S2E19. Dementia Screening Exam #2

It was just about a year ago that I reported on a cognitive exam I took (S1E19) and passed with flying colors. This week, I had occasion to take another very brief screening test. I didn’t do as well.

Sally and I have an insurance policy that provides support should we need any form of assisted living. Our contact, Linda, came for her annual visit on Tuesday to check our apartment for safety and fall risks and to see, in general, how we were doing.

Her screening exam was very brief (it took less than 10 minutes to administer), but it hit all the important functions. 

First came the orientation questions: naming the year, day of the week, and our location. I actually had to think about the date for a little bit as, just before she arrived, I was making appointments for medical checkups that all turned out to be on Wednesdays. So when she asked me to name the day of the week, ‘Wednesday’ popped into my head, but I knew that wasn’t right. I had to think about it for a second before remembering that I had done The New York Times Crossword puzzle the night before and that it was Tuesday’s puzzle. Hell of a way to remember the day of the week, eh?

Then she gave me 5 unrelated words to remember. I repeated them out loud to create a stronger memory trace before I set about trying to conjure up an image that included all 5 items. While I was doing that, though, she moved on to a math word problem that required you to add two numbers and subtract them from 100.

I realized that since my attention was focused on remembering the 5 words, I wasn’t listening to her at all and didn’t catch the numbers, so I asked her to start again. This time, though, since I knew I wouldn’t have time to form an image, I figured I would just divide my attention between listening to her and rehearsing the five items.

Much to my chagrin (and surprise), that didn’t work either. I still wasn’t able to follow her words. So I apologized and asked her to start again. At that instant, I knew that I would only remember 3 of the 5 words when she got around to asking me to repeat them.

Now attentive to the math problem she was reading, I solved it without any problem.

She gave me 3 numbers and asked me to repeat them backwards. Then 4 numbers. I did it by visualizing the numbers and then reading them from right to left. 

Then she read me a brief story and asked me three questions about it. Again, no problem. 

The next item was to name as many animals as I could in 30 seconds. I started quickly with a rush of jungle animals. I noticed, though, that at one point I had an image of a tiger in my head but that it took me a few beats to name it. That surprised me. 

It wasn’t long before I ran out of jungle animals and, in my mind’s eye, all I could see was a vast savanna without any animals on it. I was surprised that I had hit a blank spot so quickly. 

It took me a few seconds before I realized I needed to change habitats if I was going to name more animals and so I thought of a farm and came up with another bunch. Then household pets. But then I blanked out again.

Time was up.

I’m pretty sure I scored above a level that would have signaled an impairment, but I should have done a lot better. There were two problems with my performance. First, I encountered word-finding difficulty which is generally infrequent for me. Second, I didn’t shift gears quickly; I wasn’t flexible; I stayed stuck on ‘jungle animals’ for way too long. To do better, I would have had to cue myself more frequently and more quickly to generate associations that would connect me to more animal names. As it was, I never got around to fish or birds at all.

I last discussed this more than a year ago in ‘When Words Hide.’ IMHO, my performance has deteriorated a bit since then.

It wasn’t easy for me to flounder like that. The test shone a spotlight on something I didn’t think was there. When you combine this performance with my reduced participation in conversations, it starts to make sense: I’m not generating content as quickly as I used to.

Linda then got around to asking me to name the 5 objects she had asked me to remember and, as expected, a rattled off 3 of them. There was a fourth that seemed very vague and distant and I wasn’t at all sure it should be included, so I didn’t say it. Turns out it was one of the five.

We moved on to visuospatial questions. I was able to draw a clock and set the hands at ten to eleven (I can’t help but wonder if young people born in the digital age can do this task), identify a triangle from among 3 shapes, and determine which was the biggest of those 3 shapes.

And that was pretty much it.

I’m writing this the day after I took the test and I’m a little impressed with how many of the questions I remember. Sally was sitting at the table with us during the exam and she didn’t recall any items that I hadn’t already come up with. I think that’s pretty good, don’t you?

Bottom line: Although my performance was still well within the ‘normal aging’ range, there was a discernible drop-off from my previous level of functioning.

As always…I’ll keep an eye on it.

__________

2 Comments

  1. COLLEEN M THORNTON says:

    Maybe you were overthinking all of this, being so focused on your cleverly crafted pathways in order to score well, and stressed (in advance) about the outcome. Thus, you weren’t listening attentively or letting your brain respond naturally. You got stuck in your own proscribed puzzle process (like a skipping record) and stunted a natural response to this type of test. Try having Sally give you this test again and just answer without making your brain jump through hoops to get to the answers. You may be pleasantly surprised by unstressed, spontaneous responses.

    Liked by 1 person

    1. Nice reframe…thanks!

      Like

Leave a Comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s