There has been LOTS of discussion in the television, online and print news about “Cognitive Testing”. The reason, of course, has to do with questions raised (by both parties) of our current President’s cognitive status. Cognitive Testing is a more objective way of assessing a person’s cognitive status rather than relying on the affected person’s or family’s subjective assessment.
There are a number of different Cognitive Tests, but one of the most popular ones is the Mini-Mental State Examination (“MMSE”). The MMSE was developed in the 1970’s by a group head by a physician, Dr. Folstein. The test consists of eight areas of questions and they are then scored. The following summarizes the categories:
- Orientation to Time: 5 points: Ask the person what year, month, time, approximate time it is without looking at a watch or calendar
- Orientation to Place: 5 points: Ask the person where they are, recount their address
- Registration: 3 points: Repeating named prompts: Ask the person to repeat 3-5 ( or more) objects/things right after you tell the person those objects
- Attention and Calculation: 5 points: Ask the person to perform a math exercise such as serial sevens…ask the person to subtract 7 from 100 and then keep subtracting 7 from the previous number, i.e. 100, 93, 86, 79, 72, etc
- Recall: 3 points: Ask the person the name once again the 3-5 things you asked them to repeat after you previously
- Language: 2 points: Ask the person to name items you show them, such as a pencil, book, clock, etc.
- Repetition: 1 point: State a phrase and ask the person to repeat what you just said
- Complex commands/Construct Ability: 6 points: Ask the person to (roughly…not everyone is an artist!) draw a certain image
Any score of 24 or more (out of 30) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (10–18 points) or mild (19–23 points) cognitive impairment. The raw score may also need to be corrected for educational attainment and age. Even a maximum score of 30 points can never rule out dementia and there is no strong evidence to support this examination as a stand-alone one-time test for identifying high risk individuals who are likely to develop Alzheimer’s. Low to very low scores may correlate closely with the presence of dementia, although other mental disorders can also lead to abnormal findings on MMSE testing. The presence of purely physical problems can also interfere with interpretation if not properly noted; for example, a patient may be physically unable to hear or read instructions properly or may have a motor deficit that affects writing and drawing skills.
The MMSE is only one of many cognitive tests that can be administered to a person suspected of having dementia/cognitive impairment. This is a relatively easy test to administer and can be done at home without paying a health professional. Will a loved one of yours agree to take this test? My suspicion is that anyone that appears to avoid the test is probably questioning his/her own cognitive status and will be defensive about taking it.
Many aspects of the aging process sucks and most certainly, cognitive decline is at the top of the list.
I wish we all could be forever young. Enjoy Rod Stewart.
