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In screening someone for dementia, tests of mental status—for example, the Mini-Mental State Examination (MMSE), the Short Test of Mental Status, or the Cognitive Capacity Screening Examination—are given to check for any basic cognitive impairment. These tests offer a baseline for comparison should further testing be necessary.
However, although the Mini-Mental State Examination is one of the standard tests physicians use to assess dementia it has several drawbacks. The test takes 5 to 15 minutes to administer, which is a considerable amount of time during a routine checkup. In addition, the results can be affected by a patient’s educational level and do not always correlate with function in the real world. For these reasons, doctors have developed several simple alternatives.
The most widely studied are the Clock Drawing Test and the Time and Change Test. In the Clock Drawing test, which examines how well a person can represent time, patients are asked to draw a clock with the hands pointing to a specific time of day. The Time and Change Test assesses a person’s ability to tell time and perform simple math. Patients are asked to read the time on a clock; they are then given coins and asked to make change for a dollar.
Physicians may also use several of the simple tests described below to assess whether a person might have memory loss or other cognitive problems. Some of these memory loss tests may be part of a longer screening exam, while others can stand alone. These brief tests do not provide a definitive diagnosis, but they can help determine who needs a thorough evaluation for dementia. While these tests seem simple enough for a spouse or other family member to administer, the interpretation of the results requires expert training, so only a doctor should give these tests.
- Orientation Test For Memory Loss
The doctor may ask the current year, month, date, day of the week, and time of day. Small errors may be overlooked, but large errors (such as guessing the incorrect year or season) may suggest cognitive impairment.
- Word Repetition Test for Memory Loss
The doctor will say a list of several words (usually common nouns such as apple, table, or penny) and ask the person to repeat the list. People with adequate hearing should be able to repeat back three words. An inability to do so indicates that the person may have problems with language, attention, or working memory.
- Language Test for Memory Loss
The doctor may ask the person to name as many items as possible in a given category (for example, “animals” or “vegetables”). The time limit is one minute, but the doctor usually will not volunteer this information, as it can make the patient nervous. Instead, the doctor may say, “I will tell you when to start and when to stop.” Naming fewer than 10 items in one minute is a sign of decreased mental function.
Showing a person a familiar object, such as a watch or a button, can also test language. An inability to name the object, or the use of an incorrect name (for example, “bubbon” or “bubble”) also indicates a memory problem.
- Test of Attention and Working Memory
This test involves spelling a word, such as “world” forwards and backwards, or subtracting from 100 sequentially by 7s. The doctor may also ask the person to arrange the letters of the word in alphabetical order or to say the months of the year backwards beginning with December. Omitting or transposing letters or months, as well as adding extra ones, may indicate memory deficiencies.
- Memory
The doctor may ask the person to recall the list of words used earlier in the repetition test. (Usually several other tests will be given between these two in order to gauge the person’s memory.) The inability to remember at least two of three words suggests memory impairment.
- Executive Function
Executive function refers to a complex set of mental abilities that include planning, starting, sustaining, stopping, and abstracting. The doctor may ask the person a few questions that require him or her to explain similarities and differences. Some examples might include, “How is an apple like an orange?” or “How is a river different from a canal?” The inability to answer these questions suggests that the person’s ability to reason is impaired.
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Posted in Memory on February 7, 2006
Reviewed July 2009
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