Mini Mental State: A practical method for grading the cognitive state of the patients for the 
clinician. J. Psychiatric Research 12, 189-198, 1975.). The acknowledgement listed below should be cited in reports of 
technical and scientific projects using the HMSE.
 
Ganguli M, Ratcliff G, Chandra V, Sharma S, Gilby JE, Pandav R, Belle S, Ryan CM, Baker CR, Seaberg CR, and 
DeKosky ST. A Hindi version of the MMSE: the development of a cognitive screening instrument for a largely illiterate rural 
elderly population in India. International Journal of Geriatric Psychiatry, 10:367-377 (1995).
 
 
 

Correspondence to:

 

Dr. Mary Ganguli, MD MPH, 

Professor of Psychiatry and Epidemiology,

Division of Geriatrics and Neuropsychiatry

Department of Psychiatry,

University of Pittsburgh School of Medicine

 

230 McKee Place, Room 405,

Pittsburgh, PA 15213-2593, USA.

E-mail: gangulim@upmc.edu

Tel: + 412-383-9583

Fax:+ 412-647-6555

 
 
 
                                                             HINDI MENTAL STATE EXAMINATION (HMSE)
 
This test consists of 22 items, which test different components of intellectual capability.  The items cover several areas of 
cognitive functioning such as orientation to time and place, memory, attention and concentration, recognition of objects, 
language function, both comprehension and expressive speech, motor functioning and praxis.  It is relatively simple to 
administer and provides a quick, brief index of the subject's current level of functioning. It is a modified version of the MMSE 
(Folstein, M.F., Folstein, S.E., and McHugh, P.R. Mini Mental State: A practical method for grading the cognitive state of the 
patients for the clinician. J. Psychiatric Research 12, 189-198, 1975.)
 
Scores: 
 
1 =   Correct answer
0 =   Wrong answer       
 
 
Instructions:
 
Say: "Now I would like to ask you some questions to check your memory and concentration.  Some of them may be easy 
and some of them may be difficult."
 
Present the questions in the order listed.
 
1. "Is it morning or afternoon or evening?"
 
Clarifications:
 
If the subject says, "It is going to be afternoon soon," then ask him "What is it now?".
 
 
Give 1 point for correct part of the day.
 
 
2. “What day of the week is it today?”
 
Clarifications:
 
"Choose one day which you think it is.
 
If he says "second day of the week" ask:  "Yes, but what is the name of the day?"  Record only this second response.
 
Give 1 point for correct day.
 
 
3. “What date is it today?”
 
 Clarifications:  "Tell me one date which you think it is."  
 
Give 1 point for correct date. Dates from both the Hindi and the English calendars are acceptable.
 
 
4. “Which month is this?  You can tell me either the Hindi month or the English month.”
 
 Give 1 point for correct month.
 
 Months from both the Hindi and the English calendars are acceptable.
 
5. “What season of the year is this?”
 
Give 1 point for correct season.
 
 
Note: Items# 6 –10 measure orientation to place. These particular items were selected and tested because of their 
relevance to the rural Indian setting.
 
 
6. “Under which post office does this village, come?”
 
Give 1 point for correct post office.
 
Both sub-post office and main post office are acceptable.
 
 
7. “ Which district does this village fall under? ” 
 
Give 1 point for correct district.
 
 
8. “Which village is this? ”
 
Give 1 point for correct post office.
 
 
9. (Check before starting interview) If the village has only Blocks or both Blocks and numbered Areas 
    ask:  Which Block is this?
 
 If it has only numbered areas ask:  Which numbered area is this?
 
Give 1 point for correct block or numbered area.
 
10. “Which place/house is this? ”
 
If interview is being conducted anywhere but in a private house, ask: "Which place is this?"
 
 If interview is taking place in someone's home, ask: "Whose house is this?"
 
Give 1 point for correct place or house.
 
11. Registration of three objects
 
Say: "I went to Delhi and brought three things -  These are mango.....,chair..... and coin..... (The 3 words should be 
said in a clear steady tone with a gap of 2 seconds between each word).  Then ask:  "Can you tell me what are the 
three things I brought from Delhi?"
 
Then say:  "Remember the names of the three things I have brought from Delhi as I am going to ask you to 
name them after some time."
 
Score first try only.
 
 Give 1 point for each correct word, sequence does not matter.
 
 Plurals are acceptable (eg., mangoes, chairs and coins).
 
 No credit given for any other words, no matter how similar.
 
12a. Days of the week forwards
 
 Say: "Now can you tell me the names of the days of the week starting from Sunday?"
 
 
 1 = correct sequence (regardless of which attempt or if  with self-correction)
 
  2 = incorrect sequence even after 3 attempts
 
  (NOT INCLUDED IN HMSE TOTAL)
 
12b. Days of the week backwards
 
"Now can you tell me the names of these days backwards ”
  
Give 1 point for each correct response; total = 5.
 
Credit given only if the day precedes the day just named. If subject skips 1 or 2 days, then picks up the correct 
backwards sequence, he looses one point for the first error, then gets points for correct responses after that (eg., 
Sunday, Friday, Thursday:  Score: 0,1).  `Saturday' is given as an  example, it does not get credit.
 
13-15. Delayed recall of objects
 
Say: "What are the names of the three things which I told you I have brought from  Delhi?"  
 
Give 1 point for each correct word; total = 3
 
16. Ability to see watch and pen
 
Show the subject the wrist watch and pen and ask:  "Can you see these objects?”
 
If YES, items 17 & 18 should be completed if the subject is unable to see the objects, allow the subject to hold them.
 
If NO, items 17a & 18a apply
 
17. Identification of watch (Visual recognition)
 
 If the subject is ABLE to see the objects  -  Show him the wrist watch and say: 
 
"What is this?"
 
Give 1 point for correct identification.
 
17a. (If necessary) Identification of watch by touching
 
If the subject is UNABLE to see the objects -  Give the wrist watch to the subject and ask him to feel it and ask:
 
"What is this?"
 
Give 1 point for correct identification.
 
18. Identification of pen (Visual recognition)  If the subject is ABLE to see the objects then -  Show him the pen 
      and say: "What is this?"
 
Give 1 point for correct identification
 
18a. (If necessary) Identification of pen by touching
 
If the subject is UNABLE to see the objects then -  Give the pen to the subject and ask him to feel it and ask: "What is this?"
 
Give 1 point for correct identification.
 
19. Sentence repetition
 
Instruction:  "Now I am going to say something, listen carefully and repeat it exactly as I say it after I finish."
 
 Phrase:  "Neither this, nor that."  
 
Give 1 point if sentence correctly repeated.
 
Exact repetition is required, ie., same words and same word order, if extra words included, score = 0.
 
20. Follow Command
 
Say:  "Now I am going to ask you a different type of question.  Now look at my face and do exactly what I do."  Then close 
your eyes for 2 seconds and then open your eyes.  Watch the subject to see if he follows the action.  If he does it correctly 
then scores as correct response.  If after closing his eyes, he keeps them closed, ask him to open his eyes.
 
The assistant field worker should note if the subject shuts his/her eyes while the tester is demonstrating the task.  If you are 
convinced that the subject has poor vision then give the following instructions "Listen carefully and do exactly what I say – 
CLOSE YOUR EYES."
 
Give 1 point for closing eyes.
 
21. Three-step command (oral)
 
Take out a blank sheet of paper of medium size and give the following instructions consisting of three discrete actions to 
be carried out in a sequence.
 
 Say: "Now I am going to give you a piece of paper with which you have to do exactly what I ask you to do."
 
 "First, take the paper in your right hand, then with both your hands fold it into half once and then give the paper back to me”.
 
 If the subject's right hand is disabled; ask him to take the paper in his left hand.
 
Give 1 point if he takes paper in his right hand (or left, if right is disabled).
 
Give 1 point if folds it in half once (paper can be folded in any direction, ie., horizontally or diagonally).  
If folds paper more than once, score 0 for this step.
 
Give 1 point if puts he returns it.    Total points = 3.
 
 
22.  Sentence construction
 
This is a test of language function, i.e., the ability to express one self.  The task is to construct a sentence, consisting of at 
least a subject and a predicate and conveying some meaning. 
 
Tell the subject: "Now say a line about your house."
 
Make sure that you record either the spontaneous response, or whether a cue was given, and its corresponding response.  
Note: For credit to be given for a response after a cue, the respondent must say something specifically about his house.
 
The first complete sentence said by the subject is given credit.
 
If the subject says "What should I say?", the cue is given; the response then must be about the house to get credit.
 
CUE: If given, code = 1; if not given, code = 2.
(NOT INCLUDED IN HMSE TOTAL)
 
RESPONSE: if spontaneous and a complete sentence or if given after cue, was about the house and a complete
sentence, score = 1; otherwise score = 0.
 
23. Copy figure
 
This item tests the ability to visually construct by asking the subject to copy a figure.  The figure is a simple one, a diamond 
within a square.
 
First give the subject a pencil and eraser, then, present the answer sheet with the praxis figure at the top and an empty space 
for copying below.  Give the following instructions:  "Here is a drawing.  You must copy this drawing exactly as shown in the 
space provided here." (point to the blank space).
 
If the subject has severe visual difficulty or tremors of the hand, which interfere with his performance, these should be noted 
below the item, and will be considered later, during scoring.
 
Scoring Criteria for 1 point :
 
1.  Must draw two 4-sided figure 
2. One figure should be mostly inside the other.
3. Orientation of the figures should be obviously appropriate.
 
 
 
 
CALCULATION
 
This is a test of attention and concentration and requires the subject to do simple serial subtractions of 3 from 20.
 
 Ask the question as follows:
 
 "Now try to do some calculations."  "If a man has Rs 20/- for bus fare and every day he spends Rs 3/- on his bus fare,
 after spending the first day's bus fare, he will be left with Rs 17/-.  How much money will be left after next day's bus 
 fare? and next day's bus fare?.... and next day's bus fare....? and next day's bus fare?"
 
 If the subject initially gives a wrong response and then spontaneously corrects himself, note down the 2nd response.
 
 Even if there is an error in subtraction, the subject is not corrected or interrupted at any point during the test; record
 each subtracted number in the blank space provided on the response sheet.
 
At the end of the 5th subtraction, the subject is told "Okay, that is fine, you can stop now".
 
Give 1 point for each correct calculation.
 
Each calculation is treated independently, ie., if there is an error in the first calculation but not in the second, 
subject loses a point for the first, but gets a point for the second (eg., 20, 15, 12, 9: Score 0, 1, 1).   `17' is given in 
the example; it does not get credit.
 
 	

TOP

Hindi Version

Indo-US

Home

 

bullet Last Modified 09/15/03