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Qualitative Assessment of The Writing Sentence Item in The MMSE I. Biran 1, J.P. Newman 1, A. Gal 1, N. Levin 1, G. Friedman 2 Departments of Neurology(1)

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1 Qualitative Assessment of The Writing Sentence Item in The MMSE I. Biran 1, J.P. Newman 1, A. Gal 1, N. Levin 1, G. Friedman 2 Departments of Neurology(1) and Geriatrics(2) Hadassah Hebrew University Medical Center Special Thanks to Dr. Gitit Kave (Tel-Aviv University)

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11 Narrative Approach Content Self Generated Related to the individual’s experience Opens a window to the inner world

12 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…

13 Pt - 2 SentenceMMSEClock Drawing CDIS Age I LVOE MY WIFE 221770 I LOVE MY WIFE 221171 OVE MY WIFE 18672

14 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)

15 Hypothesis The MMSE can probe psychodynamic processes

16 Design AD / Control Subjects MMSE Sentence Item score=0 Perseverations – “No ifs and or buts” Excluded Sentence Item Score=1 No Perseverations Item Analyzed

17 Demographics ControlsAD 6319N - Total 5516N - Analyzed 33/229/7Sex (F/M) 72.6±5.480.8±6.3Age 13.0±3.412.8±3.6Education (years) 28.8±1.121.8±2.9MMSE

18 Informative Sentences Does a sentence convey information which might be new to the examiner? PControlsAD <0.0528/552/16

19 Information Regarding The Current Situation Is the sentence related to the current situation? “I am embarrassed by these questions” PControlsAD n.s. (0.08)17/559/16

20 Related to Oneself? Is the subject = 1 st person? “I want to be healthy” PControlsAD n.s. (0.07)23/5510/16

21 Positive information Sentence contains positive adjectives/adverbs “You are nice…” PControlsAD n.s.22/556/16

22 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

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