Studies

A friend of mine had a stroke about a year ago, and as a result of the stroke, he has some problems remembering things. His best friend told me that Larry had huge gaps in his long-term memory. When they talked about things they had done in school, Larry could not recall any of the events. He could recall other events. So, because he was concerned about his memory Larry registered for a study for stroke victims at UBC. He goes off twice a week to take part in the study and spends about, from what I understand, 10 hours a week going through tests and interviews. UBC is about an hour and a half drive one way from where Larry lives. He is spending about 16 hours a week, including travel time on this study.

Larry is very worried that he is getting Dementia and his interpretation of his results lead him to think the worst. Last week Larry was telling us that he had been interviewed for an hour and a half and had been asked a lot of questions, like count back from 100 by 7’s. The questions asked were from a test called MMSE. The Mini-Mental State Examination (MMSE) is a tool that can be used to systematically and thoroughly assess mental status. It is an 11-question measure that tests five areas of cognitive function: orientation, registration, attention and calculation, recall, and language. The maximum score is 30.

This is a test where the doctor asks several questions and your answers are scored to give an estimate of your cognitive fitness.

Some MMSE questions:

1. I would like you to count backward from 100 by sevens. (93, 86, 79, 72, 65, ...) Stop after five answers

2. The examiner names three unrelated objects clearly and slowly, then asks the patient to name all three of them. The examiner repeats them until patient learns all of them, if possible. Number of trials: _______

3. Spell WORLD backwards.” (D-L-R-O-W)

4. “Earlier I told you the names of three things. Can you tell me what those were?”

5. Show the patient two simple objects, such as a wristwatch and a pencil, and ask the patient to name them.

6. “Repeat the phrase: ‘No ifs, ands, or buts.’”

7. “Take the paper in your right hand, fold it in half, and put it on the floor.” (The examiner gives the patient a piece of blank paper.)

8. “Please read this and do what it says.” (Written instruction is “Close your eyes.”)

9. “Make up and write a sentence about anything.” (This sentence must contain a noun and a verb.)

When looked at across time Scores in this test range from zero to 30, with a score of 26 and higher generally considered normal. The range of scores for healthy people is about 27.4, compared with 22.1 in people with mild cognitive impairment (MCI) and 16.2 in people with Alzheimer's disease.

The problem is that Larry has not been given a score and the researcher suggested to him that he should have an MRI scan of his brain. The researchers at UBC had done one already, but, as Larry explained, they could not share his results with him or it would skew the results.

These scans may also be used to check for evidence of other possible problems that could explain a person's symptoms, such as a stroke or a brain tumour. I suspect they did an MRI scan to:

· See if Larry actually has dementia or what else may have caused his stroke

· Provide detailed information about any damage that Larry may have suffered as a result of his stroke

The researcher also told Larry that he did well on the test, but of course, Larry only heard part of the discussion and focused on the wrong part.

My concern is that Larry, who is prone to worry, will stress more than he needs to. His memory losses are not as severe as he thinks they are.

He still has good concentration and a good attention span, his language skills and communications skills have not deteriorated and he has a good grasp of time and place.

Larry has to keep in mind that he is part of a study and he will undergo tests which will involve a series of pen-and-paper tests and questions. These tests will assess a number of different mental abilities, including:

· short- and long-term memory

· concentration and attention span

· language and communication skills

· awareness of time and place (orientation)

I admire Larry for taking part in the study, but I hope he will decide not to self-assess his results on the tests because he, like many of us, will underestimate how well he is doing and this may cause him stress.