Transcript Qualitative Assessment of The Writing Sentence Item in The

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
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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) evaluation
Once 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 man
As 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
Age
Clock
Drawing
MMSE
Sentence
CDIS
70
17
22
I LVOE
MY WIFE
71
11
22
I LOVE
MY WIFE
72
6
18
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=0
Perseverations – “No ifs and or buts”
Sentence Item Score=1
No Perseverations
Excluded
Item Analyzed
Demographics
AD
Controls
N - Total
19
63
N - Analyzed
16
55
Sex (F/M)
9/7
33/22
Age
80.8±6.3
72.6±5.4
Education
(years)
MMSE
12.8±3.6
13.0±3.4
21.8±2.9
28.8±1.1
Informative Sentences
Does a sentence convey information which
might be new to the examiner?
AD
Controls
P
2/16
28/55
<0.05
Information Regarding The
Current Situation
Is the sentence related to the current situation?
“I am embarrassed by these questions”
AD
Controls
P
9/16
17/55
n.s. (0.08)
Related to Oneself?
Is the subject = 1st person?
“I want to be healthy”
AD
Controls
P
10/16
23/55
n.s. (0.07)
Positive information
Sentence contains positive adjectives/adverbs
“You are nice…”
AD
Controls
P
6/16
22/55
n.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