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An Informal Mental State Exam can help record strengths and areas of concern in Alzheimer's

Posted Oct 10 2009 7:57am
In your role as a caregiver, companion and observer you may want to utilize from time to time a standardized method of evaluation. Although the Mini Mental State Exam and its scoring guidelines are useful, the MMSE shouldn't be used independently to make a diagnosis. Only trained clinicians -- such as physicians, nurses, and psychologists -- should give and score the MMSE.  A diagnosis of Alzheimer's can only be made after a complete diagnostic workup rules out any other possible cause for the person's symptoms.

Caregivers may find it useful to observe the progression of Alzheimer's and to flag areas of concern to address with the physician.  Another older useful test is the Blessed Test.

MMSE - Mini Mental State Exam
The clinician asks the person the following questions:
What is the year?                 What is the season?
What is the date?                  What is the day?
What is the month?              What state are we in?
What county are we in?        What town are we in?
What room are we in?           What floor are we on?

Short-Term Memory (Retention)
The clinician names three objects (for example, apple, table, and hat) and asks the person to repeat the three words all at once. If the person can't do this correctly, the clinician can repeat the words until the person learns them (a maximum of six tries is permitted).

The person is asked to count backwards from 100 by 7s, or to spell the word “world” backwards.

Short-Term Memory (Recall)
The person is asked to repeat the three objects named earlier (apple, table, and hat).

The assessment of language
First, the clinician holds up a pencil and a watch (separately) and asks the person to name the objects.
Second, the person is asked to repeat the phrase, "No ifs, ands, or buts."
Third, the person is asked to follow a three-stage command (Take this paper in your right hand, fold it in half, and hand it back to me.).
Fourth, the person is given a piece of paper with the command "Close your eyes" written on it and is asked to do what the paper says.
Fifth, the person is asked to write a spontaneous sentence.
Sixth, the person is asked to copy a simple design.

24 – 30: "normal" range
20 – 23: mild cognitive impairment or possible early-stage/mild Alzheimer's disease
10 – 19: middle-stage/moderate Alzheimer's disease
0 – 9: late-stage/severe Alzheimer's disease
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