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Blessed-Dementia
Information-Memory-Concentration Test |
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Activity
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INFORMATION
Name
Age
Time (hour)
Time of day
Day of week
Date
Month
Season
Year
Place: name
street
town
Type of place (for example, home, hospital, etc.)
Recognition of two persons (one point for each)
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____
____
____
____
____
____
____
____
____
____
____
____
____
____
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MEMORY
Personal
Date of birth
Place of birth
School attended
Occupation
Name of siblings/name of spouse
Name of any town where patient worked/lived
Name of employers
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____
____
____
____
____
____
____
____
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| Non-personal
Date of First World War (1/2 within 3 years)
Date of Second World War (1/2 if within 3 years)
Monarch
Prime Minister
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Five-minute recall (score 0-5 points)
Mr John Brown
42 West Street
Gateshead
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CONCENTRATION (all scored
0-1-2)
Months of year backwards
Counting 1-20
Counting 20-1
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TOTAL: |
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References
Blessed G, Tomlinson BE, Roth M. “The association
between quantitative measures of dementia and of senile change
in the cerebral grey matter of elderly subjects.
Br
J Psychiatry. 1968;114:797-811.
Stern Y, Hesdorffer D, Sano M, Mayeux R. “Measurement
and prediction of functional capacity in Alzheimer’s disease.
Neurology.
1990;40:8-14.
Zillmer EA, Fowler PC, Gutnick, HN, Becker E. “Comparison
of two cognitive bedside screening instruments in nursing
home residents: a factor analytic study.”
Journal
of Gerontology. 1990;45:69-74.
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