You are about to see Mrs. Chambers, a 71 year old woman, in your outpatient clinic. She was brought in today by her husband who is concerned that she’s becoming increasingly forgetful. Take a focused history related to her husband’s complaint and perform the MMSE on Mrs. Chambers.
History
- Asks patient if she concurs with husband’s concerns (she reluctantly agrees)
- Asks patient about forgetfulness in daily context (e.g. misplace keys, forgets to turn off stove)
- Asks about forgetfulness with dangerous house appliances (has previously left stove on)
- Asks about forgetfulness with medications
- Asks patient to personally assess her current daily function
- Ambulation (uses cane)
- Hygiene and dressing (independent)
- Eating, cooking
- Banking and shopping
- Housework
- Driving and transportation (still drives)
- Assesses for polypharmacy
- Visual acuity, dizziness
- Continence
- Falls (has fallen once)
- Arthritis
- Other past medical history
- Mood changes (patient’s mood is ‘so-so’)
- Alcohol use
- Social support outside of husband (has 2 adult children)
- Addresses patient’s reluctance to address her husband’s concerns
Mini Mental Status Examination
Introduces exam to patient and explains why they are performing the test
- (/5) Orientation to Place: Country, Province/State, City, building, floor
- (/5) Orientation to Time: year, season, month, day of the week, day
- (/3) Registration: Three naming prompts, asks to repeat back
- (/5) Attention: Asks to calculate serial 7s or spell WORLD backwards
- (/3) Recall: Repeating previously remembered words
- (/2) Language: Asks to name two objects of minimal difficulty
- (/1) Repetition: Asks patient to repeat a phrase back
- (/1) Complex Task: Draw intersecting pentagons for patient to copy
- (/3) Comprehension: Patient to follow three step command
- (/1) Writing: Patient writes sentences with proper syntax
- (/1) Reading: Patient obeys simple written command
Compiles total score, correctly interprets results, and conveys results to patients
Case 2 – Forgetfulness