June 11, 2011

How to Cheat on the Mental Mini-Status Exam

Given that researchers plan to diagnose Alzheimer's Disease ten or twenty years earlier, no one is too young to practice cheating on the Mini Mental Status Exam .

Make sure all the answers are on your smart phone before your neurologist visit. 

If the examiner asks you not to look at your smart phone, offer to teach him how to use it so he won't have to waste so much time "remembering" Smirking casts doubt on your sincerity.

Mini-Mental Status Examination

The Mini-Mental Status Examination offers a quick and simple way to quantify cognitive function and screen for cognitive loss. It tests the individual’s orientation, attention, calculation, recall, language and motor skills.

Each section of the test involves a related series of questions or commands. The individual receives one point for each correct answer.To give the examination, seat the individual in a quiet, well-lit room. Ask him/her to listen carefully and to answer each question as accurately as he/she can.

Don’t time the test but score it right away. To score, add the number of correct responses. The individual can receive a maximum score of 30 points.

A score below 20 usually indicates cognitive impairment. ___

What is today’s date?
 What is the month? 
What is the year?
 What is the day of the week today? 
What season is it?

Whose home is this? 
What room is this? 
What city are we in? 
What county are we in? 
What state are we in?
Examiner: Confiscate all smart phones and ipods before administering this part of the  test. Be aware your patient will be hiding them.
Ask if you may test his/her memory. Then say “ball”, “flag”, “tree” clearly and slowly, about 1 second for each. After you have said all 3 words, ask him/her to repeat them – the first repetition determines the score (0-3):
 Examiner: Suspect surreptitious text messaging to oneself.
Ask the individual to begin with 100 and count backwards by 7. Stop after 5 subtractions. Score the correct subtractions. 
Patient: Make sure to teach your child to count backwards first so they can ace this exam.

Ask the individual to spell the word ”WORLD” backwards. The score is the number of letters in correct position.

Patient: Silly you, learning to spell forwards. No wonder there are so many people with dementia.

Ask the individual to recall the 3 words you previously asked him/her to remember.
Ball  Flag Tree 

Examiner: Suspect his mental acuity if he isn't consulting his cell phone.
Show the individual a wristwatch and ask him/her what it is. Repeat for pencil.

Examiner: Don't award any points if patient says the wristwatch was  a primitive cell phone and a pencil was a primitive ipad.

Ask the individual to repeat the following: “No if, ands, or buts”

Examiner:  "No if, ands, and buts, this is the stupidest test I have ever taken" still earns full credit.

Give the individual a plain piece of paper and say, “Take the paper in your hand, fold it in half, and put it on the floor.” 
Examiner: Duck the paper airplane headed toward your eyes.

Hold up the card reading: “Close your eyes” so the individual can see it clearly. Ask him/her to read it and do what it says. Score correctly only if the individual actually closes his/her eyes. 
Examiner: Disobedience is unmistakable proof of dementia.

Give the individual a piece of paper and ask him/her to write a sentence. It is to be written spontaneously. It must contain a subject and verb and be sensible.
Examiner: "You are a fucking idiot" is an eminently sensible sentence.  Control your emotions.

Give the individual a piece of paper and ask him/her to copy a design of two intersecting shapes. One point is awarded for correctly copying the shapes. All angles on both figures must be present, and the figures must have one overlapping angle.
Patient: The examiner is testing your motor skills. Informing him you still skateboard will not improve  your score.

Total Score:_____


NYC, 1974-1976, Nonsexist Childrearing in Action

My oldest daughter Emma belonged to a Chelsea Manhattan playgroup for two years, from 1974 to 1976. She was 17 months when it began, 3 and ready for nursery school when it disbanded. Playgroup met 5 mornings a week in the basement of the Y on West 23rd Street. Parents had the option of coming 1 to 5 mornings. Scheduling was a nightmare that I had naively accepted. I kept the minutes of playgroup, and I wrote a paper about it for a social work class in group dynamics 20 years later.

I thought you might be amused by parenting, Manhattan style, 1974. How earnest and how absurd we were in so many ways. But we were absolutely committed to allowing our kids to be free to be you and me.

Ranging in age from 28 to 40, we all lived in Chelsea and Greenwich Village. With one exception, our playgroup child was our first child. At 28, I was the youngest mother, but the only one from a large family. We all were college educated, with serious careers before we had children. There was an editor of psychiatric books, a writer, a teacher, an artist, an art therapist, two social workers, one vocational counselor, two psychology graduate students, and and a psychiatric nurse.

Most of us were struggling with our decision to stay home with our children. Confirmed apartment dwellers, we saw little relationship between mothering and housework. All of us planned to remain in Manhattan. Dreading winter cooped up with newly mobile, newly negative toddlers in one-bedroom or two-bedroom apartments, several mothers were contemplating returning to work to regain their sanity. Significantly, no one returned to work full-time during the life of the playgroup.

None of us had long-time friends who were staying at home to raise young children. We needed to build a new circle of friends; our friends from work no longer sufficed. We were not traditional wives and mothers. We desperately wanted intellectual colleagues fascinated with child development, determined to raise children without our own inhibitions and neuroses. All of us considered ourselves feminists, committed to nonsexist childrearing.

Playgroup was supposed to give us time off. The first year the ratio was one mother to two children; the second year it was one to three. Many mother who weren't on duty stayed anyway, particularly those with younger children. When we weren't playing with our toddlers, we engaged in ongoing group therapy. All of us had been or were currently in therapy and could talk comfortably and knowledgeably about conflict, repression, projection, and denial. We endlessly analyzed our marriages, our families, our psychological makeups, our childrearing philosophies, and our children's personalities.