Sep 17, 2012

What if You Had a Fire in Your Kitchen? The Tale of Two Mini–Mental State Examinations

“After doing a physical exam, he started asking me questions obviously designed to find out ‘eef’ I’m mentally competent,” he said.

What if You Had a Fire in Your Kitchen?: Two Mini-Mental Status Exams 25 Years Apart First Mini-Mental Status Exam: 1980
Ed, 1980
By Marie Marley
Alzheimer's Reading Room

It was 1980. I was deeply in love with Ed, my colorful and eccentric Romanian soul mate, and we had been living together for three years. One day I’d been circling the apartment in my grungy gray sweats collecting three days’ worth of laundry from the floors, chairs and bed when he came home from a doctor’s appointment.

“Ma-r-r-ie” he’d said excitedly. “I’m just from Dr. R-r-robert’s office back. You will never guess what he did!”

“What, Ed?” I asked. From the excitement in his voice I could tell this was going to be a good one.

“After doing a physical exam, he started asking me questions obviously designed to find out ‘eef’ I’m mentally competent,” he said.

I burst into laughter because Ed, a brilliant professor and former lawyer who was fluent in seven languages, was sharper than anyone I’d ever known.

“I had a lot of fun with him,” Ed continued. “First he asked me who’s the President. I said, ‘Unfortunately, it's Carter!’”

“Next he asked me to name going backwards the pr-r-r-esidents. I answered perfectly, of course, except I decided to leave out all the democrats! Then he told me to remember three words: ‘boat, flag, and shoe.’ He said he’d ask me to repeat those words in the visit later.”

Ed started laughing heartily. When he finally caught his breath he said, “Only thing is, Dr. R-r-roberts forgot to ask me those words again. Dr. R-r-roberts should make an appointment to see himself!”

I laughed out loud, too, at this whole amusing story.

Second Mini-Mental Status Exam: 2005

Ed, 2005
Twenty-five years later Ed was showing clear signs of dementia. I made arrangements for a local nursing home to send someone out to evaluate him for placement.

He answered the knock on his door and found Nancy, a pretty young lady in her mid-20s, standing there. He smiled and gestured for her to enter.

“Hello there!” he said. “Oh, I’m so excited to see you again. How have you been? Come in! Come in!” he bid her.

Only thing was, Ed had never seen Nancy before, which pretty much fulfilled the purpose of her visit.

I had warned her I couldn’t promise he’d even allow her in, let alone talk with her, so I was immensely relieved he was agreeable that day.

He sat in his recliner, Nancy took a seat on the sofa near him, and I - not wanting to interfere - sat at the far end of the sofa, planning to just observe.

She explained the reason she was there. He didn’t seem to understand, but he was in an excellent mood and readily agreed to talk with her. I assumed it was mostly because she was so young and pretty. He loved all young and pretty women.

Nancy consulted her paper, turned her body directly toward Ed, and began asking the usual questions, enunciating each word clearly and loudly.

“Can you tell me who’s the President?”
“Boosh,” he blurted out, grinning.
“Can you tell me what date it is today?”

He thought for a few seconds, then his head began to slowly shift downward as he simultaneously turned his left wrist inward a little.

Well, I’d be damned! His mind isn’t totally gone. He’s alert enough to remember his little Timex has the date on it.

That gave me some comfort. He stated the correct date and we all laughed about his cleverness.

“What state are we in?” she continued.

He appeared confused and looked at me.

“Sorry, Ed. You have to answer by yourself.”

“I’m so sorry,” he said, looking back toward Nancy. “I r-r-really can’t r-r-remember. I think it may be Ohio. Or Cleveland.”

“Okay,” she said. “What country do we live in?

“America!” he shouted with glee.

He was so proud to have become an American citizen after fleeing the brutal dictatorship in his Romanian homeland.

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“That’s right! Now, can you count backwards by sevens, starting at 100?”
He had a blank look on his face.

“Count how?”

“I can count very well – in English, R-r-romanian, German, French, Italian, R-r-russian.” He paused for a few seconds then added “and Latin,” making it perfectly obvious that he’d been quite the scholar.

“Can you count backwards by sevens, starting at 100?” she repeated.
He looked at me again.

“I’m sorry but I can’t help you, Ed.”

“I don’t understand the question,” he told Nancy, sounding flustered.
“That’s okay,” she said. Let’s go on to the next question.


“Can you spell the word ‘world’ backwards?”
He thought a moment then answered, “w – o – r – l - d.”

“That’s spelling it forward, Ed. Can you spell it backwards – starting with the last letter?”

“Well,” he answered, “the last letter is ‘l’.”

I hoped I wasn’t looking disappointed.

She continued with her questions and wrote down everything he said.
Then she asked the last question: “What would you do if you had a fire in your kitchen?”

He thought for a few seconds then a sly grin slowly appeared on his face. He stretched out his arm, pointed to me with his shaky finger and proudly announced, “I’d call her.”

Nancy and I laughed, which made Ed laugh, too. He was aware and proud he’d said something humorous.

But it was also sad. His mind could no longer tell him how to handle an emergency. The only solution he could think of to any problem was to call me.

As I sat there I recalled that first mini-mental status exam all those years ago. The one that had been so funny. I never could have imagined he’d have another one later and do so poorly. It was becoming clearer to me every day that my beloved Ed’s dementia was progressing.

Marie Marley, PhD, was a caregiver for Dr. Edward Theodoru, her delightfully colorful, wickedly eccentric Romanian soul mate, for seven years. After he passed away in 2007, she wrote an award-winning book about their relationship, Come Back Early Today: A Story of Love, Alzheimer’s and Joy. In the course of narrating their 30-year love story, Marie illustrates the solutions she found to 14 different issues that typically arise when loving and caring for someone with dementia. You can visit Marie’s website which contains a wealth of information about caregiving at ComeBackEarlyToday.

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