Qualitative Assessment of The Writing Sentence Item in The MMSE

I. Biran1, J.P. Newman1, A. Gal1, N. Levin1, G. Friedman2

Departments of Neurology(1) and Geriatrics(2)Hadassah Hebrew University Medical Center

Special Thanks to Dr. Gitit Kave (Tel-Aviv University)

Narrative Approach

• Content• Self Generated• Related to the individual’s

experience• Opens a window to the inner world

Pt - 1• Parkinson’s Disease patient, normal MMSE, pre-op

(Deep Brain Stimulation) evaluationOnce more into the breach, once more, or fill the breach with our English dead

• William Shakespeare, King Henry V, Act 3, Scene I (before Harfleur)

Once more unto the breach, dear friends, once more;Or close the wall up with our English dead.In peace there's nothing so becomes a manAs modest stillness and humility:But when the blast of war blows in our ears,Then imitate the action of the tiger;

• Personality type? Coping with disease…

Pt - 2

AgeClock Drawing

CDIS

MMSESentence

701722I LVOE MY WIFE

711122I LOVE MY WIFE

72618 OVE MY WIFE

MMSE

Psycho-analysis

… the fundamental rule of psycho-analysis which lays it down that what ever comes into one’s head must be reported without criticizing it… (Freud S., The Dynamics of Transference, Standard Edition, XII, 107)

… You will be tempted to say to yourself that this or that is irrelevant… …you must never give in to these criticism… … say whatever goes through your mind… (Freud S., On Beginning the Treatment, Standard Edition, XII, 135)

Hypothesis

• The MMSE can probe psychodynamic processes

Design

AD / Control Subjects

MMSE

Sentence Item score=0Perseverations – “No ifs and or buts”

Excluded

Sentence Item Score=1No Perseverations

Item Analyzed

Demographics

ADControls

N - Total1963

N - Analyzed1655

Sex (F/M)9/733/22

Age80.8±6.372.6±5.4

Education (years)

12.8±3.613.0±3.4

MMSE21.8±2.928.8±1.1

Informative Sentences

Does a sentence convey information which might be new to the examiner?

ADControlsP

2/1628/55<0.05

Information Regarding The Current Situation

Is the sentence related to the current situation?“I am embarrassed by these questions”

ADControlsP

9/1617/55n.s. (0.08)

Related to Oneself?

Is the subject = 1st person?“I want to be healthy”

ADControlsP

10/1623/55n.s. (0.07)

Positive information

Sentence contains positive adjectives/adverbs“You are nice…”

ADControlsP

6/1622/55n.s.

Conclusions

• The MMSE sentence writing item, although regarded as a linguistic item, can be utilized for affective co-morbidity in AD subjects

• The MMSE sentence writing item can serve

as a “red flag” for psychodynamic processes