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.  

Silver Princess: My Hair Wars

I have always had thick, absolutely straight hair that I was grimly determined to curl. The first picture of me in curlers was taken at age 4. I either set my hair every night or had permanents until I got married. I was a blonde until I was 3; then my hair turned to dark brown. My aunt found my first gray hair when I was 12 .

When I was 23, a colleague asked me whether I streaked my hair because I had so many gray hairs. My mom had dyed her hair from the time she was 30; I vowed to let my hair go gray like both my grandmothers had done.

Around age 38 I sold out and periodically attempted home dye jobs. I stopped when a woman in the supermarket asked me whether I had purple hair. I started to have it dyed professionally when I was 42 (depressed over my dad's death). It was expensive and time-consuming; about a week after I walked out of the beauty parlor, I would have dramatic silver roots.

At age 47, I impulsively decided to go gray. If you use permanent dye, you have stark choices. You can cut your hair very short and endure looking like a skunk while it grows out. Or you can bleach your hair ash blonde and let it grow out a bit less conspicuously. I opted for the latter. Walking into my social work field placement and my classes as a blonde, I was the focus of attention that I had never been before. It took a year to grow out while my hair felt like straw, but I was pleased with the results. My hair was silverish white.

Two years later, I was meeting my mom in Manhattan for a Broadway show. As I watched her walk down the block, I thought, "I can't stand it. She looks much younger than I do." So I dyed it dark brown again in 1995. My 28-year marriage ended in 1996, and gray hair did not seem the best advertisement for a new husband.

My mother died on Good Friday, 2004, almost 83. We asked the undertaker to touch up her roots because we knew she would have hated mourners seeing her gray hair and realizing she was old:) My 5 brothers made tasteless jokes about hair growing after death and needing touchups six feet under. That was a moment of truth. I went the bleached blonde to silver route and have not changed my mind in 5 years. For about six months I was shocked when I caught an unexpected glimpse of myself in a mirror.

I was brave. My husband is 16 years younger than me, and I dreaded being asked whether he was my son. That hasn't happened, but he is not allowed to shave his beard off and look younger. Andy calls me his silver princess. I can spend a whole day in Manhattan and never see another woman with long, straight silver hair. Too many older gray-haired women have unbecoming permanents. In contrast, when we visit England, I see lots of women in their 50's with gray, silver, or white hair. The second most important man in my life, my grandson Michael, has always loved my hair.

I believe my gray hair struggles are all about my relationship with my mom. My mom hated it when I wore my hair gray. It is not an accident that I waited until she died to revert back to silver. At least 3 of my daughters, 36, 33, and 30, have noticeable gray streaks. Mysteriously, the men in my family go gray 20 years later than the women. I have been asked if it's platinum blonde; I have been asked who is my hairdresser. Being silver is much more fun than being brunette, naturally or artificially.

Dependence and Aging Parents

My mom and Paul, 2002. The Swedish rollator kept her out of a wheelchair
In response to my post on accepting dependence, Eve asked me: "What advice would you give to those of us with older parents who are soon to enter into a dependency stage?"

I wrestle with these questions for myself. I see my cousins struggle with the same issues with my aunts and uncles. My mother was incredibly healthy and active until she fractured her pelvis on a trip to Israel. In fact, she walked around Israel for a week with a fractured pelvis. I suspect only my father could tell her what to do; I often wished my dad were still alive to cope with her destructive decisions. Mom thought that her mom had taken a defeatist attitude toward her arthritis, taken to her chair, and given up her formerly active life. She was never going to be like her mom; exercise, yoga, great diet would all prevent that. But my grandmother lived four years longer, and taking care of her was relatively easy. She remained the loving, wise grandmother who was a great listener; she lived to know 23 great grandchildren.

In her eloquent tribute to my mom, my daughter Rose points out she was always moving. My mom never seemed anxious or depressed; she coped with negative feelings by activity. As her health and life fell apart very quickly, she wasn't comfortable about expressing her fears or grief. I often wondered if she had adequately mourned her little sister who died when mom was 5, her father who died when she was 17.

If my mom had been more cautious, she might still be alive to see six grandchildren married and meet three great-grandchildren. Anne, my oldest daughter, has told me dozens of times in the five months of her son Nate's life how much she misses Grandma. I used to tell my mom, "Mom, so many of your grandkids are just on the cusp of marriage and parenthood. Isn't seeing Mommy Anne worth letting us take care of you?"

Our generation is being encouraged to think we can defeat aging. The US can't cope with dependency at the beginning or end of life. Letting people take care of you can be the most loving gift you can give them. I recommend the superb blog, Time Goes By--What It's Really Like to Get Older by Ronni Bennett. If your parents are aging, encourage them to read it and discuss with you the many issues she raises. All of us constantly struggle with being able to ask for and accept help. I recently sprained my knee, and I hate to ask my husband for the help he is happy to give.

Even though it was challenging, I have always been glad I was able to welcome my mom into my home and give back a small part of what she had given to her family, her friends, the world. My then new husband Paul was wonderful with her. Since he hadn't known the super Mary, he could love the reduced Mary without mourning what was no longer there. People used to assume Paul was mom's son; mom get confused explaining she wasn't English.

Please share your thoughts and experiences with this.

Importance of Funerals

My godfather, Jim, who served on the USS Biloxi during World War II

I am in the process of transferring a blog from a former site. I wrote this in March 2004; I left it as is, so as not to detract from the immediacy of it.

I haven't written this week. My uncle/godfather died and I was busy with wakes, funerals, memories. When I was younger, I was freaked out by funerals. Now I welcome the opportunity to see aunts, uncles, cousins I see too rarely. My uncle was 87, had been sick for a long time. He died peacefully, telling his family he "was going to see his bride," his wife who died ten years ago. So his funeral was more a mellow celebration of his life, very different from the wrenching heartbreak of four years ago, when my 64-year-old uncle succumbed to a four-month battle with cancer. Uncle Jim's four children and twelve grandchildren were all there. I feel strongly that people should go to their grandparents', aunts' and uncles' funerals. Two of my cousins brought their four month and seven month babies, which added to the celebration of my uncle's life.

My cousin, Jim's oldest son, gave a touching eulogy. I particularly liked this: "I would argue that Dad's secret was that he knew how to like people. There may be someone in this world who has met my father and who does not like him. However, with absolulute certainty, I can tell you that there is no one, whom my father has met, in whom my father did not immediately see the good and with whom my father would not immediately share his humor....Everyone who came into his presence met a warm smiling face and a friendly voice, which comjunicated immediately that one was accepted and loved."

My uncle was a wonderful storyteller who loved telling jokes. My cousin concluded: "I hope God likes to listen to jokes." My mother died three weeks after her older brother. We wondered if she liked Jim's jokes that much! It was the last time her brothers, nieces, and nephews saw her. She was in good form, admiring the family babies, obviously happy to see everyone. If her family had missed seeing her that last time, they would have always regretted it.

My Mother and Fibi

I hope no one takes the following the wrong way. I am sitting at the dining room table using my ibook looking across at my mom sleeping in her recliner in the living room. In many ways her daily life seems to resemble that of Fibi, our eleven year old cat, who is sitting on her lap. Mom enjoys eating, welcoming a variety of foods. She enjoys being around people and being touched and stroked. She is touched so much more now than when she lived alone as a widow from 1987 to 2000. I am playing Bach's St. Luke's Passion on the stereo. Mom likes the room warm. In fact the only complaint she reliably makes is if she is too cold or our hands are too cold. She gets more awake and animated when there are visitors or a change in routine; she is pleased when they sit next to her, hold her hand, tell her how good she looks.

She stills wants her gray hair touched up because she cares about looking pretty. She enjoys showering and being clean. She seems to enjoy being outside, notices trees and flowers. She seems content though her daily routine is totally different than it was when she was younger. What her inner life is, I can't guess. For all I know, she could be having thrilling dreams; certainly she doesn't seem to have nightmares. She looks peaceful when she is sleeping.

When I feel overwhelmingly sad about how Mom has changed, I remind myself that I don't feel sorry for Fibi; she is just older, not the energetic, exciting cat she used to be who used to walk across our curtains rods. But we still love her, enjoy her, love to touch her, and are very glad she is around.

All the years Mom was healthy, she wasn't overly fond of Fibi, who is a rather temperamental cat. But now they both have mellowed and spend most of their days together. Fibi seems to know Mom requires gentleness. I don't mean to insult my mom in the least. I am trying to reframe her experience to make it more bearable for everyone. Cat lovers would understand.

Fibi seemed to be searching for my mother for weeks after her death. Her personality seems to have permanently mellowed.