Written by attorney Robert Michael Slutsky

What does getting an “A” on a Mini Mental Status Exam mean?

What is a perfect score on cognitive testing and what does it mean? Having represented clients in well over 300 guardianships I have seen the common cognitive tests and how they are interpreted many times. Scoring well on them may or may not represent what you think it does.

Additional resources provided by the author

Central to that case was one of the components of the MoCA test: drawing a clock. Astor was asked repeatedly to draw analog clocks as a test of her mental acuity. On more than one occasion, she was unable to do so properly. . . . The point is not that the test is easy. The point is that an inability to complete aspects of the test reveals different types of mental decline. The clock test is about executive brain function: memory, planning ahead. The different parts of the MoCA are labeled according to what they test, with the clock test falling under “visuospatial/executive.” Questions about the current year and date are under “orientation.” The request to identify a drawing of a camel is under “naming.” In the test’s scoring instructions, it explains what is covered: “attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations and orientation.” In some cases a lack of short term recall is a clear symptom of cognitive dysfunction. However, some with short term memory loss are quite insightful about their deficit and compensate in other ways because their overall judgement is intact. For others, memory functions are intact but their ability to discern when someone is trying to scam them is poor. As Donald Trump’s doctor noted when he acknowledged that the President passed the trust with flying colors, these tests are a tool for identifying early signs of mental deterioration, like the mental version of a blood sample on which your doctor runs a battery of tests. It’s not the SAT; it’s a screening device. As I represent Older Adult Protective Services in guardianships, I see the Folstein and Montreal tests often. There are people who score well (26 to 30 out of 30) who are still impaired. It is often not until a battery of neuropsychological tests are performed that more specifically test overall function and judgment that we determine exactly how impaired or what type of impairment exists. So, while getting a consistently poor score (20 or less our of 30) is well correlated to cognitive and functional impairment, the reverse is not necessarily true. For more information click on the link below.

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