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:_____

DISCLAIMER: ANYTHING WRITTEN  IN BOLDFACE IS NOT PART OF THE TEST. ANYTHING NOT WRITTEN IN BOLDFACE IS THE ACTUAL TEST.  

Confessions of Misogyny

5/22. Eight years later I need to edit this, but nothing has changed f fundamentally. After my longest attempt to work with a women therapist, I realize I do much better with a male therapist.  She seems to be turning nto my mother. My four daughters would assure you that I am one of the worst misogynists they know. Having 5 younger brother was the most formative experience of my life. Until I became a mother at age 28, I would always join the circle of men, never the circle of women. I was positive the conversation would be more stimulating. I despise women's fashion magazines and all the talk of diets, hair, shoes, and makeup. Being forced to watch Sex and the City would be cruel and unusual punishment.

Spending a year in a Catholic girls college in Rochester was an alienating experience. My dad, my brothers, and I  were sarcastic and no one seemed to realize I didn't  mean it. One night my friends and I stayed up all night, discussing politics, sex, religion, life, death, etc. The rumor rapidly spread that we were gossiping about everyone on the floor. Learning from the college dean that "there was something in the nature of a woman that unsuits her for intellectual debate with men" elicited my jail break to being the only girl in the political science classes at Fordham. I talked them into admitting me as a sophmore the year they first admitted women as freshman. I was the first woman the Jesuits had taught.

I dropped out of Columbia Law School before I suffered permanent brain damage. Working in the female-dominated fields of public librarianship and social work was not a wise decision. I never can accept "that is the way it is" and "you can't do anything about it." I was perceived as a trouble maker. Being open about my manic depression doomed me.  When I am upset, I defend myself by getting more ascerbic and intellectual.  As my brothers 18 years younger observed, "you need crying lessons." But crying was tolerated in my home. I perceive that men enjoy gutsy women who giggle, smile, tease, humorously insult, and debate them  lots more than women do. I never flirt. I am alwalys the big sister.  Until last year, I have always gone to male shrinks.

My most successful social work job was working with a great group of seriously mentally ill guys who were absolutely trapped in the system. Some had been in jail; most had substance abuse problems. I never was so appreciated by a group of people in my whole life. They were  wonderful to hang out with. I excel at eliciting the sanity in crazy people and the craziness in apparently sane people. Undoubtedly I would have been better off working in a jail.

I also did extremely well with male gay clients. One told me I must have been a gay male in a previous lifetime I understand him so well. Another paid me the greatest compliment I got as a shrink: he said I was his only experience of unconditional love. We had a strong therapeutic relationship. Until I treated him, an Irishmen from an utterly abusive family, I never realized how Irish I was.

I have never been hassled on the street by a guy in my entire life. I do have a promiscuous smile. I am perfectly comfortable being the only women in a subway car full of men. African American men and immigrants tend to find older, curvier women attractive, which is lovely fun. In the early days of women's lib, women whined incessantly about street hassles. I wondered if I was the ugliest woman in the entire women's liberation movement. I often have long conversations with homeless men. One street person teased me that I was warm, friendly, approachable, happy to talk, sometimes generous depending upon whether I had exceeded my day's handout limit. " But I know you would turn me to stone if I messed with you." I've never had to attempt it. I project a big sister vibe.

1st Child, 2nd Child

This is from a graduate school paper on child development I wrote in 1977, when Anne was 4 and Michelle was 2. Michelle is younger in this photo.

I am still realizing to what extent the mother I am is shaped by the child I am mothering. When I had only one child, I congratulated myself for all of Anne's superior qualities and blamed myself for her troublesome ones. Since I've had 2 children, I've become remarkably more tolerant of other mothers and of myself. I've also grown to understand why my my mom, after mothering 6 kids, has always been quite skeptical of childrearing theories.

Since I belong to a unique Chelsea community where young parents support each other through babysitting cooperatives, cooperative playgroups and nursery schools, and mothers' support groups, I've had the chance to observe many children of similar ages interact with their parents. When I first moved here when Anne was 17 months, I was quick to correlate the children's characteristics with their parents' childrearing practices. Now I am humbly aware of how infinitely complex the whole question is.

The only dramatic change in our lives beween Anne's and Michelle's births was our move to Chelsea from the Upper West Side. We still lived on a high floor in an apartment with a terrace and spectacular views. Although I was still at home full-time and their dad was gone from 8 to 6, their day-to-day routine was completely different. When Anne was born, none of my NYC friends had children; consequently no one I knew was home during the day. To relieve my isolation, I frequently visited my parents and my husband's parents on Long Island. As a result, Anne had frequent contact with her grandparents and her teenage aunts and uncles, but very little contact with other babies and toddlers.

When Michelle was born, I was immersed in Anne's playgroup, with daily contact with 10 familes and their 2-year-olds. Monday to Friday Michelle was constantly exposed to the stimulation-bedlam of young kids. In fact playing with baby Michelle was playgroup's surefire activity when all else failed. On the other hand, I seldom visited Long Island; our parents and sibs came to visit us. Michelle's comings and goings are always tied to Anne's schedules.

In addition to having different daily routines, they had a different mother. After Anne's birth, I still did some free-lance editing. I kept wrestling with combining motherhood with my editing career. I almost accepted a 20-hour a week editing job when Anne was 9 months. By the time Michelle was born, I had wholeheartedly renounced publishing and was fully committed to full-time motherhood when my children were small. I had chosen working with young children and their parents as my future career. My expectations for myself and my baby had been transformed by what I experienced and by how I had grown during Anne's infancy. I was far freer to respond to my emotions and intuitions about Michelle. I had gained confidence in my own style of mothering and was no longer so swayed by "expert" opinion or my prior expectations of what kind of mother I should be. I was much more relaxed about introducing solids, long-term nursing, the family bed.

Michelle's relationship with me was hardly as symbiotic as my relationship with Anne during infancy. Anne was as much as part of Michelle's life as my husband and I were. Unless Anne was asleep, she was almost always in the same room when I nursed or played with Michelle. As soon as Michelle could reliably sit up, we bathed them together. Since Michelle was 8 months old, they've amicably shared the same room. I successfully diminished Anne's jealousy by involving her in every way possible in Michelle's care. I always read to Anne when I was nursing Michelle, since she hated playing in her bedroom by herself.

The result? Michelle's social skills seem far more sophisticated than Anne's were at 2. Sometimes she stays at Anne's cooperative nursery school when I am the helping mommy. She knows all the children's names, interacts warmly with them, participates fully in painting, block building, clay, water play, and dress up. She manages surprisingly well at meeting time and story time. She needs to establish eye contact with me fairly often, but she leaves me free to interact with the other children. At home she holds her own with her high-powered sister very well. As I observe her avoiding no-win confrontations with Anne, I try to imitate her skillful mixture of unmistakable self-assertion and judicious compromise. As Michelle chortles, "even Anne loves me."

Join the Revolution for a Family-Friendly US

Are children, elders, families in general, the poor better off than they were in 1968, at the start of the Second Wave of Feminism?  Are you outraged  with a society where 2 month olds are cared for by strangers for 10 hours a day  because there is no genuine paternity and maternity leave? Are you outraged that  childhood bipolar disorder has only been discovered in the United States? Are you outraged that 2 year olds and 3 years olds are pushed into early academics, that 5 year olds are perceived as backward if they can't read before leaving kindergarten? Are you outraged that teaching for the standardized tests is replacing art, music, recess and gym? Are you  outraged that our four year olds are taking  dangerous anti-psychotics not proven safe for chronic schizophrenics? Are you outraged  that poor immigration women are exploited as nannies and home health aides? A nonviolent revolution as sweeping as the civil rights movement is required to make the US a child-friendly, family-friendly, elder-friendly, human -friendly society. Join me.

When I was an active young feminist in the late 60s and early 70s, the upper middle class nature of New  York feminism was profoundly disturbing. Only a tiny minority of women could afford to become doctors, lawyers, college professors, corporate executives. The needs of  women of color  were ignored. African American women had always worked and taken care of their children. They were more dubious about abortion, since the babies were more welcomed and taken care of by family members.

Unlike many women with my intellect and education, I stayed home with my four children full-time for 15 years and part-time until the youngest was in high school. I also care for my mother in my home 24/7  during the last four years of my life.  Both my husbands made career and financial sacrifices to make that possible.

Women's Issues Are Family Issues

The recurring reference to women's issues in the media needs to be clarified. Most of these are better described as family and caregiver issues. However, vitally important women's issues exist. These include the availability of abortions and the morning after pill, the scandalous C-section rate, and the obscene harassment of nursing mothers. Too many companies expect breastfeeding mothers to pump in filthy toilets for 20 minutes and refuse to provide a comfortable room for them to pump and adequate short-time storage for breastmilk.This is a health issue as well since the American Academy of Pediatris recommends breastfeeding for at least a year. Working mothers of infants are heroic, incredibly dedicated to making sure their babies only get breastmilk and not formula. Encouraging, supporting, and facilitating breastfeeding is an integral part of wellness and prevention.

The best way to reduce the C-section rate is to to use nurse- midwives for normal births, but obstetricians fiercely resist giving nurse-midwives hospital privileges. At this point in New York City, the first question after how big is the baby is did you have a C-Section? It appalls me that the most educated professional women in history are allowing that to happen to them. When I was pregnant with my first child 35 years ago, baby books advised not considering a doctor with a C-section rate higher than 5 percent. Obviously the human race would have died out long ago if a 30 to 40 percent C-secton ate was the norm. I crusaded for natural childbirth and had my two youngest daughters at home with a nurse midwife.