Geriatric Assessment – Healthcare Professional Tool

Karnofsky Performance Status

Timed “Up and Go”

  

Cognition: Orientation-Memory-Concentration Test

1. What year is it now? [without looking at a calendar]
Patient’s Response
Maximum Errors
1
Score
Weight
x4
Final Score

2. What month is it now? [without looking at a calendar]
Patient’s Response
Maximum Errors
1
Score
Weight
x3
Final Score

Memory Phrase Repeat this phrase after me: ‘John Brown, 42 Market Street, Chicago.’

3. About what time is it? [within 1 hour – without looking at your watch]
Patient’s Response
  
Maximum Errors
1
Score
Weight
x3
Final Score

4. Count backwards from 20 to 1.

 
Maximum Errors
2
Score
Weight
x2
Final Score

5. Say the months in reverse order.

 
Maximum Errors
2
Score
Weight
x2
Final Score

6. Repeat the memory phrase.

 
Maximum Errors
5
Score
Weight
x2
Final Score


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