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) 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
Sentence MMSE Clock Age
Drawing
CDIS

I LVOE 22 17 70
MY WIFE
I LOVE MY 22 11 71
WIFE
OVE MY 18 6 72
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 Sentence Item Score=1

”Perseverations – “No ifs and or buts No Perseverations

Excluded Item Analyzed

 Demographics
Controls AD
63 19 N - Total
55 16 N - Analyzed
33/22 9/7 Sex (F/M)
72.6±5.4 80.8±6.3 Age
13.0±3.4 12.8±3.6 Education
(years)
28.8±1.1 21.8±2.9 MMSE
 Informative Sentences

Does a sentence convey information which

might be new to the examiner?

P Controls AD
<0.05 28/55 2/16
 Information Regarding The
Current Situation
Is the sentence related to the current situation?
“I am embarrassed by these questions”

P Controls AD
n.s. (0.08) 17/55 9/16
 ?Related to Oneself

Is the subject = 1st person?

“I want to be healthy”

P Controls AD
n.s. (0.07) 23/55 10/16
 Positive information

Sentence contains positive adjectives/adverbs

“You are nice…”

P Controls AD
n.s. 22/55 6/16
 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