Image: Mark du to it
It’s that time of year again. I had my annual physical on Monday. I can’t believe a year has passed since I learned that I have A-Fib.
You’re not going to believe what they made me do …. again! As soon as the nurse closed the door to the examining room, she asked me how old I was. I told her 61, and that’s when she informed me that I would be taking a Mini-Cog test in a few minutes. Yes, cog stands for cognition. A short-term memory test is standard procedure (at least in my doctor’s practice) for patients over 60. H’s doctor has never mentioned a short-term memory test of any kind.
Is there no end to this? Only a few months ago, during the process of applying for long-term care insurance, I was forced to take a ridiculously lengthy and exhaustive version of a cognitive test, not a Mini-Cog but the BIG DOG version of cog tests. You might say the English Mastiff version of cog tests. It took about twenty miserable minutes. I had to solve math problems without benefit of pencil and paper and answer all kinds of questions. I had a
major mini anxiety attack during the process. Remember?
Yesterday’s Mini-Cog did not compare. It turned out to be as simple as eating French apple pie á la mode, but how was I suppose to know that? So I just had myself another panic attack. What is that all about?
When faced with one of these tests, I can’t seem to manage my anxiety. When the nurse took my blood pressure, her eyes widened and she asked, “Did you forget to take your medication.”
My blood pressure was a whopping 210/100! I was in the throes of a monster panic attack. How ridiculous is that?
I believe this is all rooted in the fact that atrial fibrillation can increase the risk of dementia. I know what they’re looking for, and I suddenly feel pressured to perform – performance anxiety. And no matter the size of the audience, I do love to please.
The nurse was very sweet, unlike the robot-like nurse from the LTC insurance company.
Nurse ~ I’m going to say the names of three unrelated objects. I want you to repeat each one and try to remember them.
Bella ~ *wide eyed* Okay.
Nurse ~ Watch
Bella ~ Watch
Nurse ~ Apple
Bella ~ Apple
Nurse ~ Penny
Bella ~ Penny
Bella ~ imagines an APPLE sitting on her kitchen table WATCHing a PENNY doing back flips… and tells herself to remember that scary (Stephen-King-type) apple watching that acrobatic penny…
As you can see, they are unrelated objects, but it’s easier to remember them later if you make them relate to one another. Is there something a little sick about teaching people how to cheat on a test for dementia? What ever happened to the days when getting a cute boy to do your algebra homework constituted cheating? Oh, how the mighty have fallen.
Nurse hands me a sheet of paper with an empty circle on it.
Nurse ~ Draw the numbers in this circle exactly as they appear on the face of a clock, and draw the hands so the clock is at 10:45.
Bella ~ 10:45 ?
Nurse ~ Yes.
Bella ~ That’s easy. I’ll just look at my watch.
Nurse ~ …..
Bella ~ Okay. I won’t.
Yes, I know it was simple! But after I gave her my rendering, I sat there obsessing about whether I made the clock look more like 9:45 than 10:45. You know the difference. The big hand is in the same place, but the small hand should be between the 10 and 11 at 10:45. What seemed like a child’s exercise suddenly carried some weight.
The way mine should have appeared.
The way mine actually appeared.
I drew the long hand perfectly, but the small (hour) hand pointed almost directly at the 10 – at the top side of the ten… but still… it should have been precisely in the middle of the 10 and 11. Oh, and I forgot to put a smile on mine. *SIGH*
Forget Alzheimer’s. They should have tested me for OCD. H said he was surprised I didn’t ask for a fresh sheet of paper to start over.
Yes, I obsess about perfection (big surprise). Which is why I felt like buying a package of brand new number twos with fresh erasers when the doctor told me I’d passed with flying colors. I recalled all three words and they liked my clock! *I* was the only one who realized my clock wasn’t perfect. What is wrong with these people? Are there no standards left?
Instructions for the Mini-Cog Test
The Mini-Cog test (video to follow) is a 3-minute instrument to screen for cognitive impairment in older adults in the primary care setting. The Mini-Cog uses a three-item recall test for memory and a simply scored clock-drawing test (CDT). The latter serves as an “informative distractor,” helping to clarify scores when the memory recall score is intermediate.
The Mini-Cog was as effective as or better than established screening tests in both an epidemiologic survey in a mainstream sample and a multi-ethnic, multilingual population comprising many individuals of low socioeconomic status and education level. In comparative tests, the Mini-Cog was at least twice as fast as the Mini-Mental State Examination. The Mini-Cog is less affected by subject ethnicity, language, and education, and can detect a variety of different dementias. Moreover, the Mini-Cog detects many people with mild cognitive impairment (cognitive impairment too mild to meet diagnostic criteria for dementia).
1 point for each recalled word
Score clock drawing as Normal (the patient places the correct time and the clock
appears grossly normal) or Abnormal
Score based on number of words remembered
0 Positive for cognitive impairment
1-2 Abnormal CDT then positive for cognitive impairment
1-2 Normal CDT then negative for cognitive impairment
3 Negative screen for dementia (no need to score CDT – clock drawing)
The CDT – Clock Drawing Test
There are a number of scoring systems for this test. The Alzheimer’s disease cooperative scoring system is based on a score of five points.
1 point for the clock circle (That’s if you’re asked to draw the circle. My paper already had the circle on it.)
1 point for all the numbers being in the correct order
1 point for the numbers being in the proper special order
1 point for the two hands of the clock
1 point for the correct time.
A normal score is four or five points.
I just realized that I’ve mentioned Alzheimer’s and dementia several times over the past few months. All kidding aside, I guess it’s a little scary to me now. I know that I’m fine, but I feel a little vulnerable every time a professional wants to test me (this is the third time). It may be unwarranted, but it feels kind of like the reins could drop at any minute and I would no longer be the one in control. Who would? Oh, crap. I can’t give H the keys to the farm. Anyway, I’m sure I’ll write about it again because it will be on my mind – as long as I have one.
Here’s a video of the Mini-Cog being administered.
Sources: About.com, docs.google.com