For the uninitiated, the Mini Mental State Exam (or MMSE) is a fairly quick way of assessing a patient's cognition.
Academic side: Though it has reasonably high sensitivity and specificity (i.e. low false positives and false negatives) it can be somewhat biased in favor of younger patients with higher levels of education.
Reality side: It is a horrible, annoying, frustrating test for many elderly people. Either they are sharp as a razor and the test is insulting, i.e "tell me where you are, the month, name this object, write me a sentence", or they are mildly demented and get quite upset and befuddled when you ask them to do things like count backwards from 100 in increments of 7.
I thought that there was no way that administering a MMSE could get any more heartbreaking and painful than having to conduct it on someone who had Alzheimer's.
Well today I found out that there is one more thing which is worse: having to watch it conducted by a train of medical students, in front of about 20 people, on a mildly demented patient. Oh, yeah.
It was sad. And I felt so awkward and uncomfortable watching this burly, checkered-shirt-wearing retired farmer trying to scrawl a sentence on his knee.
The session was conducted professionally, I must say, but it still made me think that if it had been my Grandad up there I'd have probably swooped to the front of the class (created a scene) and escorted him out for an afternoon of fishing.
Academic side: Though it has reasonably high sensitivity and specificity (i.e. low false positives and false negatives) it can be somewhat biased in favor of younger patients with higher levels of education.
Reality side: It is a horrible, annoying, frustrating test for many elderly people. Either they are sharp as a razor and the test is insulting, i.e "tell me where you are, the month, name this object, write me a sentence", or they are mildly demented and get quite upset and befuddled when you ask them to do things like count backwards from 100 in increments of 7.
I thought that there was no way that administering a MMSE could get any more heartbreaking and painful than having to conduct it on someone who had Alzheimer's.
Well today I found out that there is one more thing which is worse: having to watch it conducted by a train of medical students, in front of about 20 people, on a mildly demented patient. Oh, yeah.
It was sad. And I felt so awkward and uncomfortable watching this burly, checkered-shirt-wearing retired farmer trying to scrawl a sentence on his knee.
The session was conducted professionally, I must say, but it still made me think that if it had been my Grandad up there I'd have probably swooped to the front of the class (created a scene) and escorted him out for an afternoon of fishing.
8 comments:
Oooh. I agree. Fishing for fishes sounds better than fishing for words in front of a gaggle of students.
I would argue that the MMSE is ALWAYS going to be awkward no matter what. You're essentially singling out someone's mental deficiencies in a formal context. What made it worse here was the audience, which, again, I think is a necessary evil in medical education, so that you can see the strengths/failings of other people's approach.
I was told by my neuropsychologist friend that the Mini mental was not good for a true assessment...
what does Dr Grumpy have to say? :)
Ugh, I'm right there with you! Poor grandpa. I agree that it's necessary, even just for med students, since we have to learn somehow - but that's still so sad.
just to clarify: I understand the sensitivity and specificity...there still seems to be differing opinions...and the MDs that I have seen use it...doesn't seem to come out to any conclusions that make sense...from what I have observed...
Anyway....I feel so bad for the old gentleman...so sad...my first inclination would be to take him somewhere to enjoy what life is left....who cares if he is not as mentally sharp, as long as he has enjoyment in life... :(
CC -- The mini-mental is NOTHING compared to what they do for a full cognitive workup. That assessment takes at least an hour.
Ditto what OMDG said....Addenbrookes et al have nothing "mini" about them. The MMSE can take long enough though! (Generally a sign that someone is sadly going to score less than 20).
What about streaming video in another room? Why isn't that technology used to help preserve dignity.
Also, for the record, I have never been able to count backwards by odd number increments. I could probably handle 5s.
What do these assessments do with patients who have learning differences?
M
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