Saturday, 18 January 2014

YOUR MINI MENTAL STATE EXAM

Before we rumble on let's remind ourselves that a number of conditions or problems can affect mental status:

Alcohol intoxication
Certain drugs and medications
Encephalopathy, either chronic or acute
Head trauma or concussion
Many psychiatric conditions
Many neurologic conditions
Withdrawal from narcotics and barbiturates

We are not the same people this year as last; nor are those we love. It is a happy chance if we, changing, continue to love a changed person.

The Mini Mental State Examination (MMSE) is the most commonly used test for complaints of memory problems. It can be used by specialists to help diagnose dementia and to help assess its progression and severity.

God grant us the serenity to accept the people we cannot change, the courage to change those we can, and the wisdom to know it's us.

The MMSE tests a number of different mental abilities, including an individual's memory, attention and language. The test can also be used to assess changes in an individual who has already been diagnosed with dementia. 

Some people change their ways when they see the light, others when they feel the heat, but when they encounter dementia they helpless to change.

The MMSE is a series of questions and tests, each of which scores points if answered correctly. If every answer is correct, a maximum score of 30 points is possible. This is actually a tool that is used by specialists such as a GP or a neuropsychologist (a psychologist who specialises in the brain and its function) to help them diagnose and assess dementia. It is only one part of these processes and the professionals will often consider a person's MMSE score alongside the results of other tests.

Not everything that is faced can be corrected, but nothing can be rectify until it is faced.

In general, scores of 27 or above (out of 30) are considered normal. However, getting a score below this does not always mean that a person has dementia, their mental abilities might be impaired for another reason or they may have a physical problem such as difficulty hearing, which makes it harder for them to take the test. It can also help to give an indication of how severe a person's symptoms are and how quickly their dementia is progressing. On average, people with Alzheimer's disease who are not receiving treatment lose two to four test points each year.

Just because things are different do not mean some are imperfect.

The MMSE score is one of the things a doctor considers when deciding if drugs will help a person with dementia. The severity of a person's dementia gives an indication of which drugs may be of benefit, if and when well administered.

Currently recommendations are that for mild-to-moderate Alzheimer's disease (MMSE score 10-26), the individual should be considered for treatment with donepezil (Aricept), rivastigmine (Exelon) or galantamine (Reminyl). Also the regulated, memantine (Ebixa), for individuals with severe Alzheimer's disease (MMSE score less than 10) and for some of those with moderate disease (MMSE score 10-20).

Today the world changes so quickly that in growing up we take leave not just of youth but of the world we were young in. Fear and resentment of what is new is really a lament for the memories of our childhood.

Nevertheless it is important to note that an individual's MMSE score can be affected by their level of education. This is because for highly educated people the questions may be too easy and for poorly educated people some may be too difficult. This means that a highly educated person with mild dementia may score in the normal range, whereas a poorly educated person with no problems in cognition may score in the dementia range. Moreover the person's cultural background could also affect their score as some of the questions may be easier for people from certain cultures to answer, for example questions that require knowledge relevant to English literature.

Dementia hurts. It makes people insecure, confused, and angry. People want things to be the same as they've always been, because that makes life easier.
For people with learning disabilities, difficulty speaking, or for those who are not fluent enough in a language in which the MMSE can be given, a different method should be used to assess dementia severity when treatment is being introduced. This is to ensure that people from different ethnic or cultural backgrounds and people with disabilities have equal access to treatment.

A coward gets scared and quits. A hero gets scared, but still goes on.

An individual's MMSE score should also be considered in the light of the particular difficulties that they experience. For example, a person with posterior cortical atrophy (PCA - a rare type of Alzheimer's disease) might score in the normal range, despite having significant symptoms and problems. This is because the MMSE is weighted towards measuring memory and orientation (on which people with PCA are relatively strong), but has few questions examining vision or literacy (which are the main problems experienced by people with PCA). This could lead to the person not being considered for treatment as their MMSE score gives the impression that their difficulties are very mild.

The voice of conscience is so delicate that it is easy to stifle it; but it is also so clear that it is impossible to mistake it.

The test is made up of a range of different questions and measures, which aims particularly to aid in early diagnosis of dementia. Thus positively bridging the gap whereby the condition would have been observed or noticed too late and per such rendering it's treatment a bigger challenge.

MMSE possibly could be an adventure based upon structures reassembling these samples:

Appearance

The person’s physical appearance would be checked, including:

Age
Dress
General level of comfort
Gender
Grooming
Height/weight
Orientation

The questions may include:

The person’s name, age, and job
The place where the person lives, type of building, city, and state, or the hospital or facility they are currently in. The time, date, and season.

ATTENTION SPAN

Attention span may be tested earlier, because this fundamental skill can influence the rest of the tests.

The person’s ability to complete a thought, ability to think and solve problems. Whether the person is easily distracted; the person may be asked to do the following:

Start at a certain number, and then begin to subtract backwards by 7s.
Spell a word such as “WORLD” forward, and then backward.
Repeat up to 7 numbers foward, and up to 5 numbers in reverse order.

Recent and Past History

The individual would be asked questions related to recent people, places, and events in the person’s life or in the world. Three items may be presented, and the person may then be asked to repeat them, and then recall them after 5 minutes. Also questions related to childhood, school, or events that occurred earlier in life could be asked.

Language Function

Things like everyday items in the room would be pointed to and individual would be asked  to name them, and possibly to name less common items.

The person may be asked to follow a 1-step, 2-step, and 3-step instruction.

The individual may be asked to say as many words as possible that start with a certain letter, or that are part of a certain category, in 1 minute.

The person may be asked to read or write a sentence.

Judgment

To test the person’s judgment and ability to solve a problem or situation, the person mar be asked questions such as;

“If you found a driver’s license on the ground, what would you do?”
“If a police officer approached you from behind in a car with lights flashing, what would you do?”

No preparation is necessary for these tests and there should be no physical discomfort. Some people might find it stressful to answer all of the questions. Difficulties answering could lead to frustration or possibly, stress later.

Normal Results

The most commonly used test, the mini-mental state examination (MMSE) might also be identified as Folstein test. A test actually divided up into sections, each one with its own smaller score and meant to help show which part of an individual's thinking and memory may be affected and needed treatment.

The brain is the future, the future is not a result of choices among alternative paths offered by the brain, but a place that is created, created first in the mind and will, created next in activity. The future is not some place we are going to, but one we are creating. The paths are not to be found, but made, and the activity of making them, changes both the maker and the destination.