MENTAL TESTING

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Byter John P sent me a mental test . . . more about that later, thanks John.

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A Mini-Mental State Examination (MMSE) is a set of 11 questions that doctors and other healthcare professionals commonly use to check for cognitive impairment (problems with thinking, communication, understanding and memory).

An MMSE is performed if there is a reason to suspect a person may be confused, such as after a head injury or during a sudden episode of illness such as an infection. It is also sometimes used as part of the process for determining if someone has cognitive impairment, such as dementia. Lawyers may also use it to check capacity and understanding to determine competency to make a Will, a Power of Attorney and an Appointment of Guardian.

The test used in Australia is known as the SMMSE (Standardised Mini-Mental State Examination).

The original MMSE (created in 1975!) can be vulnerable to poor inter-rater reliability. The Standardized SMMSE was developed in 1997 to provide exact scoring instructions with clear and unambiguous guidelines to administer the test, in order to increase reliability and reduce variability.

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The SMMSE is not an easy test and I personally have difficulty with some of the answers, even in understanding at least one question.

Here is the SMMSE, with notes and guidance:

Standardised Mini-Mental State Examination (SMMSE)

Please see accompanying guidelines for administration and scoring instructions

Say: I am going to ask you some questions and give you some problems to solve. Please try to answer as best you can.

1. Allow ten seconds for each reply. Say:

a) What year is this? (accept exact answer only)

b) What season is this? (during the last week of the old season or first week of a new season, accept either)

c) What month is this? (on the first day of a new month or the last day of the previous month, accept either)

d) What is today’s date? (accept previous or next date)

e) What day of the week is this? (accept exact answer only)

2. Allow ten seconds for each reply. Say:

a) What country are we in? (accept exact answer only)

b) What state are we in? (accept exact answer only)

c) What city/town are we in? (accept exact answer only)

d) <At home> What is the street address of this house? (accept street name and house number or equivalent in rural areas)

<In facility> What is the name of this building? (accept exact name of institution only)

e) <At home> What room are we in? (accept exact answer only)

<In facility> What floor of the building are we on? (accept exact answer only)

3. Say: I am going to name three objects. When I am finished, I want you to repeat them. Remember what they are because I am going to ask you to name them again in a few minutes (say slowly at approximately one-second intervals).

Ball Car Man

For repeated use: Bell, jar, fan; bill, tar, can; bull, bar, pan

Say: Please repeat the three items for me (score one point for each correct reply on the first attempt) Allow 20 seconds for reply; if the person did not repeat all three, repeat until they are learned or up to a maximum of five times (but only score first attempt)

4. Say: Spell the word WORLD (you may help the person to spell the word correctly). Say: Now spell it backwards please (allow 30 seconds; if the person cannot spell world even with assistance, score zero). Refer to accompanying guide for scoring instructions (score on reverse of this sheet)

5. Say: Now what were the three objects I asked you to remember?

(score one point for each correct answer regardless of order; allow ten seconds)

6. Show wristwatch. Ask: What is this called?

(score one point for correct response; accept ‘wristwatch’ or ‘watch’; do not accept ‘clock’ or ‘time’, etc.; allow ten seconds)

7. Show pencil. Ask: What is this called?

(score one point for correct response; accept ‘pencil’ only; score zero for pen; allow ten seconds for reply)

8. Say: I would like you to repeat a phrase after me: No ifs, ands, or buts

(allow ten seconds for response. Score one point for a correct repetition. Must be exact, e.g. no ifs or buts, score zero)

9. Say: Read the words on this page and then do what it says

Then, hand the person the sheet with CLOSE YOUR EYES (score on reverse of this sheet) on it. If the subject just reads and does not close eyes, you may repeat:

Read the words on this page and then do what it says, a maximum of three times.

See point number three in Directions for Administration section of accompanying guidelines. Allow ten seconds; score one point only if the person closes their eyes. The person does not have to read aloud.

10. Hand the person a pencil and paper. Say: Write any complete sentence on that piece of paper (allow 30 seconds.

Score one point. The sentence must make sense. Ignore spelling errors).

11. Place design (see page 3), pencil, eraser and paper in front of the person. Say: Copy this design please. Allow multiple tries. Wait until the person is finished and hands it back.

Score one point for a correctly copied diagram. The person must have drawn a four-sided figure between two five-sided figures. Maximum time: one minute.

12. Ask the person if he is right or left handed. Take a piece of paper, hold it up in front of the person and say the following: Take this paper in your right/left hand (whichever is non-dominant), fold the paper in half once with both hands and put the paper down on the floor.

Takes paper in correct hand

Folds it in half

Puts it on the floor

TOTAL TEST SCORE: 30 ADJUSTED SCORE:

The SMMSE tool and guidelines are provided for use in Australia by the Independent Hospital Pricing Authority under a licence agreement with the copyright owner, Dr D. William Molloy. The SMMSE Guidelines for administration and scoring instructions and the SMMSE tool must not be used outside Australia without the written consent of Dr D. William Molloy.

Molloy DW, Alemayehu E, Roberts R. Reliability of a standardized Mini-Mental State Examination compared with the traditional Mini-Mental state Examination. American Journal of Psychiatry, Vol. 14, 1991a, pp.102-105.

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Anyway, you get the idea of the SMMSE.

Which is all an introduction to the mental test John P sent me . . .

Your Yearly Dementia Test! ( Only 4 questions this year ). This one has some different questions than last year. Yep, it's that time of year again for us to take our annual senior citizen test.

Exercise of the brain is as important as exercise of the muscles. As we grow older, it’s important to keep mentally alert. If you don’t use it, you will lose it!!

The spaces below are so you don’t see the answers until you’ve answered.

#1. What do you put in a toaster ?

Answer: 'Bread.' If you said 'Toast', just give up now and go do something else. And, try not to hurt yourself. If you said, Bread, go to Question #2.

# 2. Say 'Silk' ten times. Now spell 'Silk.' What do cows drink?

Answer: Cows drink Water. If you said 'Milk,' don't attempt the next question. Your brain is already over-stressed and may even overheat. Content yourself with reading more appropriate literature such as Women's Weekly or Auto World. However, if you did say 'Water', proceed to Question #3.

# 3. If a red house is made from red bricks and a blue house is made from blue bricks and a pink house is made from pink bricks and a black house is made from black bricks, what is a Green House made from ?

Answer: Greenhouses are made from Glass. If you said 'Green Bricks', why are you still reading this?; PLEASE, go and lie down! But, if you said 'Glass', go on to Question #4.

# 4. Please do not use a calculator for this for it would be cheating:

You are driving a bus from Jurong to Changi at Bukit Batok, 17 people got on the bus.

At Clementi, 6 people get off the bus and 9 people get on.

At Outram, 2 people get off and 4 get on.

At Marine Parade, 11 people get off and 16 people get on.

And at Eunos, 3 people get off and 5 people get on.

You then arrive at Changi.

Without going back to review, how old is the bus driver ?

Answer: Oh, for crying out loud !

Don't you remember your own age?!?! It was YOU driving the bus!

If you pass this along to your friends, pray they do better than you.

PS: 95% of people fail most of the questions!

If you had fun with this, send it on... I did... I already know that even when you missed a question, you went on to the next one, didn't you...

😂😂😂😂

Congratulations.. life is like that , even when you fail, you keep going and persisting. Failure is no reason to give up... Stay blessed... ❤