Mental Status Testing Pitfalls
Dementia is a tricky thing. Highly functioning people often get an awful score on the usual mental status exams. On the other hand, many score well, but exhibit serious disabilities related to memory.
Families will often send me notes describing a patient’s terrible memory and ask that I test them. They also add: “Don’t tell him/her that I mentioned this.”As the patient comes in, one or two family members may arrive to accompany the person. Easing into the mental status evaluation is not always simple. When the person does not do well, it is an incredibly demoralizing experience, leaving hurt and anger.
Fortunately, the person’s disability is usually already known to us and we can adjust the exam to reduce the pain. Other times, I’ve been totally surprised at how successfully the person has hidden their memory loss.
Mental status exams are stressful for everyone in the room. Most people with dementia are well aware, terrified and are trying to hide their progressive memory loss. They may quickly forget the three words you asked them to remember, but they seem to never forget how you humiliated them in front of their family.
As our doctors and office staff get older, we have adopted a dark gallows humor regarding our own memory. “Forgetfulness of Aging” is supposed to be benign, except for when it is not and it scares the hell out of me.
Intelligent people can spoof the MMSE for a long time without much problem. My brother in law, who had a PhD in physics could ace the MMSE for some time after he started getting lost on the way home from the grocery store. (RIP)
Yeah, but folks brought their mom or dad for me to “fix” their dementia with a “pill”. Sucked as the pills of the time didn’t work and the patients went downhill anyways. Better to have nursing home insurance as I have. Glad to be retired now and don’t have to put up with this headache anymore. Kurt (used to M.D. but retired now)
One more reason not to worry about cholesterol.