1. Doctor’s Analysis of Mental State and Cognition
After the Rivermead & Folstein MMSE are done,
the doctor must analyze (think about) what is
wrong with the patient.
The form titled
Doctor’s Analysis of Mental State
and Cognition
is used to help you think about it.

2. Doctor’s Analysis of Mental State and Cognition
Class 1 Impairment (1% to 14% WPI)
Paroxysmal disorder with pre-impairment
Able to perform all ADLs
Slight, moderate, severe on Rivermead
Folstein usually normal (24-30)
The AMA Guides gives the doctor discretion from 1% to 14% to determine how many
problems the patient is having with cognition.

3. Doctor’s Analysis of Mental State & Cognition
Class 2 Impairment (15% to 29% WPI)
Requires direction with some ADLs
Loss of interest in current events
Inability to find his home or location
Wandering out of the house
Poor short term memory
Inability to balance checkbook
inability to calculate
Failure to follow through on instructions
Disorientation to time, person, & place
Can’t recall three unrelated words
Can’t spell world backward
Can copy pentagons
Can write a sentence
Needs assistance dressing and eating
has articulate speech
The AMA Guides gives this example
of a person with a 29% Impairment !

4. Doctor’s Analysis of Mental State & Cognition
I sure wish I had a form to do all this…
Download this form at:

5. Doctor’s Analysis of Mental State and Cognition
Hmmm…
What do I do?
You make the initial impairment rating.
Bill ($150 along with Folstein exam)
Get an MD (preferably a neurologist or
neuropsychiatrist) involved in the case.
Re-do this form at each re-exam
There MUST be a
Medical Doctor
to make the final
impairment rating.

6. Doctor’s Analysis of Mental State and Cognition
In Summary:
Look for symptoms of cognitive dysfunction on the Symptoms Form
Have patient fill out Rivermead & Folstein on the 2nd visit (your staff knows why)
Fill out the Doctor’s Analysis of Mental State & Cognition Form
Get an MD, neurologist, or neuropsych involved in the case
Have the MD make the final impairment rating (make sure they know how)

7. Doctor’s Analysis of Mental State and Cognition